Abnormalities of the Cranio-Vertebral Junction with Cervico-Medullary Compression

Menezes, Arnold H.; Graf, Carl J.; Hibri, Nadi S.

doi:10.1159/000119926

Cited by 26 publications

(28 citation statements)

References 29 publications

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“…This was the first large series that demonstrated that the transoral approach was not fraught with complications as suggested by the series from Fang and Ong. 23 This was found to be true in both children 71 and adults. 77 This report also ignited a new era in CVJ treatment.…”

Section: 77 Transoral Approaches To the Cvj-historical Beginningsmentioning

confidence: 77%

“…3). 71,77 In Menezes and colleagues' 1980 report, 77 9 of 17 patients underwent a transoral approach for congenital, developmental, and acquired CVJ pathology. 71 No postoperative infections occurred and complications were minimal.…”

Section: 77 Transoral Approaches To the Cvj-historical Beginningsmentioning

confidence: 99%

“…71,77 In Menezes and colleagues' 1980 report, 77 9 of 17 patients underwent a transoral approach for congenital, developmental, and acquired CVJ pathology. 71 No postoperative infections occurred and complications were minimal. This was the first large series that demonstrated that the transoral approach was not fraught with complications as suggested by the series from Fang and Ong.…”

Section: 77 Transoral Approaches To the Cvj-historical Beginningsmentioning

confidence: 99%

“…1) 71,77 for the treatment of CVJ pathology continues to hold true 35 years after initial publication and defines when to use a transoral or other appropriate anterior approach for ventral CVJ decompression. Reduction pertains to the reestablishment of anatomical alignment to relieve compression of neural structures.…”

Section: Indications For Standard Approachmentioning

confidence: 99%

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Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Dlouhy

Dahdaleh

Menezes³

et al. 2015

FOC

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The craniovertebral junction (CVJ), or the craniocervical junction (CCJ) as it is otherwise known, houses the crossroads of the CNS and is composed of the occipital bone that surrounds the foramen magnum, the atlas vertebrae, the axis vertebrae, and their associated ligaments and musculature. The musculoskeletal organization of the CVJ is unique and complex, resulting in a wide range of congenital, developmental, and acquired pathology. The refinements of the transoral approach to the CVJ by the senior author (A.H.M.) in the late 1970s revolutionized the treatment of CVJ pathology. At the same time, a physiological approach to CVJ management was adopted at the University of Iowa Hospitals and Clinics in 1977 based on the stability and motion dynamics of the CVJ and the site of encroachment, incorporating the transoral approach for irreducible ventral CVJ pathology. Since then, approaches and techniques to treat ventral CVJ lesions have evolved. In the last 40 years at University of Iowa Hospitals and Clinics, multiple approaches to the CVJ have evolved and a better understanding of CVJ pathology has been established. In addition, new reduction strategies that have diminished the need to perform ventral decompressive approaches have been developed and implemented. In this era of surgical subspecialization, to properly treat complex CVJ pathology, the CVJ specialist must be trained in skull base transoral and endoscopic endonasal approaches, pediatric and adult CVJ spine surgery, and must understand and be able to treat the complex CSF dynamics present in CVJ pathology to provide the appropriate, optimal, and tailored treatment strategy for each individual patient, both child and adult. This is a comprehensive review of the history and evolution of the transoral approaches, extended transoral approaches, endoscopie assisted transoral approaches, endoscopie endonasal approaches, and CVJ reduction strategies. Incorporating these advancements, the authors update the initial algorithm for the treatment of CVJ abnormalities first published in 1980 by the senior author.

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Section: 77 Transoral Approaches To the Cvj-historical Beginningsmentioning

confidence: 77%

Section: 77 Transoral Approaches To the Cvj-historical Beginningsmentioning

confidence: 99%

Section: 77 Transoral Approaches To the Cvj-historical Beginningsmentioning

confidence: 99%

Section: Indications For Standard Approachmentioning

confidence: 99%

See 2 more Smart Citations

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Dlouhy

Dahdaleh

Menezes³

et al. 2015

FOC

Self Cite

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“…7,19,21,28,38 Rates of significant upper respiratory tract edema requiring intervention following transoral approaches have been reported in up to 5% of adults and 4% of children, but this rate may be artificially low due to a more cautious timetable for extubation. 6,9,13,20,26,27,36,39,40 Additionally, an endoscopic transnasal approach may allow for a more prompt return to a normal oral diet. 21,24 The incidence of new-onset dysphagia after a traditional transoral approach ranges from 0%-20% in adults and 0%-4% in the pediatric population, which is not unexpected given the dissection of the posterior pharyngeal tissues that is required.…”

Section: Advantages and Disadvantages Of The Endoscopic Transnasal Apmentioning

confidence: 99%

Transnasal endoscopic approach to the pediatric craniovertebral junction and rostral cervical spine: case series and literature review

Hickman¹,

McDowell²,

Barton³

et al. 2013

FOC

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The endoscopic transnasal approach to the rostral pediatric spine and craniovertebral junction is a relatively new technique that provides an alternative to the traditional transoral approach to the anterior pediatric spine. In this case series, the authors provide 2 additional examples of patients undergoing endoscopic transnasal odontoidectomies for ventral decompression of the spinal cord. Both patients would have required transection of the palate to undergo an effective transoral operation, which can be a cause of significant morbidity. In one case, transnasal decompression was initially incomplete, and decompression was successfully achieved via a second endoscopic transnasal operation. Both cases resulted in significant neurological recovery and stable long-term spinal alignment. The transnasal approach benefits from entering into the posterior pharynx at an angle that often reduces the length of postoperative intubation and may speed a patient's return to oral intake. Higher reoperation rates are a concern for many endoscopic approaches, but there are insufficient data to conclude if this is the case for this procedure. Further experience with this technique will provide a better understanding of the indications for which it is most effective. Transcervical and transoral endoscopic approaches have also been reported and provide additional options for pediatric anterior cervical spine surgery.

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Transoral labiomandibular approach to basiocciput chordomas in childhood

Nagib¹,

Wisiol²,

Simonton³

et al. 1990

Child's Nerv Syst

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Many excellent reports have dealt with the various aspects of cranial chordoma. It remains a relatively rare neoplasm, particularly in younger children. The authors have had the opportunity to treat a 5-year-old child harboring a basiocciput chordoma. It extended from the mid-clivus to C3. A transoral labiomandibular approach was used, allowing its resection. No evidence of recurrence was noted 3 years later. A literature search confirmed the rarity of basiocciput chordoma in young children. The perioperative difficulties encountered prompted this report.

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Abnormalities of the Cranio-Vertebral Junction with Cervico-Medullary Compression

Cited by 26 publications

References 29 publications

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Transnasal endoscopic approach to the pediatric craniovertebral junction and rostral cervical spine: case series and literature review

Transoral labiomandibular approach to basiocciput chordomas in childhood

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