title: Mucosal-sparing posterior septectomy for endoscopic endonasal approach to the craniocervical junction.
abstract: Recent technological advances and developments in surgical technique have made the craniocervical junction (CCJ) accessible through the transnasal surgical corridor. Endoscopic endonasal transclival and transodontoid approaches have been previously described in the literature. Traditionally, these approaches entail a posterior bony and mucosal septectomy. This posterior bony and mucosal septectomy can compromise the integrity of the posterior septum and damage the vascularized pedicled nasoseptal flap (PNSF), a robust reconstructive option. With the possibility of an intraoperative cerebrospinal fluid (CSF) leak and the reported success of the PNSF for repair of these defects, preserving the integrity of the PNSF is beneficial during the endoscopic endonasal approach to the CCJ. Here, we present a new variation which preserves the mucosal integrity of the posterior nasal septum and PNSF. This mucosal-sparing variation of the traditional endoscopic endonasal transclival and transodontoid approaches allows for the preservation of posterior mucosal nasoseptal integrity, and salvages a reconstructive option for future usage. This is accomplished at no expense to visualization, surgical access, or maneuverability.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ. Electronic address: Jean.anderson.eloy@gmail.com.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Vazquez
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.
authors.forename: Leila J
authors.initials: LJ
authors.lastname: Mady
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Patel
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ.
authors.forename: Ira M
authors.initials: IM
authors.lastname: Goldstein
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ.
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
mesh_terms: D001268:Atlanto-Axial Joint / Q000601:surgery*; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009297:Nasal Mucosa / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*