Anterior Cranio-Cervical Approach: Transnasal
Anterior and anterolateral cranio-cervical lesions present challenging operative cases given their proximity to vital neurovascular structures. Several pathologies can affect the cranio-cervical junction (CCJ) including neoplasms, rheumatologic disease, fibroconnective tissue disease, congenital disease, infections, and traumatic and degenerative disorders. Numerous approaches have been employed to gain access to this region, including the transcervical, transnasal, transoral, and variations of the far-lateral approach. The transnasal approach for the cranio-cervical region provides an alternative approach that allows for good visualization of the CCJ while limiting the number of complications. The use of endoscopy for the transnasal approach provides a panoramic view that can provide improved lighting and resolution compared to the operative microscope. It also provides direct access to the anterior and anterolateral CCJ without needing to mobilize the surrounding neurovasculature. This chapter describes the transnasal surgical approach to the anterior cranio-cervical junction.
KeywordsCranio-cervical junction Transnasal Endoscopy Transclival Clivus Cranio-vertebral Endonasal Nasopalatine line Naso-axial line Chordoma
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