Video-assisted microsurgical transoral approach to the craniovertebral junction: personal experience in childhood.
OBJECTIVE
This paper outlines the perspectives of transoral craniosurgery for anterior craniovertebral junction (CVJ) compressive abnormalities in the specific subset of paediatric patients. In particular we analyzed the opportunity for endoscopic video-assisted approach to the CVJ along with neuronavigation for anterior decompression by the transoral approach in paediatric patients.


METHODS
Among 30 patients ranging 6-78 years undergoing CVJ decompressive procedures, we operated transorally 3 paediatric patients (ranging 11-15 years) by using open access, microsurgical technique, neuronavigation, and endoscopy.


RESULTS
The microscope was the main stone of the transoral procedure; a complete CVJ decompression was accomplished in all the cases by using the 30-degree endoscope that allowed to identify residual compression not clearly visible by using the microscope alone. The use of an angled-lens endoscope can significantly improve the exposure of the clivus without splitting the soft palate.


CONCLUSIONS
Endoscopically assisted transoral surgery represents an emerging alternative to the standard microsurgical approach to the anterior CVJ. Used in conjunction with traditional microsurgery and intraoperative fluoroscopy, endoscopy provides information for a better decompression with a reduced need for extensive soft-palate splitting, no need for hard-palate resection, or extended maxillotomy. Transoral video-assisted microsurgical approach should be considered the gold standard especially in the paediatric patient.
Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
Massimiliano
M
Visocchi
Giuseppe Maria
GM
Della Pepa
Francesco
F
Doglietto
Giuseppe
G
Esposito
Giuseppe
G
La Rocca
Luca
L
Massimi
D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000002:abnormalities; D001269:Atlanto-Occipital Joint / Q000601:surgery*; D001270:Cervical Atlas / Q000601:surgery; D002648:Child; D000013:Congenital Abnormalities; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D008297:Male; D044583:Neuroendoscopy; D038361:Neuronavigation; D013123:Spinal Fusion / Q000379:methods; D013515:Surgery, Oral / Q000379:methods*
Int J Oral Maxillofac Surg. 1998 Aug;27(4):295-8
9698178
Orthopade. 1991 Apr;20(2):140-6
2067840
Neurosurgery. 2005 May;56(5):1045-50; discussion 1045-50
15854253
J Neurosurg Spine. 2006 Oct;5(4):367-73
17048776
Laryngoscope. 2009 Feb;119(2):239-44
19172603
Neurosurgery. 2009 May;64(5 Suppl 2):437-42; discussion 442-4
19404122
Acta Neurochir (Wien). 2009 Oct;151(10):1329-31; author reply 1333-6
19727547
J Neurosurg Pediatr. 2008 Apr;1(4):337-42
18377313
Neurosurgery. 1998 Dec;43(6):1398-407; discussion 1407-8
9848854
Neurosurg Rev. 2007 Jul;30(3):189-94; discussion 194
17492320
Acta Neurochir (Wien). 2003 Apr;145(4):265-72; discussion 272
12748886
Acta Neurochir (Wien). 2002 Mar;144(3):219-25; discussion 225
11956934
Neurosurgery. 2005 Jul;57(1 Suppl):E213; discussion E213
15987596
Neurosurgery. 2002 Nov;51(5 Suppl):S60-6
12234431
Neurosurg Focus. 2005 Jul 15;19(1):E2
16078816
J Neurosurg Spine. 2007 Feb;6(2):184-91
17330590
Neurosurgery. 2003 Jan;52(1):247-50; discussion 251
12493127
Childs Nerv Syst. 2009 May;25(5):563-8
19225786
Childs Nerv Syst. 2008 Oct;24(10):1187-93
18389262