Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies

Massimiliano Visocchi, Francesco Doglietto, Giuseppe Maria Della Pepa, Giuseppe Esposito, Giuseppe La Rocca, Concezio Di Rocco, Giulio Maira, Eduardo Fernandez

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

At the present time, an update to the classical microsurgical transoral decompression is strongly provided by the most recent literature dealing with the introduction of the endoscopy in spine surgery. In this paper, we present our experience on the endoscope-assisted microsurgical transoral approach to anterior craniovertebral junction (CVJ) compressive pathology. We analysed seven patients (3 paediatrics and 4 adults ranging from 6 to 78 years) operated on for CVJ decompressive procedures using an open access, microsurgical technique, neuronavigation and endoscopy. All techniques mentioned were simultaneously employed. Among the endoscopic routes described in the literature, we have preferred the transoral using 30° endoscopes. In all the cases endoscopy allowed a radical decompression compared to the microsurgical technique alone, as confirmed intraoperatively with contrast medium fluoroscopy. In conclusion, endoscopy represents a useful complement to the standard microsurgical approach to the anterior CVJ; it provides information for a better decompression with no need for soft palate splitting, hard palate resection, or extended maxillotomy. Moreover, intraoperative fluoroscopy helps to recognize residual compression. Virtually, in normal anatomic conditions, no surgical limitations exist for endoscopically assisted transoral approach, compared with the pure endonasal and transcervical endoscopic approaches. In our opinion, the endoscope deserves a role as "support" to the standard transoral microsurgical approach since 30° angulated endoscopy significantly increases the surgical area exposed at the level of the anterior CVJ.

Original languageEnglish
Pages (from-to)1518-1525
Number of pages8
JournalEuropean Spine Journal
Volume20
Issue number9
DOIs
Publication statusPublished - Sep 2011

Fingerprint

Endoscopes
Endoscopy
Pathology
Decompression
Fluoroscopy
Neuronavigation
Hard Palate
Soft Palate
Contrast Media
Spine
Pediatrics

Keywords

  • Craniovertebral junction
  • Endoscope-assisted
  • Microsurgical
  • Transoral

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Visocchi, M., Doglietto, F., Pepa, G. M. D., Esposito, G., La Rocca, G., Di Rocco, C., ... Fernandez, E. (2011). Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies. European Spine Journal, 20(9), 1518-1525. https://doi.org/10.1007/s00586-011-1769-7

Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies. / Visocchi, Massimiliano; Doglietto, Francesco; Pepa, Giuseppe Maria Della; Esposito, Giuseppe; La Rocca, Giuseppe; Di Rocco, Concezio; Maira, Giulio; Fernandez, Eduardo.

In: European Spine Journal, Vol. 20, No. 9, 09.2011, p. 1518-1525.

Research output: Contribution to journalArticle

Visocchi, M, Doglietto, F, Pepa, GMD, Esposito, G, La Rocca, G, Di Rocco, C, Maira, G & Fernandez, E 2011, 'Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies', European Spine Journal, vol. 20, no. 9, pp. 1518-1525. https://doi.org/10.1007/s00586-011-1769-7
Visocchi, Massimiliano ; Doglietto, Francesco ; Pepa, Giuseppe Maria Della ; Esposito, Giuseppe ; La Rocca, Giuseppe ; Di Rocco, Concezio ; Maira, Giulio ; Fernandez, Eduardo. / Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies. In: European Spine Journal. 2011 ; Vol. 20, No. 9. pp. 1518-1525.
@article{895f59a129514f31962c3a827e5b7aa6,
title = "Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies",
abstract = "At the present time, an update to the classical microsurgical transoral decompression is strongly provided by the most recent literature dealing with the introduction of the endoscopy in spine surgery. In this paper, we present our experience on the endoscope-assisted microsurgical transoral approach to anterior craniovertebral junction (CVJ) compressive pathology. We analysed seven patients (3 paediatrics and 4 adults ranging from 6 to 78 years) operated on for CVJ decompressive procedures using an open access, microsurgical technique, neuronavigation and endoscopy. All techniques mentioned were simultaneously employed. Among the endoscopic routes described in the literature, we have preferred the transoral using 30° endoscopes. In all the cases endoscopy allowed a radical decompression compared to the microsurgical technique alone, as confirmed intraoperatively with contrast medium fluoroscopy. In conclusion, endoscopy represents a useful complement to the standard microsurgical approach to the anterior CVJ; it provides information for a better decompression with no need for soft palate splitting, hard palate resection, or extended maxillotomy. Moreover, intraoperative fluoroscopy helps to recognize residual compression. Virtually, in normal anatomic conditions, no surgical limitations exist for endoscopically assisted transoral approach, compared with the pure endonasal and transcervical endoscopic approaches. In our opinion, the endoscope deserves a role as {"}support{"} to the standard transoral microsurgical approach since 30° angulated endoscopy significantly increases the surgical area exposed at the level of the anterior CVJ.",
keywords = "Craniovertebral junction, Endoscope-assisted, Microsurgical, Transoral",
author = "Massimiliano Visocchi and Francesco Doglietto and Pepa, {Giuseppe Maria Della} and Giuseppe Esposito and {La Rocca}, Giuseppe and {Di Rocco}, Concezio and Giulio Maira and Eduardo Fernandez",
year = "2011",
month = "9",
doi = "10.1007/s00586-011-1769-7",
language = "English",
volume = "20",
pages = "1518--1525",
journal = "European Spine Journal",
issn = "0940-6719",
publisher = "Springer Verlag",
number = "9",

