title: Endoscopic-assisted lateral transatlantal approach to craniovertebral junction.
abstract: BACKGROUND
  The lateral approach to the craniocervical junction is directed along the atlantal and occipital condyles to the dens. The advantages of the lateral approach compared with the anterior transoral and transnasal approaches are that it provides a sterile field, and anterior decompression and postdecompression fixation can be performed in one procedure.
  
  
  OBJECTIVE
  To examine the usefulness of endoscopy as an auxiliary tool during lateral transatlantal odontoidectomy.
  
  
  METHODS
  Six cadaver heads, in which the vessels were injected with colored silicone, were dissected using a surgical microscope and 0- and 30-degree endoscopes. A flap incision was chosen to accomplish exposure of the area of the decompression, the occipital squama and adjacent laminae for fixation, and the vertebral artery from C2 to its dural entrance for its stabilization.
  
  
  RESULTS
  Study findings revealed that endoscopy adds several advantages to microscopy in the lateral transatlantal approach to the craniovertebral junction in cases of craniovertebral malformation by providing magnification and illumination not limited by corners, thus helping to avert substandard decompression and complications such as dural tears and cerebrospinal fluid leaks; flexibility in surgical positioning of patients; and improved ergonomics that enable the surgeon to complete the procedure in a more efficient, comfortable, and safe manner.
  
  
  CONCLUSIONS
  Endoscopy is a useful adjunct to microscopy in completing lateral approaches to the craniovertebral junction.
authors.affiliation: Department of Anatomy, Medical School of Pernambuco-IMIP, Recife, Brazil.
authors.forename: Carolina
authors.initials: C
authors.lastname: Martins
authors.forename: Alberto Capel
authors.initials: AC
authors.lastname: Cardoso
authors.forename: Luiz Felipe
authors.initials: LF
authors.lastname: Alencastro
authors.forename: Caio Souza
authors.initials: CS
authors.lastname: Leão
authors.forename: Albert L
authors.initials: AL
authors.lastname: Rhoton
mesh_terms: D001269:Atlanto-Occipital Joint / Q000033:anatomy & histology* / Q000601:surgery*; D002102:Cadaver; D001270:Cervical Atlas / Q000033:anatomy & histology* / Q000601:surgery*; D019299:Decompression, Surgical; D004388:Dura Mater / Q000293:injuries / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D008866:Microsurgery; D019635:Neurosurgical Procedures / Q000379:methods; D009777:Occipital Bone / Q000033:anatomy & histology* / Q000601:surgery*; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000033:anatomy & histology