Der ventrale Zugang zum dens epistropheus

Grote, W; Römer, Felicitas; Bettag, W

doi:10.1007/bf01239463

Cited by 10 publications

(7 citation statements)

References 10 publications

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“…In cases of atlanto-axial dislocation extension by a Crutchfleld tongs before, during, and after the operation is useful and reduces the risk of increasing the dislocation [37,40,49]. In cases of stable basilar invaginations internal or external fixation is needed [12,14,26,40,45,46]. In the rare cases of anterior fusions performed in congenital atlanto-axial luxations no informations about fixations are available which could be compared with our cases.…”

Section: Discussionmentioning

confidence: 84%

“…Depending on these types the operative approach has to be chosen. In pure basilar invagination with narrowing of the anterior cerebellomedullary cistern the transoral removal of the space-occupying parts of the clivus, odontoid process, and the body of C2 is the most reasonable measure [12,14,26,40,41,45,46,64]. Regarding the operative result the transoral approach is superior to posterior decompressive operations [1,7,11,23].…”

Section: Choice Of the Operative Approach In Craniospinal Malformationsmentioning

confidence: 97%

“…Past experience with transoral operations in ~,entrally situated space-occupying craniospinal malformations (Tab. I) has shown that this method is more suitable for a primary decompression [8,12,14,24,26,37,40,41,45,46,48,49,64] than a laminectomy, which is associated with a high rate of complications [1,7,11,23]. If beyond these indications the transoral approach is recommendable for fusion operations in congenital craniospinal instabilities [47], remains open, nevertheless successful fusion operations have been done in traumatic lesions of C1 and C2 [17, 18, 33, 34, 62].…”

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confidence: 99%

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Transoral operations for craniospinal malformations

Gilsbach

Eggert

1983

Neurosurg. Rev.

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The transoral approach to the lower third of the clivus and to the ventral aspect of the upper cervical spine is used in craniospinal malformations with or without dislocation as well as in basilar aneurysms, ventrally situated cranio-spinal tumours, fractures of the odontoid process, and in rheumatoid arthritis compressing the spinal cord. In consideration of the literature and ten personal cases the indications and techniques of the transoral approach in craniospinal malformations are discussed. According to our own experiences and those of other authors it is possible to expose the lower clivus and the cervical spine down to C2 by a midline incision of the pharyngeal wall using a mouth retractor and oral intubation. Splitting of the soft palate or resection of the hard palate are not necessary, a tracheotomy should be performed only in exceptional cases. In congenital craniospinal malformations without dislocation or instability causing a ventral compression of the spinal cord, for instance by the odontoid process, the transoral decompression is preferable to dorsal decompressing operations. In cases of pure instability without any space-occupying lesion the transoral and posterior approach are possible in order to perform a fusion. The last one seems more advantageous in these cases. In craniospinal malformations with dislocation causing a ventral and dorsal narrowing of the spinal canal, apart from the decompression a stabilization has to be achieved. In these usually complex malformations individual treatment is necessary. According to the rare cases in the literature and to our own experience a primary anterior decompression, followed by a most careful posterior stabilization seems to produce the most favourable results.

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Section: Discussionmentioning

confidence: 84%

Section: Choice Of the Operative Approach In Craniospinal Malformationsmentioning

confidence: 97%

mentioning

confidence: 99%

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Transoral operations for craniospinal malformations

Gilsbach

Eggert

1983

Neurosurg. Rev.

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“…11,1g,15, 19,22 In conclusion, this retrospective study of CVJ malformations operated on via a posterior approach suggests that there is a high probability of relieving or arresting neurological symptoms after this operation (75% of patients either benefited or were unchanged). Removal of the atlanto-clivusodontoid bone complex by the transoral approach is usually feasible with only minor technical problems.…”

Section: Discussionmentioning

confidence: 87%

Craniovertebral junction malformations

Lorenzo¹,

Fortuna²,

Guidetti³

1982

Journal of Neurosurgery

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The fate of a series of 63 patients operated on between 1953 and 1979 was studied retrospectively to assess the efficacy of neurosurgical treatment in relieving symptoms associated with craniovertebral junction (CVJ) malformations. Fifty-eight patients underwent posterior cervicomedullary decompression, and the other five underwent transoral clivus-atlanto-odontoidectomy. Long-term results with the posterior approach showed that 50% of the patients benefited from surgery, 25% remained unchanged, and 25% continued to deteriorate or died. Patients with dorsal nervous tissue and/or meningeal anomalies, such as Arnold-Chiari malformation, hydrosyringomyelia, dural fibrous ring, or obstruction of the cisterna magna, did better than patients with ventral cervicomedullary indentation caused by a clivus-atlanto-odontoid bone complex. Anterior decompression is preferable to a posterior approach only if the CVJ malformation involves a ventral deformity in the absence of dorsal compression by soft tissue.

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“…The transpharyngeal approach has been described by DeLandslieer et al [10], Grole el al. [20], Pech el al. [35], and others [5,9,12,43].…”

Section: Discussionmentioning

confidence: 99%

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

Menezes

Graf

Hibri³

1980

Pediatr Neurosurg

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8 children with cranio-vertebral abnormalities and neurological deficits are reviewed. The specific treatment is dependent on etiology, mechanisms of compression, and whether the bony abnormality can be reduced to its normal position. Irreducible ventral compression of the cervico-medullary junction was relieved by transoral removal of the odontoid-clivus complex in 3 patients. Primary posterior decompression was done in 4 children with dorsal encroachment. A reducible Cl–C2 dislocation in 1 child with juvenile rheumatoid arthritis underwent primary posterior fusion. A detailed surgical physiological approach is described.

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Der ventrale Zugang zum dens epistropheus

Cited by 10 publications

References 10 publications

Transoral operations for craniospinal malformations

Transoral operations for craniospinal malformations

Craniovertebral junction malformations

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

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