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Craniocervical Approach: Transcervical

  • Wataru Ishida
  • Kyle L. McCormick
  • Sheng-fu Larry LoEmail author
Chapter

Abstract

The craniovertebral junction (CVJ) is a deep, anatomically complex region that is affected by a wide variety of pathologies. As a result, surgical approaches must be tailored to allow the surgeon to safely and effectively achieve appropriate surgical objectives. Currently, the transoral-transpharyngeal approach is most commonly used to reach the anterior CVJ. It can be modified with a Le Fort osteotomy or transmandibular osteotomy and circumglossal approach to expand the working area, particularly for large tumor resections. However, significant morbidities associated with traversing the oral cavity could occur in this approach, including postoperative bacterial meningitis, especially in the setting of intraoperative dural tears, the need for tracheostomy, pharyngeal wound dehiscence, dysphasia, changes in phonation, airway impairment, and suboptimal cosmetic outcomes. Recently, Wolinksy et al. described an anterior transcervical approach to the CVJ, which allowed for ventral brainstem and spinal cord decompression as well as odontoid resection while avoiding the oral cavity altogether. When combined with endoscopy, neuronavigation, and intraoperative fluoroscopy, the transcervical approach allows access to the ventral CVJ with the decreased risk of bacterial meningitis or other complications associated with a transoral or transnasal approach. In this chapter, we aim to describe the techniques, indications, advantages, and limitations of the anterior transcervical craniocervical approach.

Keywords

Transcervical approach Endoscopic Odontoidectomy Craniovertebral junction Video-assisted approaches C1–C2 junction Tubular retraction Cervical spine 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Wataru Ishida
    • 1
  • Kyle L. McCormick
    • 2
  • Sheng-fu Larry Lo
    • 3
    Email author
  1. 1.The Johns Hopkins Hospital, Department of NeurosurgeryBaltimoreUSA
  2. 2.Neurosurgery Department, Columbia University Medical CenterNew YorkUSA
  3. 3.Johns Hopkins University School of Medicine, Department of NeurosurgeryBaltimoreUSA

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