Radiographic and anatomic basis of endoscopic anterior craniocervical decompression: A comparison of endonasal, transoral, and transcervical approaches

Clinton J. Baird, James E. Conway, Daniel M. Sciubba, Daniel M. Prevedello, Alfredo Quinones-Hinojosa, Amin B. Kassam

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate surgical access to the craniocervical junction using 3 endoscopic approaches: endonasal, transoral, and transcervical. METHODS: Nine cadaveric specimens were used. Image guidance was used in 1 specimen for each approach; fluoroscopy was used in every case. The Vitrea imaging station (Vital Images Inc., Minnetonka, MN) was used to evaluate the angles and distances to the target of the approach, centered on the tip of the odontoid. The entry site was defined as: 1) the endonasal approach (inferior midline of the nasal bone), 2) the transoral approach (the tip of the upper incisor), and 3) the transcervical approach (the skin at the C4-C5 level). RESULTS: Adequate lower clivus and craniocervical decompression was achieved using the endonasal and transoral approaches. Lower clivus decompression was not achieved with the transcervical approach. The average distance to the surgical target was as follows: endonasal (94 mm), transoral (102 mm), and transcervical (100 mm). The angle of attack was as follows: endonasal (28 degrees), transoral (30 degrees), and transcervical (15 degrees). The working area at the base of the field was as follows: endonasal (1305 mm), transoral (1406 mm), and transcervical (743 mm). CONCLUSION: The endonasal and transoral approaches allow wide exposure with large working angles to the craniocervical junction. The transcervical approach accesses the odontoid for resection from the body of C2 to the lip of the basion. The angles of attack in the transcervical approach when centered on the surgical target are limited, but this approach offers a clean, sterile operative field. Clinical investigation will be required to determine the optimal indications for each approach.

Original languageEnglish (US)
JournalNeurosurgery
Volume65
Issue number6 SUPPL. 1
DOIs
StatePublished - Dec 2009
Externally publishedYes

Fingerprint

Posterior Cranial Fossa
Decompression
Nasal Bone
Fluoroscopy
Incisor
Lip
Skin

Keywords

  • Craniocervical junction
  • Endonasal
  • Endoscopic
  • Odontoid
  • Transcervical
  • Transoral

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Radiographic and anatomic basis of endoscopic anterior craniocervical decompression : A comparison of endonasal, transoral, and transcervical approaches. / Baird, Clinton J.; Conway, James E.; Sciubba, Daniel M.; Prevedello, Daniel M.; Quinones-Hinojosa, Alfredo; Kassam, Amin B.

In: Neurosurgery, Vol. 65, No. 6 SUPPL. 1, 12.2009.

Research output: Contribution to journalArticle

Baird, Clinton J. ; Conway, James E. ; Sciubba, Daniel M. ; Prevedello, Daniel M. ; Quinones-Hinojosa, Alfredo ; Kassam, Amin B. / Radiographic and anatomic basis of endoscopic anterior craniocervical decompression : A comparison of endonasal, transoral, and transcervical approaches. In: Neurosurgery. 2009 ; Vol. 65, No. 6 SUPPL. 1.
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T2 - A comparison of endonasal, transoral, and transcervical approaches

AU - Baird, Clinton J.

AU - Conway, James E.

AU - Sciubba, Daniel M.

AU - Prevedello, Daniel M.

AU - Quinones-Hinojosa, Alfredo

AU - Kassam, Amin B.

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N2 - OBJECTIVE: To evaluate surgical access to the craniocervical junction using 3 endoscopic approaches: endonasal, transoral, and transcervical. METHODS: Nine cadaveric specimens were used. Image guidance was used in 1 specimen for each approach; fluoroscopy was used in every case. The Vitrea imaging station (Vital Images Inc., Minnetonka, MN) was used to evaluate the angles and distances to the target of the approach, centered on the tip of the odontoid. The entry site was defined as: 1) the endonasal approach (inferior midline of the nasal bone), 2) the transoral approach (the tip of the upper incisor), and 3) the transcervical approach (the skin at the C4-C5 level). RESULTS: Adequate lower clivus and craniocervical decompression was achieved using the endonasal and transoral approaches. Lower clivus decompression was not achieved with the transcervical approach. The average distance to the surgical target was as follows: endonasal (94 mm), transoral (102 mm), and transcervical (100 mm). The angle of attack was as follows: endonasal (28 degrees), transoral (30 degrees), and transcervical (15 degrees). The working area at the base of the field was as follows: endonasal (1305 mm), transoral (1406 mm), and transcervical (743 mm). CONCLUSION: The endonasal and transoral approaches allow wide exposure with large working angles to the craniocervical junction. The transcervical approach accesses the odontoid for resection from the body of C2 to the lip of the basion. The angles of attack in the transcervical approach when centered on the surgical target are limited, but this approach offers a clean, sterile operative field. Clinical investigation will be required to determine the optimal indications for each approach.

AB - OBJECTIVE: To evaluate surgical access to the craniocervical junction using 3 endoscopic approaches: endonasal, transoral, and transcervical. METHODS: Nine cadaveric specimens were used. Image guidance was used in 1 specimen for each approach; fluoroscopy was used in every case. The Vitrea imaging station (Vital Images Inc., Minnetonka, MN) was used to evaluate the angles and distances to the target of the approach, centered on the tip of the odontoid. The entry site was defined as: 1) the endonasal approach (inferior midline of the nasal bone), 2) the transoral approach (the tip of the upper incisor), and 3) the transcervical approach (the skin at the C4-C5 level). RESULTS: Adequate lower clivus and craniocervical decompression was achieved using the endonasal and transoral approaches. Lower clivus decompression was not achieved with the transcervical approach. The average distance to the surgical target was as follows: endonasal (94 mm), transoral (102 mm), and transcervical (100 mm). The angle of attack was as follows: endonasal (28 degrees), transoral (30 degrees), and transcervical (15 degrees). The working area at the base of the field was as follows: endonasal (1305 mm), transoral (1406 mm), and transcervical (743 mm). CONCLUSION: The endonasal and transoral approaches allow wide exposure with large working angles to the craniocervical junction. The transcervical approach accesses the odontoid for resection from the body of C2 to the lip of the basion. The angles of attack in the transcervical approach when centered on the surgical target are limited, but this approach offers a clean, sterile operative field. Clinical investigation will be required to determine the optimal indications for each approach.

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KW - Transcervical

KW - Transoral

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