}

TY - JOUR

T1 - Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies

AU - Visocchi, Massimiliano

AU - Doglietto, Francesco

AU - Pepa, Giuseppe Maria Della

AU - Esposito, Giuseppe

AU - La Rocca, Giuseppe

AU - Di Rocco, Concezio

AU - Maira, Giulio

AU - Fernandez, Eduardo

PY - 2011/9

Y1 - 2011/9

N2 - At the present time, an update to the classical microsurgical transoral decompression is strongly provided by the most recent literature dealing with the introduction of the endoscopy in spine surgery. In this paper, we present our experience on the endoscope-assisted microsurgical transoral approach to anterior craniovertebral junction (CVJ) compressive pathology. We analysed seven patients (3 paediatrics and 4 adults ranging from 6 to 78 years) operated on for CVJ decompressive procedures using an open access, microsurgical technique, neuronavigation and endoscopy. All techniques mentioned were simultaneously employed. Among the endoscopic routes described in the literature, we have preferred the transoral using 30° endoscopes. In all the cases endoscopy allowed a radical decompression compared to the microsurgical technique alone, as confirmed intraoperatively with contrast medium fluoroscopy. In conclusion, endoscopy represents a useful complement to the standard microsurgical approach to the anterior CVJ; it provides information for a better decompression with no need for soft palate splitting, hard palate resection, or extended maxillotomy. Moreover, intraoperative fluoroscopy helps to recognize residual compression. Virtually, in normal anatomic conditions, no surgical limitations exist for endoscopically assisted transoral approach, compared with the pure endonasal and transcervical endoscopic approaches. In our opinion, the endoscope deserves a role as "support" to the standard transoral microsurgical approach since 30° angulated endoscopy significantly increases the surgical area exposed at the level of the anterior CVJ.

AB - At the present time, an update to the classical microsurgical transoral decompression is strongly provided by the most recent literature dealing with the introduction of the endoscopy in spine surgery. In this paper, we present our experience on the endoscope-assisted microsurgical transoral approach to anterior craniovertebral junction (CVJ) compressive pathology. We analysed seven patients (3 paediatrics and 4 adults ranging from 6 to 78 years) operated on for CVJ decompressive procedures using an open access, microsurgical technique, neuronavigation and endoscopy. All techniques mentioned were simultaneously employed. Among the endoscopic routes described in the literature, we have preferred the transoral using 30° endoscopes. In all the cases endoscopy allowed a radical decompression compared to the microsurgical technique alone, as confirmed intraoperatively with contrast medium fluoroscopy. In conclusion, endoscopy represents a useful complement to the standard microsurgical approach to the anterior CVJ; it provides information for a better decompression with no need for soft palate splitting, hard palate resection, or extended maxillotomy. Moreover, intraoperative fluoroscopy helps to recognize residual compression. Virtually, in normal anatomic conditions, no surgical limitations exist for endoscopically assisted transoral approach, compared with the pure endonasal and transcervical endoscopic approaches. In our opinion, the endoscope deserves a role as "support" to the standard transoral microsurgical approach since 30° angulated endoscopy significantly increases the surgical area exposed at the level of the anterior CVJ.

KW - Craniovertebral junction

KW - Endoscope-assisted

KW - Microsurgical

KW - Transoral

UR - http://www.scopus.com/inward/record.url?scp=84855200654&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84855200654&partnerID=8YFLogxK

U2 - 10.1007/s00586-011-1769-7

DO - 10.1007/s00586-011-1769-7

M3 - Article

C2 - 21556730

AN - SCOPUS:84855200654

VL - 20

SP - 1518

EP - 1525

JO - European Spine Journal

JF - European Spine Journal

SN - 0940-6719

IS - 9

ER -