Transoral approach to the craniovertebral junction

Landeiro, José Alberto; Boechat, Sávio; Christoph, Daniel de Holanda; Gonçalves, Mariângela Barbi; Castro, Igor de; Lapenta, Mário Alberto; Ribeiro, Carlos Henrique

doi:10.1590/s0004-282x2007000700014

Cited by 49 publications

(30 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This process avoided the morbidity of a second approach (velopalatal insufficiency, CSF fistula, wound problems, etc.) [6,7] in patients who already had swallowing difficulty. Goel and Desai [24] described good clinical outcomes in posterior fossa decompression alone in patients with reduced posterior cranial fossa volume secondary to various causes including a large anterior odontoid.…”

Section: Discussionmentioning

confidence: 99%

“…Often these patients are treated with transoral-transpharyngeal odontoid resection. Although effective in alleviating symptoms, this treatment is associated with significant morbidity and mortality including the need for tracheostomy and gastrostomy, velopalatal insufficiency, and cerebrospinal fluid (CSF) leak [6,7]. Consequently, we offer posterior cervical decompression with occipitocervical (OC) fusion to these patients.…”

Section: Background/aimsmentioning

confidence: 99%

See 1 more Smart Citation

Aggressive Surgical Management of Patients with Chiari II Malformation and Brainstem Dysfunction

Rahman¹,

Perkins²,

Pincus³

2009

Pediatr Neurosurg

View full text Add to dashboard Cite

Background/Aims: Chiari II malformation represents a group of developmental abnormalities involving the caudal displacement of the cervicomedullary junction, pons, fourth ventricle, and medulla. This constellation of malformations is strongly associated with myelomeningocele (MM) and is a known cause of neurologic deterioration in older MM patients. We describe the evaluation and management of 4 adult MM patients who presented with brainstem compression and a retroflexed odontoid who were subject to aggressive surgical management including occipitocervical (OC) fusion with good clinical results. Methods: Four MM patients who underwent OC fusion for new-onset brainstem dysfunction and myelopathy were identified in the practice of the principal investigator (D.W.P.) from 2003 to 2008. Results: The initial evaluation of these patients included consideration of other diagnoses, such as hydrocephalus due to shunt malfunction and tethered cord. These patients were treated with aggressive surgical management. In some cases, multiple surgeries were performed. All 4 patients were treated with cervical decompression and OC fixation and initially had good outcomes. No patients required transoral decompression. Three of the 4 had stable improvement at their last follow-up appointment (mean follow-up of 9 months). Conclusion: Late deterioration in older MM patients may be secondary to brainstem or cervical spinal cord compression from ventral odontoid compression and Chiari II malformation, hydrocephalus, hydromyelia, or tethered cord. These patients may benefit from more than one surgery. Posterior decompression and OC fusion can avoid a morbid transoral odontoid resection, greatly improve patients’ symptoms and prevent further neurologic decline.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Background/aimsmentioning

confidence: 99%

Aggressive Surgical Management of Patients with Chiari II Malformation and Brainstem Dysfunction

Rahman¹,

Perkins²,

Pincus³

2009

Pediatr Neurosurg

View full text Add to dashboard Cite

show abstract

“…7,19,21,28,38 Rates of significant upper respiratory tract edema requiring intervention following transoral approaches have been reported in up to 5% of adults and 4% of children, but this rate may be artificially low due to a more cautious timetable for extubation. 6,9,13,20,26,27,36,39,40 Additionally, an endoscopic transnasal approach may allow for a more prompt return to a normal oral diet. 21,24 The incidence of new-onset dysphagia after a traditional transoral approach ranges from 0%-20% in adults and 0%-4% in the pediatric population, which is not unexpected given the dissection of the posterior pharyngeal tissues that is required.…”

Section: Advantages and Disadvantages Of The Endoscopic Transnasal Apmentioning

confidence: 99%

Transnasal endoscopic approach to the pediatric craniovertebral junction and rostral cervical spine: case series and literature review

Hickman¹,

McDowell²,

Barton³

et al. 2013

FOC

View full text Add to dashboard Cite

The endoscopic transnasal approach to the rostral pediatric spine and craniovertebral junction is a relatively new technique that provides an alternative to the traditional transoral approach to the anterior pediatric spine. In this case series, the authors provide 2 additional examples of patients undergoing endoscopic transnasal odontoidectomies for ventral decompression of the spinal cord. Both patients would have required transection of the palate to undergo an effective transoral operation, which can be a cause of significant morbidity. In one case, transnasal decompression was initially incomplete, and decompression was successfully achieved via a second endoscopic transnasal operation. Both cases resulted in significant neurological recovery and stable long-term spinal alignment. The transnasal approach benefits from entering into the posterior pharynx at an angle that often reduces the length of postoperative intubation and may speed a patient's return to oral intake. Higher reoperation rates are a concern for many endoscopic approaches, but there are insufficient data to conclude if this is the case for this procedure. Further experience with this technique will provide a better understanding of the indications for which it is most effective. Transcervical and transoral endoscopic approaches have also been reported and provide additional options for pediatric anterior cervical spine surgery.

show abstract

“…1 This approach is most commonly used for bony tumors (clivus chordoma), atlanto-axial pathology (subluxation and odontoid fracture), and vascular pathology (basilar artery aneurysm) and basilar invagination. [1][2][3][4] The trans-oral approach was first described in 1909 by Kanavel when he used it to access a bullet at the craniocervical junction. 1 Many have suggested modifications, with the current technique being attributed to Crockard and colleagues 1,2 and Menezes and VanGilder.…”

Section: Introductionmentioning

confidence: 99%