Endoscopic Transnasal Approach for Urgent Decompression of the Craniocervical Junction in Acute Skull Base Osteomyelitis

Burns, Terry C.; Mindea, Stefan A.; Pendharkar, Arjun V; Lapustea, Nicolae B.; Irime, Ioana; Nayak, Jayakar V.

doi:10.1055/s-0034-1395492

Cited by 22 publications

(13 citation statements)

References 28 publications

(56 reference statements)

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“…Terry C. Burns [45] In our opinion and in agreement with other authors, the endoscopic endonasal approach, rather than an alternative, should be considered a complementary approach to the standard transoral-transpharyngeal route [42].…”

Section: Surgical Studiessupporting

confidence: 81%

Nuances of Microsurgical and Endoscope Assisted Surgical Techniques to the Cranio-Vertebral Junction: Review of the Literature

Visocchi¹,

Signorelli²,

Iacopino³

et al. 2017

Open J Orthop Rheumatol

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Purpose: An update of the technical nuances of microsurgical-endoscopic assisted approaches to the craniocervical junction (transnasal, transoral and transcervical) if provided from the literature in order to better contribute to identify the best strategy. Methods: A non-systematic update of the review and reporting on the anatomical and clinical results of endoscopic assisted and microsurgical approaches to the craniocervical junction (CVJ) is performed. Results: Pure endonasal and cervical endoscopic approaches still have some disadvantages, including the learning curve and the deeper surgical fi eld. Endoscopically assisted transoral surgery with 30° endoscopes represents an emerging option to standard microsurgical techniques for transoral approaches to the anterior CVJ. This approach should be considered as complementary rather than an alternative to the traditional transoral-transpharyngeal approach. Conclusions: Transoral (microsurgical or video-assisted) approach with sparing of the soft palate still remains the gold standard compared to the ''pure'' transnasal and transcervical approaches due to the wider working channel provided by the former technique. Transnasal endoscopic approach alone appears to be superior when the CVJ lesion exceeds the upper limit of the inferior third of the clivus. Of particular interest the evidence that advancement in reduction techniques can avoid ventral approach.

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Section: Surgical Studiessupporting

confidence: 81%

Nuances of Microsurgical and Endoscope Assisted Surgical Techniques to the Cranio-Vertebral Junction: Review of the Literature

Visocchi¹,

Signorelli²,

Iacopino³

et al. 2017

Open J Orthop Rheumatol

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“…25,26 The endoscopic endonasal approach has been considered an option for transoraltranspharyngeal approach in very selective cases. Most specialists in endoscopic endonasal skull base techniques suggest this route for small to medium-sized midline lesions without significant neurovascular involvement, 29,30 as we observed in the present case.…”

Section: Discussionsupporting

confidence: 69%

Endoscopic Endonasal Approach to Foramen Magnum Meningioma—Technical Note and Case Example

Romero

Vieira²,

Ancheschi³

2018

Arq Bras Neurocir

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Foramen magnum (FM) tumors represent one of the most complex cases for the neurosurgeon, due to their location in a very anatomically complex region surrounded by the brainstem and the lower cranial nerves, by bony elements of the craniocervical junction, and by the vertebrobasilar vessels. Currently, the open approach of choice is a lateral extension of the posterior midline approach including far lateral, and extreme lateral routes. However, the transoraltranspharyngeal approach remains the treatment of choice in cases of diseases affecting the craniocervical junction. For very selective cases, the endoscopic endonasal route to this region is another option. We present a case of a ventral FM meningioma treated exclusively with the endoscopic endonasal approach.

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“…1,5,7,8,15,18,26,[28][29][30][31]38 However, the approach often necessitates dissection of the soft tissue (e.g., maxillotomy, palatal split, mandibulotomy) and is known to be associated with velopharyngeal insufficiency, dysphagia, and dysphonia. 7,21,35,40 The endonasal approach to the CVJ 4,6,13,14,19,20,22,24,25,27,32,33,37,[42][43][44] obviates the need for palatal splitting and an oral retractor system. This is believed to decrease velopharyngeal insufficiency and postoperative tongue and oral swelling associated with postoperative tracheostomy and gastrostomy.…”

mentioning

confidence: 99%

The endoscopic transoral approach to the craniovertebral junction: an anatomical study with a clinical example

Chan¹,

Benet

Ohya³

et al. 2016

FOC

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OBJECTIVE The microscopic transoral, endoscopic transnasal, and endoscopic transoral approaches are used alone and in combination for a variety of craniovertebral junction (CVJ) pathologies. The endoscopic transoral approach provides a more direct exposure that is not restricted by the nasal cavity, pterygoid plates, and palate while sparing the potential morbidities associated with extensive soft-tissue dissection, palatal splitting, or mandibulotomy. Concerns regarding the extent of visualization afforded by the endoscopic transoral approach may be limiting its widespread adoption. METHODS A dissection of 10 cadaver heads was undertaken. CT-based imaging guidance was used to measure the working corridor of the endoscopic transoral approach. Measurements were made relative to the palatal line. The built-in linear measurement tool was used to measure the superior and inferior extents of view. The superolateral extent was measured relative to the midline, as defined by the nasal process of the maxilla. The height of the clivus, odontoid tip, and superior aspect of the C-1 arch were also measured relative to the palatal line. A correlated clinical case is presented with video. RESULTS The CVJ was accessible in all cases. The superior extent of the approach was a mean 19.08 mm above the palatal line (range 11.1–27.7 mm). The superolateral extent relative to the midline was 15.45 mm on the right side (range 9.6–23.7 mm) and 16.70 mm on the left side (range 8.1–26.7 mm). The inferior extent was a mean 34.58 mm below the palatal line (range 22.2–41.6 mm). The mean distances were as follows: palatal line relative to the odontoid tip, 0.97 mm (range −4.9 to 3.7 mm); palatal line relative to the height of the clivus, 4.88 mm (range −1.5 to 7.3 mm); and palatal line relative to the C-1 arch, −2.75 mm (range −5.8 to 0 mm). CONCLUSIONS The endoscopic transoral approach can reliably access the CVJ. This approach avoids the dissections and morbidities associated with a palate-splitting technique (velopharyngeal insufficiency) and the expanded endonasal approach (mucus crusting, sinusitis, and potential lacerum or cavernous-paraclival internal carotid artery injury). For appropriately selected lesions near the palatal line, the endoscopic transoral approach appears to be the preferred approach.

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Endoscopic Transnasal Approach for Urgent Decompression of the Craniocervical Junction in Acute Skull Base Osteomyelitis

Cited by 22 publications

References 28 publications

Nuances of Microsurgical and Endoscope Assisted Surgical Techniques to the Cranio-Vertebral Junction: Review of the Literature

Nuances of Microsurgical and Endoscope Assisted Surgical Techniques to the Cranio-Vertebral Junction: Review of the Literature

Endoscopic Endonasal Approach to Foramen Magnum Meningioma—Technical Note and Case Example

The endoscopic transoral approach to the craniovertebral junction: an anatomical study with a clinical example

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