Contemporary Transoral Approach for Resection of Craniocervical Junction Tumors

  • Brian D. Thorp
  • Deb A. Bhowmick


The transoral approach to the craniocervical junction provides unique challenges for tumor resection due to varied anatomy, visualization, and reconstruction options. The technical considerations of the operation are strongly dependent on nasopharyngeal anatomy and personal comfort with visualization of the tumor. The combination of postoperative complications associated with the approach is unique and requires a team of medical professionals to plan, operate, and manage postoperatively. In this chapter, we discuss the special considerations for operative decision making, the technical aspects of the approach, and possible modern variances in surgery that may minimize postoperative complications.


Transoral approach Tumor resection Craniocervical junction Odontoid process Retro-odontoid space Nasopharyngeal anatomy Cervical spine Cervical vertebra Cervical axis Atlantoaxial complex Skull base Subaxial spine 


  1. 1.
    Crockard HA. The transoral approach to the base of the brain and upper cervical cord. Ann R Coll Surg Eng. 1985;167:321–5.Google Scholar
  2. 2.
    Yadav YR, Madhariya SN, Parihar VS, Namdev H, Bhatele PR. Endoscopic transoral excision of odontoid process in irreducible atlantoaxial dislocation: our experience of 34 patients. J Neurol Surg A Cent Eur Neurosurg. 2013;74(3):162–7.PubMedGoogle Scholar
  3. 3.
    Lee JY, Lega B, Bhowmick D, Newman JG, O’Malley BW Jr, Weinstein GS, et al. Da Vinci robot-assisted transoral odontoidectomy for basilar invagination. ORL J Otorhinolaryngol Relat Spec. 2010;72(2):91–5.CrossRefGoogle Scholar
  4. 4.
    Ponce-Gómez JA, Ortega-Porcayo LA, Soriano-Barón HE, Sotomayor-González A, Arriada-Mendicoa N, Gómez-Amador JL, et al. Evolution from microscopic transoral to endoscopic endonasal odontoidectomy. Neurosurg Focus. 2014;37(4):E15.CrossRefGoogle Scholar
  5. 5.
    Shriver MF, Kshettry VR, Sindwani R, Woodard T, Benzel EC, Recinos PF. Transoral and transnasal odontoidectomy complications: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2016;148:121–9.CrossRefGoogle Scholar
  6. 6.
    Mazzatenta D, Zoli M, Mascari C, Pasquini E, Frank G. Endoscopic endonasal odontoidectomy: clinical series. Spine (Phila Pa 1976). 2014;39(10):846–53.CrossRefGoogle Scholar
  7. 7.
    Pasztor E, Vajda J, Piffkó P, Horváth M, Gádor I. Transoral surgery for craniocervical space-occupying processes. J Neurosurg. 1984;60:276–81.CrossRefGoogle Scholar
  8. 8.
    Bettegowda C, Shajari M, Suk I, Simmons OP, Gokaslan ZL, Wolinsky JP. Sublabial approach for the treatment of symptomatic basilar impression in a patient with Klippel-Feil syndrome. Neurosurgery. 2011;69(1 Suppl Operative):ons77-82. discussion ons82.Google Scholar
  9. 9.
    Liu JK, Couldwell WT, Apfelbaum RI. Transoral approach and extended modifications for lesions of the ventral foramen magnum and craniovertebral junction. Skull Base. 2008;18(3):151–66.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Otolaryngology-Head and Neck SurgeryUniversity of North Carolina School of MedicineChapel HillUSA
  2. 2.University of North Carolina HealthcareDepartment of NeurosurgeryChapel HillUSA

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