title: Da Vinci Robot-assisted transoral odontoidectomy for basilar invagination.
abstract: The transoral approach is an effective way to decompress the craniocervical junction due to basilar invagination. This approach has been described and refined, but significant limitations and technical challenges remain. Specifically, should the transoral route be used for intradural pathology, such as a meningioma, or should an inadvertent durotomy occur during extradural dissection, achieving a watertight closure of the dura in such a deep and narrow working channel is limited with the current microscopic and endoscopic techniques. Even closure of the posterior pharyngeal mucosa can be challenging, and problems with wound dehiscence encountered in some case series may be attributable to this difficulty. These problems, and the corollary aversion to the procedure felt by many neurosurgeons, led our group to investigate an alternative approach.
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pa. 19104, USA. leejohn@uphs.upenn.edu
authors.forename: John Y K
authors.initials: JY
authors.lastname: Lee
authors.forename: Bradley
authors.initials: B
authors.lastname: Lega
authors.forename: Deb
authors.initials: D
authors.lastname: Bhowmick
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newman
authors.forename: Bert W
authors.initials: BW
authors.lastname: O'Malley
authors.forename: Greg S
authors.initials: GS
authors.lastname: Weinstein
authors.forename: M Sean
authors.initials: MS
authors.lastname: Grady
authors.forename: William C
authors.initials: WC
authors.lastname: Welch
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging / Q000601:surgery; D019299:Decompression, Surgical / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000601:surgery*; D012371:Robotics / Q000295:instrumentation* / Q000379:methods*; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed