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

Abstract

Two patients presented with congenital basilar invagination manifesting as progressive myelopathy. Both patients underwent surgery using a neuronavigation-assisted transoral-transpharyngeal approach. The Brain-LAB Vector Vision navigation system was used for image guidance. The registration accuracies were 0.9 and 1.3 mm. After decompression, posterior stabilization was performed. Both patients had an uneventful postoperative course. The transoral-transpharyngeal approach with the neuronavigation system provides safe exposure and decompression for basilar invagination.

Intraoperative Magnetic Resonance Imaging and Neuronavigation for Transoral Approaches to Upper Cervical Pathology

“…As Pillai et al (31) have remarked, numerous technological advances including microscopes, fluoroscopy, flexible endotracheal tubes, highspeed drills, and spinal cord monitoring have made this procedure safer (28). The concept of using neuronavigation for accessing lesions at the cranial base has been introduced in preliminary reports (36)(37)(38)(39)(40). At the University of Calgary, the iMRI and neuronavigation have been used for various surgical procedures including transoral resections of pathologic mass at the craniovertebral junction.…”

“…The first advantage of using the neuronavigation system in combination with the iMRI is that the registration of the image guidance system is not dependent on anatomic landmarks or skin surface fiducial markers (31,37). Early experience with the use of image guidance systems for the upper cervical spine proved to be frustrating because of intersegmental motion and the limitations of neuronavigation systems based on surface fiducial markers.…”

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].…”

Experience with intraoperative navigation and imaging during endoscopic transnasal spinal approaches to the foramen magnum and odontoid

“…Ugur et al used this system for image guidance in their 2 cases of transoral treatment of basilar invagination. 37 This system can assist with sequential and updated image guidance without the need to switch to a navigation probe. The Iso-C navigation system, in conjunction with BrainLab image guidance, can allow stereotactic navigation as well as fluoroscopic 3D reconstructions for intraoperative imaging to confirm the extent of resection.…”

“…Its utility was demonstrated by Laufer 23 Image guidance is equally important in transoral approaches to the cervical spine, where it can provide accuracy with reduced radiation exposure. 37,38 We have found the combined use of CT and MR technology to be extremely useful for odontoid surgery. This combination allows excellent visualization of bone landmarks as well as soft tissue during endoscopic surgery.…”