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Endoscopic approach to the upper cervical spine and clivus: an anatomical study of the upper limits of the transoral corridor.

Abstract：

BACKGROUND:Recent advances in endoscopic techniques have allowed minimally invasive approaches to the cranio-vertebral junction (CVJ) through the oropharynx (ETA) in addition to the transnasal approach (EEA). These minimally invasive endoscopic techniques allow for increased surgical exposure using no visible incisions, with a potential less morbidity. The ability to know preoperatively the limit of the ETA is vital for the surgical planning in order to better address CVJ pathology. The aim of the present study is to determine the anatomical limits of endoscopic dissection of the skull base and upper cervical spine through the transoral corridor and the superior limit reached by adopting this approach. METHODS:Six fresh-frozen adult cadaver heads were dissected adopting ETA preserving the hard and soft palate. The most superior extent of the exposure was dissected. Post-operative CT scans were performed to confirm the superior extent. RESULTS:The superior most limit of dissection corresponded to the sphenoid-occipital junction, where the basilar portion of the occipital bone joins with the sphenoid bone's body. This ranged from 12.7 to 18.9 mm above the line of the hard palate. This was achieved without having to transgress any of the palatine structures. CONCLUSIONS:The sphenoid-occipital junction represents the rostral limit of endoscopic transoral approach to the lower skull base and CVJ area. This approach is limited superiorly by the orientation of the hard palate and mouth aperture and lower dentition due to the linear nature of the endoscope. Using the endoscope for this approach can allow for a more superior exposure than the traditional open transoral approach.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

La Corte E,Aldana PR

doi

10.1007/s00701-017-3103-6

subject

Has Abstract

pub_date

2017-04-01 00:00:00

pages

633-639

issue

4

eissn

0001-6268

issn

0942-0940

pii

10.1007/s00701-017-3103-6

journal_volume

159

pub_type

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