Intraoperative Computed Tomography Guidance to Confirm Decompression Following Endoscopic Endonasal Approach for Cervicomedullary Compression

Abstract

Introduction?Cervicomedullary compression often requires an anterior approach to address the compressive vector. In certain cases an endoscopic endonasal approach (EEA) is ideal for decompression. It is essential that an adequate decompression be achieved and verified before the patient leaves the operating room. The purpose of this study was to evaluate the use intraoperative computed tomography (IO-CT) in assessing the adequacy of decompression. Methods?A retrospective chart review revealed 11 cases of EEA odontoid resection IO-CT verification of decompression. Operative reports and review of imaging was used to determine if further decompression was performed following the intraoperative scan. Results?Out of 11 EEA cases, 4 (36%) patients showed evidence of residual compression following an initial IO-CT. Further operative decompression was undertaken following the first scan in all cases. A second intraoperative scan was then used to confirm complete decompression. No patient left the operating room with residual compression. Discussion?IO-CT provided valuable utility in 36% of the cases after the initial resection was incomplete. The standard fluoroscopic guidance may not provide adequate resolution and enhanced utility like IO-CT.

A combined approach for stabilization and endoscopic/ endonasal odontoid and clivus resection for treatment of basilar invagination

“…[ 1 , 3 , 5 , 7 ] Notably, in one small series, four out of 11 patients (38%) undergoing anterior odontoidectomies required further decompression after utilizing an O-arm for an endoscope/endonasal approach without neuronavigation. [ 2 ] In our case, the resection of the posterior hard palate increased the operative corridor to complete the odontoid resection utilizing neuronavigation. Nevertheless, further verification of the extent of decompression should be confirmed with additional fluoroscopic imaging.…”

Minimally invasive surgery of the anterior skull base: transorbital approaches

“…For the anterior skull base, such specific data are not available at the current time [ 82 ], [ 83 ]. Intraoperative CT scan on the other hand has been shown to be beneficial in anterior skull base surgery, as this aides with precise identification of bony landmarks [ 84 ], [ 85 ], [ 86 ].…”

Minimal-invasive Chirurgie der vorderen Schädelbasis: Transorbitale Zugänge

“…Nur wenige wissenschaftliche Arbeiten evaluierten jedoch bislang die Anwendung der intraoperativen MRT bei Prozessen der frontalen Schädelbasis, sodass hier keine validen Daten herangezogen werden können [79,80]. Anders verhält es sich mit der intraoperativen CT. Diese Untersuchungsform zeigt bekanntermaßen vornehmlich knöcherne Strukturen und wird daher erfolgreich im Rahmen von Zugängen zur, und Resektionen an der Schädelbasis eingesetzt [81][82][83]. Eine intraoperative CT wäre naturgemäß auch bei Läsionen und operativen Zugängen im Rahmen des TONES Approaches wünschenswert, allerdings fehlen auch hier Daten, die die Effektivität und Machbarkeit in diesem Setting evaluiert haben.…”