Early Experiences With Image-Guided Transoral Surgery for the Pathologies of the Upper Cervical Spine

Abstract

Image guidance during transoral exposure of the upper cervical spine offered excellent three-dimensional guidance on the ventral surface of the craniocervical junction, allowing a safer, more controlled surgery. As the targets of the transoral spinal surgery are fixed bony and ligamentous structures, no shifting occurs and continuous high navigation accuracy can be achieved. The use of the navigation can reduce the significance of the intraoperative fluoroscopy, diminishing the radiograph load of the patient and the operating room team.

Comparison of multilevel oblique corpectomy with and without image guided navigation for multi-segmental cervical spondylotic myelopathy

“…The application of IGN to anterior spinal surgery has been restricted to thoracolumbar segments or upper cervical areas (the craniovertebral junction) for technical reasons and because of tiresome registration requirements [20][21][22][23][24][25]. IGN has also been used in screw placement, but its use has not been considered in simple anterior plate-screw systems on the subaxial cervical spine [26][27][28].…”

Neuronavigation-Assisted Transoral-Transpharyngeal Approach for Basilar Invagination-Two Case Reports-

“…5) HALO fixation (HALO Torque screwdriver, Hannover, Germany) has been advised for image-guided transoral procedures. 18) The navigated transoral approach to the cranial base and the craniocervical junction has been used in three patients with chordomas and one patient with rheumatoid atlantoaxial subluxation. 19) Intraoperative MR imaging 9) and endoscopic transoral surgery 7) and safety.…”

Long-term follow up of transoral anterior decompression and posterior fusion for irreducible bony compression of the craniovertebral junction

“…Various monitoring systems have been recommended, including intraoperative fluoroscopy, spinal cord monitoring, and intraoper- ative MRI. [18][19][20][21][22][23] The results of the present study show that intraoperative spinal cord monitoring and neuronavigation during the TOA allow safer and more effective surgery for the treatment of craniovertebral anomalies in complex anatomical areas. A navigation system provides essential information on both the ventrodorsal and cephalocaudal dimensions to assist the surgeon in addressing the pathology, while protecting the spinal cord.…”