Endoscopic Endonasal Approach for Craniovertebral Junction Pathologic Conditions: Myth and Truth in Clinical Series and Personal Experience.
OBJECTIVE
For many years, the microsurgical transoral approach has been accepted as the gold standard for anterior decompressions of the craniovertebral junction (CVJ). The introduction of the endoscopic endonasal approach (EEA) has gained wide recognition and overwhelming support in recent years, including for diseases of the CVJ. The aim of this study was to critically analyze and discuss all cases of CVJ diseases approached by means of an EEA so far reported in the literature, including our institutional experience consisting of 6 consecutive patients.


METHODS
Six consecutive patients affected by CVJ disease underwent an EEA. Three patients had a tumor (2 chordomas and 1 myeloma) and 3 had impressio basilaris.


RESULTS
Five patients had an uncomplicated postoperative course and 1 developed an intraoperative cerebrospinal fluid leak and subsequent meningitis and died 5 weeks after surgery. A total of 107 patients (including our 6) affected by CVJ disease and treated with EEA have been reported so far. Among these patients, cerebrospinal fluid leak was reported in 13 (12.4%), transient velopharyngeal incompetence in 6 (5.6%), postoperative epistaxis in 2 (1.86%), and respiratory dysfunction requiring a tracheostomy in 2 (1.86%). In our extended institutional series of more than 20 consecutive anterior decompressions for CVJ diseases (including transoral and transnasal microsurgical approaches), the only fatal complication was associated with EEA.


CONCLUSIONS
On the basis of the reviewed literature and our personal experience, the reported increased safety of the EEA needs to be reassessed and discussed.
Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
Massimiliano
M
Visocchi
Institute of Neurosurgery, Catholic University of Rome, Rome, Italy. Electronic address: francesco.signorelli1984@gmail.com.
Francesco
F
Signorelli
Department of Neurosurgery, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Chenlong
C
Liao
Institute of Otolaryngology, Catholic University of Rome, Rome, Italy.
Mario
M
Rigante
Institute of Otolaryngology, Catholic University of Rome, Rome, Italy.
Gaetano
G
Paludetti
Division of Neurosurgery, Department of Neurosciences, Policlinico "G.Rodolico" University Hospital, Catania, Italy.
Giuseppe
G
Barbagallo
Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
Alessandro
A
Olivi
D000293:Adolescent; D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
Craniovertebral junction; Endoscopy; Transnasal approach; Transoral approach