title: Endoscopic approaches to the craniovertebral junction and odontoid process.
abstract: BACKGROUND
  The microsurgical transoral approach has traditionally been the preferred access for ventral decompression of the craniovertebral junction. This natural corridor, although direct, may be a challenging approach because of potential morbidities. The evolution of endoscopic methods in skull base surgeries has reduced morbidity and improved results. Endoscopic approaches are also being used for ventral decompression at the craniovertebral junction. Some technical modifications in this approach are described.
  
  
  METHODS
  An endoscope is inserted endonasally for a panoramic view of the entire area of interest, from the sphenoid to second cervical vertebra. Image guidance systems are used in all cases to guide the resection. The soft palate is retracted away with a rubber catheter sling when both nasal and oral corridors are being used. Various mucosal flaps are raised for access and reconstruction. Actual decompression can be done through the nasal or oral corridors based on the relationship of the pathology to the palate. Reconstruction is done using standard principles with the vascularized flaps, fat, and fibrin glue.
  
  
  RESULTS
  Reduced surgical morbidity by avoiding palatal split and good postoperative healing are some of the advantages of this modified endoscopic technique. Better surgical exposure and a wide perspective facilitate the decompression. However, as with all newer perspectives, a learning curve exists.
  
  
  CONCLUSIONS
  Used judiciously, this modified endoscopic approach to the craniovertebral junction and odontoid process is minimally invasive and adds to the surgeon's armamentarium.
authors.affiliation: Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India. Electronic address: cdeopujari@gmail.com.
authors.forename: Chandrashekhar E
authors.initials: CE
authors.lastname: Deopujari
authors.affiliation: Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India.
authors.forename: Vikram S
authors.initials: VS
authors.lastname: Karmarkar
authors.affiliation: Department of Otorhinolaryngology, Bombay Hospital Institute of Medical Sciences, Mumbai, India.
authors.forename: Nishit J
authors.initials: NJ
authors.lastname: Shah
mesh_terms: D001269:Atlanto-Occipital Joint / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D009055:Mouth / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D009809:Odontoid Process / Q000601:surgery*; D010347:Patient Care Planning; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery*
keywords: Dens; Endonasal; Extended skull base approach; Odontoid process; Skull base reconstruction; Ventral cervicomedullary compression