Endoscopic endonasal approach for craniovertebral junction pathology: a review of the literature

Saul F. Morales-Valero, Elena Serchi, Matteo Zoli, Diego Mazzatenta, Jamie J. Van Gompel

Research output: Contribution to journalArticle

Abstract

OBJECT: The transoral approach is the gold standard for ventral decompression of the brainstem caused by craniovertebral junction (CVJ) pathology. This approach is often associated with significant morbidity, related to swallowing and respiratory complications. The endoscopic endonasal approach was introduced to reduce the rate of these complications. However, the exact role of this approach in the treatment of CVJ pathology is not well defined.

METHODS: A comprehensive literature search was performed to identify series of patients with pathology of the CVJ treated via the endoscopie endonasal approach. Data on patient characteristics, indications for treatment, complications, and outcome were obtained and analyzed.

RESULTS: Twelve studies involving 72 patients were included. The most common indications for treatment were rheumatoid pannus (38.9%) and basilar invagination (29.2%). Cerebrospinal fluid leak was found in 18% of cases intraoperatively and 4.2% of cases postoperatively. One case of meningitis complicated by sepsis and death represents the procedure-related mortality of 1.4%. Of the patients without preoperative swallowing impairment, 95% returned to oral feeding on the 3rd postoperative day. Ninety-three percent of patients experienced improvement in neurological symptoms after the procedure.

CONCLUSIONS: The endonasal endoscopie approach is effective for the treatment of neural compression caused by CVJ pathology. It offers advantages such as lower rates of postoperative dysphagia and respiratory complications when compared with the more traditional transoral approach. However, these 2 approaches should be seen as complementary rather than alternatives. Patient-related factors as well as the surgeon's expertise must be considered when making treatment decisions.

Original languageEnglish
Pages (from-to)E15
JournalNeurosurgical Focus
Volume38
Issue number4
DOIs
Publication statusPublished - Apr 1 2015

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Pathology
Deglutition
Therapeutics
Deglutition Disorders
Decompression
Meningitis
Brain Stem
Sepsis
Decision Making
Morbidity
Mortality

Keywords

  • basilar invagination
  • craniovertebral junction
  • CVJ = craniovertebral junction
  • endoscopie surgery
  • odontoidectomy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Endoscopic endonasal approach for craniovertebral junction pathology : a review of the literature. / Morales-Valero, Saul F.; Serchi, Elena; Zoli, Matteo; Mazzatenta, Diego; Van Gompel, Jamie J.

In: Neurosurgical Focus, Vol. 38, No. 4, 01.04.2015, p. E15.

Research output: Contribution to journalArticle

Morales-Valero, Saul F. ; Serchi, Elena ; Zoli, Matteo ; Mazzatenta, Diego ; Van Gompel, Jamie J. / Endoscopic endonasal approach for craniovertebral junction pathology : a review of the literature. In: Neurosurgical Focus. 2015 ; Vol. 38, No. 4. pp. E15.
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abstract = "OBJECT: The transoral approach is the gold standard for ventral decompression of the brainstem caused by craniovertebral junction (CVJ) pathology. This approach is often associated with significant morbidity, related to swallowing and respiratory complications. The endoscopic endonasal approach was introduced to reduce the rate of these complications. However, the exact role of this approach in the treatment of CVJ pathology is not well defined.METHODS: A comprehensive literature search was performed to identify series of patients with pathology of the CVJ treated via the endoscopie endonasal approach. Data on patient characteristics, indications for treatment, complications, and outcome were obtained and analyzed.RESULTS: Twelve studies involving 72 patients were included. The most common indications for treatment were rheumatoid pannus (38.9{\%}) and basilar invagination (29.2{\%}). Cerebrospinal fluid leak was found in 18{\%} of cases intraoperatively and 4.2{\%} of cases postoperatively. One case of meningitis complicated by sepsis and death represents the procedure-related mortality of 1.4{\%}. Of the patients without preoperative swallowing impairment, 95{\%} returned to oral feeding on the 3rd postoperative day. Ninety-three percent of patients experienced improvement in neurological symptoms after the procedure.CONCLUSIONS: The endonasal endoscopie approach is effective for the treatment of neural compression caused by CVJ pathology. It offers advantages such as lower rates of postoperative dysphagia and respiratory complications when compared with the more traditional transoral approach. However, these 2 approaches should be seen as complementary rather than alternatives. Patient-related factors as well as the surgeon's expertise must be considered when making treatment decisions.",
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