A neurosurgical view of anatomical evaluation of anterior C1–C2 for safer transoral odontoidectomy

Tun, Kağan; Kaptanoğlu, Erkan; Cemil, Berker; Karahan, S. Tuna; Esmer, Ali Fırat; Elhan, A.

doi:10.1007/s00586-008-0647-4

Cited by 17 publications

(15 citation statements)

References 19 publications

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“…The distance between the ventral surface of the C1 anterior arch and the ventral joint of the odontoid at ML, a distance reflecting the depth required to reach the odontoid process, was reported to be 7.0 ± 1.2 mm by Tun et al (14). This distance is 6.43 ± 1.29 mm in the current study.…”

Section: Ventromedian Parameters Related To C1 and C2supporting

confidence: 61%

Radiological and surgical anatomy of ventral c1-c2 complex

Çırpan

Sayhan²,

Yonguc³

et al. 2018

Turkish Neurosurgery

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ventral plating. Although the TO approach to the CVJ is an effective and important approach, it is associated with a high rate of morbidity. Therefore, many surgeons have recently started to perform minimally-invasive transnasal (TN) endoscopic odontoidectomy. Both TO and TN approaches require information about bony and neurovascular structures. The aim of this study is to measure bony structures related to these approaches after anterior exploration of the C1 (first cervical vertebra)-C2 (second cervical vertebra) complex. █ INTRODUCTIONT he transoral (TO) approach is an important route to reach to the upper cervical spine. This approach is commonly used for decompression of the craniovertebral junction (CVJ) ventrally, particularly for decompression of the upper cervical spinal cord due to cranial settling of the odontoid, CVJ tumours and infections. This route has also been used occasionally for C0-C1-C2 (occipito-atlanto-axial complex) AIM: To evaluate anatomical data of the bony structures during exploration of the C1-C2 complex. MATERIAL and METHODS:This study included six formalin-fixed cadaveric head and neck specimens. Radiological images and anatomical measurements included: C1-C2 distance, bony distance between C1 anterior tubercle-nares and superior incisors, height of C1 anterior arch, and height and width of odontoid articular surface. RESULTS:The mean distance between C1 anterior tubercle-nares and superior incisors on maxilla were 96.16 ± 8.07 mm and 84.14 ± 9.16 mm, respectively. The mean height of C1 anterior arch was 13.89 mm. The meandistance between medial borders of right-left C1 lateral masses was 19.10 ± 1.80 mm. The mean distance between medial border of lateral midline on mass right and left sides were 9.43 ± 0.88 mm and 9.68 ± 0.97 mm, respectively. The mean height of C1 anterior arch at midline was 13.89 ± 2.48 mm, and the mean distance between ventral surface of anterior arch and ventral joint of odontoid at midline was 6.43 ± 1.29 mm. The anteroposterior, horizontal diameters of odontoid on its base were 12.12 ± 0.38 mm, and 11.12 ± 0.94 mm, respectively. The angles of transoral and transnasal approaches to C1 were 32.67 ± 4.59° and 32.00 ± 2.10°, respectively. CONCLUSION:A safe transoral or transnasal odontoidectomy requires accurate measurements and imaging regarding ventral C1-C2 relationships, distances of odontoid, lateral mass and midline.

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Section: Ventromedian Parameters Related To C1 and C2supporting

confidence: 61%

Radiological and surgical anatomy of ventral c1-c2 complex

Çırpan

Sayhan²,

Yonguc³

et al. 2018

Turkish Neurosurgery

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“…Thus, knowledge of this region becomes more important for surgeons. The VA may be injured during anterior approaches to the craniovertebral junction, 4 especially during anterior C1 decompression in a transoral odontoidectomy 5 and anterior odontoid screw fixation procedures. Although VA injury is uncommon in cervical spine surgeries, the consequences may be catastrophic, as it is associated with complications such as fistulas, pseudoaneurysms, late-onset hemorrhage, thrombosis, embolism, cerebral ischemia, and death.…”

Section: Discussionmentioning

confidence: 99%

The importance of vertebral artery proximity to the odontoid process during anterior odontoid approaches

Tun

Cemil

Altin

et al. 2009

Journal of Clinical Neuroscience

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“…medial border of the lateral mass of C 1 ) [14] . Upon completion of the removal of the C 1 arch, the apical ligament was identified.…”

Section: Methodsmentioning

confidence: 99%

Da Vinci Robot-Assisted Transoral Odontoidectomy for Basilar Invagination

Lee¹,

Lega²,

Bhowmick³

et al. 2010

ORL

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The transoral approach is an effective way to decompress the craniocervical junction due to basilar invagination. This approach has been described and refined, but significant limitations and technical challenges remain. Specifically, should the transoral route be used for intradural pathology, such as a meningioma, or should an inadvertent durotomy occur during extradural dissection, achieving a watertight closure of the dura in such a deep and narrow working channel is limited with the current microscopic and endoscopic techniques. Even closure of the posterior pharyngeal mucosa can be challenging, and problems with wound dehiscence encountered in some case series may be attributable to this difficulty. These problems, and the corollary aversion to the procedure felt by many neurosurgeons, led our group to investigate an alternative approach.

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A neurosurgical view of anatomical evaluation of anterior C1–C2 for safer transoral odontoidectomy

Cited by 17 publications

References 19 publications

Radiological and surgical anatomy of ventral c1-c2 complex

Radiological and surgical anatomy of ventral c1-c2 complex

The importance of vertebral artery proximity to the odontoid process during anterior odontoid approaches

Da Vinci Robot-Assisted Transoral Odontoidectomy for Basilar Invagination

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