Submandibular Approach for Single-Stage Craniovertebral Junction Ventral Decompression and Stabilization: A Preliminary Cadaveric Study of Technical Feasibility

Luca Ricciardi, Carmelo Lucio Sturiale, Alessandro Izzo, Resi Pucci, Valentino Valentini, Nicola Montano, Filippo Maria Polli, Massimiliano Visocchi, Tito Vivas-Buitrago, Kaisorn L. Chaichana, Alfredo Quinones-Hinojosa, Alessandro Olivi, Selby Chen

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The craniovertebral junction (CVJ) may be affected by several diseases. It is an anatomically complex region, involving the osteoligamentous, vascular, and nervous structures, which makes surgery challenging. In a case of ventral compression, an anterior approach is preferable, although posterior fixation is often required. Anterior transmucosal approaches are associated with high rates of complications. However, decompression and fixation by the use of retropharyngeal extramucosal approaches may be challenging. Objective: To investigate the feasibility of a single-stage, anterior, extramucosal submandibular (SM) approach modification to the CVJ for simultaneous decompression and stabilization. Materials and Methods: This was a preliminary cadaveric feasibility study on 2 injected specimens. A variation of the SM approach with a short “boomerang” incision, microsurgical decompression of the ventral CVJ, and a new hybrid construct for an anterior atlantoaxial stabilization was investigated. The surgical approach, the decompression, and the instrumentation technique have been described. In addition, intraprocedural images and radiographs and also postprocedural computed tomographic images were collected. Furthermore, surgical exposure, working corridors and angles, and decompression grade were measured. Results: The SM approach provided wide exposure of the ventral CVJ and the possibility for instrumentation and decompression by removing the anterior arch of C1 and the odontoid process. Conclusion: A single- stage anterior extramucosal SM approach for decompression and stabilization of the CVJ is feasible and could result in shorter surgical duration, avoiding the complications related to both the transmucosal approach and the prone position, although specific related risks exist. Mechanical investigation of this hybrid system and in vivo studies are needed to confirm our results.

Original languageEnglish (US)
Pages (from-to)206-212
Number of pages7
JournalWorld neurosurgery
Volume127
DOIs
StatePublished - Jul 1 2019

Fingerprint

Feasibility Studies
Decompression
Odontoid Process
Surgical Decompression
Prone Position
Blood Vessels

Keywords

  • Atlantoaxial
  • Craniovertebral junction
  • Extramucosal
  • Hybrid
  • Instrumentation
  • Upper cervical spine
  • Ventral approach

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Submandibular Approach for Single-Stage Craniovertebral Junction Ventral Decompression and Stabilization : A Preliminary Cadaveric Study of Technical Feasibility. / Ricciardi, Luca; Sturiale, Carmelo Lucio; Izzo, Alessandro; Pucci, Resi; Valentini, Valentino; Montano, Nicola; Polli, Filippo Maria; Visocchi, Massimiliano; Vivas-Buitrago, Tito; Chaichana, Kaisorn L.; Quinones-Hinojosa, Alfredo; Olivi, Alessandro; Chen, Selby.

In: World neurosurgery, Vol. 127, 01.07.2019, p. 206-212.

Research output: Contribution to journalArticle

Ricciardi, L, Sturiale, CL, Izzo, A, Pucci, R, Valentini, V, Montano, N, Polli, FM, Visocchi, M, Vivas-Buitrago, T, Chaichana, KL, Quinones-Hinojosa, A, Olivi, A & Chen, S 2019, 'Submandibular Approach for Single-Stage Craniovertebral Junction Ventral Decompression and Stabilization: A Preliminary Cadaveric Study of Technical Feasibility', World neurosurgery, vol. 127, pp. 206-212. https://doi.org/10.1016/j.wneu.2019.04.038
Ricciardi, Luca ; Sturiale, Carmelo Lucio ; Izzo, Alessandro ; Pucci, Resi ; Valentini, Valentino ; Montano, Nicola ; Polli, Filippo Maria ; Visocchi, Massimiliano ; Vivas-Buitrago, Tito ; Chaichana, Kaisorn L. ; Quinones-Hinojosa, Alfredo ; Olivi, Alessandro ; Chen, Selby. / Submandibular Approach for Single-Stage Craniovertebral Junction Ventral Decompression and Stabilization : A Preliminary Cadaveric Study of Technical Feasibility. In: World neurosurgery. 2019 ; Vol. 127. pp. 206-212.
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abstract = "Background: The craniovertebral junction (CVJ) may be affected by several diseases. It is an anatomically complex region, involving the osteoligamentous, vascular, and nervous structures, which makes surgery challenging. In a case of ventral compression, an anterior approach is preferable, although posterior fixation is often required. Anterior transmucosal approaches are associated with high rates of complications. However, decompression and fixation by the use of retropharyngeal extramucosal approaches may be challenging. Objective: To investigate the feasibility of a single-stage, anterior, extramucosal submandibular (SM) approach modification to the CVJ for simultaneous decompression and stabilization. Materials and Methods: This was a preliminary cadaveric feasibility study on 2 injected specimens. A variation of the SM approach with a short “boomerang” incision, microsurgical decompression of the ventral CVJ, and a new hybrid construct for an anterior atlantoaxial stabilization was investigated. The surgical approach, the decompression, and the instrumentation technique have been described. In addition, intraprocedural images and radiographs and also postprocedural computed tomographic images were collected. Furthermore, surgical exposure, working corridors and angles, and decompression grade were measured. Results: The SM approach provided wide exposure of the ventral CVJ and the possibility for instrumentation and decompression by removing the anterior arch of C1 and the odontoid process. Conclusion: A single- stage anterior extramucosal SM approach for decompression and stabilization of the CVJ is feasible and could result in shorter surgical duration, avoiding the complications related to both the transmucosal approach and the prone position, although specific related risks exist. Mechanical investigation of this hybrid system and in vivo studies are needed to confirm our results.",
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T2 - A Preliminary Cadaveric Study of Technical Feasibility

