Endoscopic Transseptal Approach with Posterior Nasal Spine Removal

A Wide Surgical Corridor to the Craniovertebral Junction and Odontoid: Technical Note and Case Series

Zefferino Rossini, Davide Milani, Federico Nicolosi, Francesco Costa, Giovanni Battista Lasio, Vincenzo Antonio D'Angelo, Maurizio Fornari, Giovanni Colombo

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The transnasal approach to lesions involving the craniovertebral junction represents a technical challenge because of limited inferior exposure. The endoscopic transseptal approach (EtsA) with posterior nasal spine (PNS) removal is described. This technique can create a wide exposure of the craniovertebral junction, thereby increasing the caudal exposure.

METHODS: On patients undergoing anterior craniovertebral junction decompression, we calculated the degree of exposure on the sagittal plan through a paraseptal route, an EtsA without and with PNS removal. The horizontal exposure and working area with the latter approach were also evaluated.

RESULTS: Five patients underwent the transnasal procedure. The age of patients ranged from 34-71 years. All patients harbored basilar impression. The mean postoperative Nurick grade (1, 8) was improved versus the average preoperative grade (3). The average follow-up duration was 16 months. All patients underwent occipitocervical fixation. The mean vertical distances, from the clinoid recess to the inferior most limit with the paraseptal approach, EtsA without and with PNS removal were 38.52, 44.12, and 51.16 mm, respectively. The difference between our approach and a standard paraseptal route was statistically significant (P = 0.041; P< 0.05). The mean horizontal distances were 31.68 mm (mononostril entry) and 35.37 mm (binostril entry). The mean working area was 1795.53 mm2.

CONCLUSIONS: Endoscopic endonasal approaches to the craniovertebral junction are increasing, but the downward extension on the anterior cervical spine represents a limit. Therefore, many surgeons prefer transoral or transcervical approaches. The EtsA with PNS removal allows for a more caudal exposure than the standard paraseptal approach, with reduced nasal trauma.

Original languageEnglish
Pages (from-to)373-385
Number of pages13
JournalWorld Neurosurgery
Volume110
DOIs
Publication statusPublished - Feb 2018

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Nose
Spine
Platybasia
Decompression
Wounds and Injuries

Keywords

  • Journal Article

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Endoscopic Transseptal Approach with Posterior Nasal Spine Removal : A Wide Surgical Corridor to the Craniovertebral Junction and Odontoid: Technical Note and Case Series. / Rossini, Zefferino; Milani, Davide; Nicolosi, Federico; Costa, Francesco; Lasio, Giovanni Battista; D'Angelo, Vincenzo Antonio; Fornari, Maurizio; Colombo, Giovanni.

In: World Neurosurgery, Vol. 110, 02.2018, p. 373-385.

Research output: Contribution to journalArticle

Rossini, Zefferino ; Milani, Davide ; Nicolosi, Federico ; Costa, Francesco ; Lasio, Giovanni Battista ; D'Angelo, Vincenzo Antonio ; Fornari, Maurizio ; Colombo, Giovanni. / Endoscopic Transseptal Approach with Posterior Nasal Spine Removal : A Wide Surgical Corridor to the Craniovertebral Junction and Odontoid: Technical Note and Case Series. In: World Neurosurgery. 2018 ; Vol. 110. pp. 373-385.
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abstract = "BACKGROUND: The transnasal approach to lesions involving the craniovertebral junction represents a technical challenge because of limited inferior exposure. The endoscopic transseptal approach (EtsA) with posterior nasal spine (PNS) removal is described. This technique can create a wide exposure of the craniovertebral junction, thereby increasing the caudal exposure.METHODS: On patients undergoing anterior craniovertebral junction decompression, we calculated the degree of exposure on the sagittal plan through a paraseptal route, an EtsA without and with PNS removal. The horizontal exposure and working area with the latter approach were also evaluated.RESULTS: Five patients underwent the transnasal procedure. The age of patients ranged from 34-71 years. All patients harbored basilar impression. The mean postoperative Nurick grade (1, 8) was improved versus the average preoperative grade (3). The average follow-up duration was 16 months. All patients underwent occipitocervical fixation. The mean vertical distances, from the clinoid recess to the inferior most limit with the paraseptal approach, EtsA without and with PNS removal were 38.52, 44.12, and 51.16 mm, respectively. The difference between our approach and a standard paraseptal route was statistically significant (P = 0.041; P< 0.05). The mean horizontal distances were 31.68 mm (mononostril entry) and 35.37 mm (binostril entry). The mean working area was 1795.53 mm2.CONCLUSIONS: Endoscopic endonasal approaches to the craniovertebral junction are increasing, but the downward extension on the anterior cervical spine represents a limit. Therefore, many surgeons prefer transoral or transcervical approaches. The EtsA with PNS removal allows for a more caudal exposure than the standard paraseptal approach, with reduced nasal trauma.",
keywords = "Journal Article",
author = "Zefferino Rossini and Davide Milani and Federico Nicolosi and Francesco Costa and Lasio, {Giovanni Battista} and D'Angelo, {Vincenzo Antonio} and Maurizio Fornari and Giovanni Colombo",
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T1 - Endoscopic Transseptal Approach with Posterior Nasal Spine Removal

