The Endoscopic Endonasal Approach to Craniovertebral Junction Pathologies: Surgical Skills and Anatomical Study

Pacca, Paolo; Tardivo, Valentina; Pecorari, Giancarlo; Garbossa, Diego; Ducati, Alessandro; Zenga, Francesco

doi:10.1007/978-3-319-62515-7_5

Cited by 11 publications

(9 citation statements)

References 21 publications

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“…The SBCs located in these spaces have the lowest GTR rate, whether with open surgery or EES ( 2 , 19 , 23 ). We can resect the SBCs located above the body of C2 by EES ( 30 ). While for the tumors extending to lower than C2, which is regarded as below the inferior limitation of EES, we will use EES combined with transoral approach or purely use the transoral method.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Surgical Strategy for Skull Base Chordomas Based on Tumor Growth Directions: Surgical Outcomes of 167 Patients During 3 Years

Bai

Xiong

et al. 2021

Front. Oncol.

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BackgroundSkull base chordomas (SBCs) are rare malignant bone tumors with dismal long-term local control. Endoscopic endonasal surgeries (EESs) are increasingly adopted to resect SBCs recently. Gross total resection (GTR) favors good outcomes. However, the SBCs often invade the skull base extensively and hide behind vital neurovascular structures; the tumors were challenging to remove entirely. To improve the GTR, we established a surgical strategy for EES according to the tumor growth directions.MethodsA total of 112 patients with SBCs from 2018 to 2019 were classified into the derivation group. We retrospectively analyzed their radiologic images and operation videos to find the accurate tumor locations. By doing so, we confirmed the tumor growth directions and established a surgical strategy. Fifty-five patients who were operated on in 2020 were regarded as the validation group, and we performed their operations following the surgical strategy to verify its value.ResultsIn the derivation group, 78.6% of SBCs invade the dorsum sellae and posterior clinoid process region. 62.5% and 69.6% of tumors extend to the left and right posterior spaces of cavernous ICA, respectively. 59.8% and 61.6% of tumors extend to the left and right posterior spaces of paraclival and lacerum ICA (pc-la ICA), respectively. 30.4% and 28.6% of tumors extended along the left and right petroclival fissures that extend toward the jugular foramen, respectively. 30.4% of tumors involved the foramen magnum and craniocervical junction region. The GTR was achieved in 60.8% of patients with primary SBCs in the derivation group. Based on the tumors’ growth pattern, pituitary transposition and posterior clinoidectomy techniques were adopted to resect tumors that hid behind cavernous ICA. Paraclival ICA transposition was used when the tumor invaded the posterior spaces of pc-la ICA. Lacerum fibrocartilage resection and eustachian tube transposition may be warranted to resect the tumors that extended to the jugular foramen. GTR was achieved in 75.0% of patients with primary SBCs in the validation group.ConclusionBesides the midline clival region, the SBCs frequently grow into the eight spaces mentioned above. The surgical strategy based on the growth pattern contributes to increasing the GTR rate.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Surgical Strategy for Skull Base Chordomas Based on Tumor Growth Directions: Surgical Outcomes of 167 Patients During 3 Years

Bai

Xiong

et al. 2021

Front. Oncol.

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“…The procedure has been previously reported by the senior author (F.Z. ); here, the main steps are illustrated [3,14]. An image-guided endoscopic endonasal odontoidectomy with a 3-dimensional-HD (3D-HD) endoscope was performed.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Different pathologies may affect the CVJ, leading to impairment/limitation of its physiological function with a loss of mobility and eventually compression of neurovascular structures. Prompt surgical intervention is required when these disorders cause symptomatic high spinal cord or brainstem compression [3,4].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic endonasal odontoidectomy: a long-term follow-up results for a cohort of 21 patients

et al. 2022

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Background Endoscopic endonasal odontoidectomy (EEO) has been described as a potential approach for craniovertebral junction (CVJ) disease which could cause anterior bulbomedullary compression and encroaching. Due to the atlantoaxial junction’s uniqueness and complex biomechanics, treating CVJ pathologies uncovers the challenge of preventing C1–C2 instability. A large series of patients treated with endonasal odontoidectomy is reported, analyzing the feasibility and necessity of whether or not to perform posterior stabilization. Furthermore, the focus is on the long-term follow-up, especially those whom only underwent partial C1 arch preservation without posterior fixation. Methods This study is a retrospective analysis of patients with ventral spinal cord compression for non-reducible CVJ malformation, consecutively treated with EEO from July 2011 to March 2019. Postoperative dynamic X-ray and CT scans were obtained in each case in order to document CVJ decompression as well as to exclude instability. The anterior atlas‐dens interval, posterior atlas‐dens interval and C1–C2 total lateral overhang were measured as a morphological criteria to determine upper cervical spine stability. Results Twenty-one patients (11:10 F:M) with a mean age of 60.6 years old at the time of surgery (range 34–84 years) encountered the inclusion criteria. For all 21 patients, a successful decompression was achieved at the first surgery. In 11 patients, the partial C1 arch integrity did not require a posterior cervical instrumentation on the bases of postoperative and constant follow-up radiological examination. In 13 cases, an improvement of motor function was recorded at the time of discharge. Only one patient had further motor function improvement at follow-up. Among the patients that did not show any significant motor change at discharge, 4 patients showed an improvement at the last follow-up. Conclusions The outcomes, even in C1 arch preservation without posterior fixation, are promising, and it could be said that the endonasal route potentially represents a valid option to treat lesions above the nasopalatine line.

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“…Every case was accurately pre-operatively studied with CT scan and 3D reconstruction; neuronavigation is also mandatory in order to always double check the cranio-caudal bone removal. This is especially true in the presence of partial fusion and malformation [2].…”

mentioning

confidence: 99%

Answer to the Letter to the Editor of V. Kumar et al. concerning "Endoscopic endonasal odontoidectomy: a long-term follow-up results for a cohort of 21 patients" by Penner F, De Marco R, Di Perna G, et al. (2022) Eur Spine J 31:2693–2703

2022

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The Endoscopic Endonasal Approach to Craniovertebral Junction Pathologies: Surgical Skills and Anatomical Study

Cited by 11 publications

References 21 publications

Endoscopic Endonasal Surgical Strategy for Skull Base Chordomas Based on Tumor Growth Directions: Surgical Outcomes of 167 Patients During 3 Years

Endoscopic Endonasal Surgical Strategy for Skull Base Chordomas Based on Tumor Growth Directions: Surgical Outcomes of 167 Patients During 3 Years

Endoscopic endonasal odontoidectomy: a long-term follow-up results for a cohort of 21 patients

Answer to the Letter to the Editor of V. Kumar et al. concerning "Endoscopic endonasal odontoidectomy: a long-term follow-up results for a cohort of 21 patients" by Penner F, De Marco R, Di Perna G, et al. (2022) Eur Spine J 31:2693–2703

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