AU - Ricciardi, Luca

AU - Sturiale, Carmelo Lucio

AU - Izzo, Alessandro

AU - Pucci, Resi

AU - Valentini, Valentino

AU - Montano, Nicola

AU - Polli, Filippo Maria

AU - Visocchi, Massimiliano

AU - Vivas-Buitrago, Tito

AU - Chaichana, Kaisorn L.

AU - Quinones-Hinojosa, Alfredo

AU - Olivi, Alessandro

AU - Chen, Selby

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N2 - Background: The craniovertebral junction (CVJ) may be affected by several diseases. It is an anatomically complex region, involving the osteoligamentous, vascular, and nervous structures, which makes surgery challenging. In a case of ventral compression, an anterior approach is preferable, although posterior fixation is often required. Anterior transmucosal approaches are associated with high rates of complications. However, decompression and fixation by the use of retropharyngeal extramucosal approaches may be challenging. Objective: To investigate the feasibility of a single-stage, anterior, extramucosal submandibular (SM) approach modification to the CVJ for simultaneous decompression and stabilization. Materials and Methods: This was a preliminary cadaveric feasibility study on 2 injected specimens. A variation of the SM approach with a short “boomerang” incision, microsurgical decompression of the ventral CVJ, and a new hybrid construct for an anterior atlantoaxial stabilization was investigated. The surgical approach, the decompression, and the instrumentation technique have been described. In addition, intraprocedural images and radiographs and also postprocedural computed tomographic images were collected. Furthermore, surgical exposure, working corridors and angles, and decompression grade were measured. Results: The SM approach provided wide exposure of the ventral CVJ and the possibility for instrumentation and decompression by removing the anterior arch of C1 and the odontoid process. Conclusion: A single- stage anterior extramucosal SM approach for decompression and stabilization of the CVJ is feasible and could result in shorter surgical duration, avoiding the complications related to both the transmucosal approach and the prone position, although specific related risks exist. Mechanical investigation of this hybrid system and in vivo studies are needed to confirm our results.

AB - Background: The craniovertebral junction (CVJ) may be affected by several diseases. It is an anatomically complex region, involving the osteoligamentous, vascular, and nervous structures, which makes surgery challenging. In a case of ventral compression, an anterior approach is preferable, although posterior fixation is often required. Anterior transmucosal approaches are associated with high rates of complications. However, decompression and fixation by the use of retropharyngeal extramucosal approaches may be challenging. Objective: To investigate the feasibility of a single-stage, anterior, extramucosal submandibular (SM) approach modification to the CVJ for simultaneous decompression and stabilization. Materials and Methods: This was a preliminary cadaveric feasibility study on 2 injected specimens. A variation of the SM approach with a short “boomerang” incision, microsurgical decompression of the ventral CVJ, and a new hybrid construct for an anterior atlantoaxial stabilization was investigated. The surgical approach, the decompression, and the instrumentation technique have been described. In addition, intraprocedural images and radiographs and also postprocedural computed tomographic images were collected. Furthermore, surgical exposure, working corridors and angles, and decompression grade were measured. Results: The SM approach provided wide exposure of the ventral CVJ and the possibility for instrumentation and decompression by removing the anterior arch of C1 and the odontoid process. Conclusion: A single- stage anterior extramucosal SM approach for decompression and stabilization of the CVJ is feasible and could result in shorter surgical duration, avoiding the complications related to both the transmucosal approach and the prone position, although specific related risks exist. Mechanical investigation of this hybrid system and in vivo studies are needed to confirm our results.

KW - Atlantoaxial

KW - Craniovertebral junction

KW - Extramucosal

KW - Hybrid

KW - Instrumentation

KW - Upper cervical spine

KW - Ventral approach

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