T2 - A Wide Surgical Corridor to the Craniovertebral Junction and Odontoid: Technical Note and Case Series

AU - Rossini, Zefferino

AU - Milani, Davide

AU - Nicolosi, Federico

AU - Costa, Francesco

AU - Lasio, Giovanni Battista

AU - D'Angelo, Vincenzo Antonio

AU - Fornari, Maurizio

AU - Colombo, Giovanni

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2018/2

Y1 - 2018/2

N2 - BACKGROUND: The transnasal approach to lesions involving the craniovertebral junction represents a technical challenge because of limited inferior exposure. The endoscopic transseptal approach (EtsA) with posterior nasal spine (PNS) removal is described. This technique can create a wide exposure of the craniovertebral junction, thereby increasing the caudal exposure.METHODS: On patients undergoing anterior craniovertebral junction decompression, we calculated the degree of exposure on the sagittal plan through a paraseptal route, an EtsA without and with PNS removal. The horizontal exposure and working area with the latter approach were also evaluated.RESULTS: Five patients underwent the transnasal procedure. The age of patients ranged from 34-71 years. All patients harbored basilar impression. The mean postoperative Nurick grade (1, 8) was improved versus the average preoperative grade (3). The average follow-up duration was 16 months. All patients underwent occipitocervical fixation. The mean vertical distances, from the clinoid recess to the inferior most limit with the paraseptal approach, EtsA without and with PNS removal were 38.52, 44.12, and 51.16 mm, respectively. The difference between our approach and a standard paraseptal route was statistically significant (P = 0.041; P< 0.05). The mean horizontal distances were 31.68 mm (mononostril entry) and 35.37 mm (binostril entry). The mean working area was 1795.53 mm2.CONCLUSIONS: Endoscopic endonasal approaches to the craniovertebral junction are increasing, but the downward extension on the anterior cervical spine represents a limit. Therefore, many surgeons prefer transoral or transcervical approaches. The EtsA with PNS removal allows for a more caudal exposure than the standard paraseptal approach, with reduced nasal trauma.

AB - BACKGROUND: The transnasal approach to lesions involving the craniovertebral junction represents a technical challenge because of limited inferior exposure. The endoscopic transseptal approach (EtsA) with posterior nasal spine (PNS) removal is described. This technique can create a wide exposure of the craniovertebral junction, thereby increasing the caudal exposure.METHODS: On patients undergoing anterior craniovertebral junction decompression, we calculated the degree of exposure on the sagittal plan through a paraseptal route, an EtsA without and with PNS removal. The horizontal exposure and working area with the latter approach were also evaluated.RESULTS: Five patients underwent the transnasal procedure. The age of patients ranged from 34-71 years. All patients harbored basilar impression. The mean postoperative Nurick grade (1, 8) was improved versus the average preoperative grade (3). The average follow-up duration was 16 months. All patients underwent occipitocervical fixation. The mean vertical distances, from the clinoid recess to the inferior most limit with the paraseptal approach, EtsA without and with PNS removal were 38.52, 44.12, and 51.16 mm, respectively. The difference between our approach and a standard paraseptal route was statistically significant (P = 0.041; P< 0.05). The mean horizontal distances were 31.68 mm (mononostril entry) and 35.37 mm (binostril entry). The mean working area was 1795.53 mm2.CONCLUSIONS: Endoscopic endonasal approaches to the craniovertebral junction are increasing, but the downward extension on the anterior cervical spine represents a limit. Therefore, many surgeons prefer transoral or transcervical approaches. The EtsA with PNS removal allows for a more caudal exposure than the standard paraseptal approach, with reduced nasal trauma.

KW - Journal Article

U2 - 10.1016/j.wneu.2017.11.153

DO - 10.1016/j.wneu.2017.11.153

M3 - Article

VL - 110

SP - 373

EP - 385

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -