title: Purely endoscopic endonasal surgery of the craniovertebral junction: A systematic review.
abstract: BACKGROUND
  Endoscopic endonasal surgery (EES) is a relatively novel approach to the craniovertebral junction (CVJ). The purpose of this analysis is to determine the surgical outcomes of patients who undergo purely EES of the CVJ.
  
  
  METHODS
  A search for articles related to EES of the CVJ was performed using the MEDLINE/PubMed database. A bibliographic search was done for additional articles. Demographics, presenting symptoms, imaging findings, complications, follow-up, and patient outcomes were analyzed.
  
  
  RESULTS
  Eighty-five patients from 30 articles were included. The mean patient age was 47.9 ± 24.8 years (range, 3 to 96 years), with 44.7% being male. The most common presenting symptom was myelopathy (n = 64, 75.3%). The most common indications for surgery were brainstem compression secondary to basilar invagination (n = 41, 48.2%) and odontoid pannus (n = 20, 23.5%). Odontoidectomy was performed in 97.6% of cases. Intraoperative complications occurred in 16 patients (18.8%) and postoperative complications occurred in 18 patients (21.2%). Six patients developed postoperative respiratory failure necessitating a tracheostomy. Neurologic improvement was seen in 89.4% of patients at a mean follow-up of 22.2 months.
  
  
  CONCLUSIONS
  Our analysis found that EES of the CVJ results in a high rate of neurologic improvement with acceptable complication rates. Given its minimally invasive nature and high success rate, this approach appears to be a reasonable alternative to the traditional transoral approach in select cases. This study represents the largest pooled sample size of EES of the CVJ to date. Increasing use of the endoscopic endonasal approach will allow for further studies with greater statistical power.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.
authors.forename: Christina H
authors.initials: CH
authors.lastname: Fang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.
authors.forename: Remy
authors.initials: R
authors.lastname: Friedman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.
authors.forename: Sam D
authors.initials: SD
authors.lastname: Schild
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark.
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.|Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark.
authors.forename: Soly
authors.initials: S
authors.lastname: Baredes
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.|Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark.|Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark.
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.|Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark.|Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000601:surgery; D001933:Brain Stem / Q000601:surgery; D002574:Cervical Vertebrae / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000601:surgery; D019291:Skull Base / Q000601:surgery*; D013117:Spinal Cord Compression / Q000601:surgery; D013122:Spinal Diseases / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: bulbomedullary junction; cervicomedullary junction; craniocervical junction; craniovertebral junction; endonasal endoscopic surgery; endoscopic skull-base surgery; odontoid endoscopic; odontoidectomy; skull base surgery; transnasal