Authors: Massimiliano Visocchi Giuseppe La Rocca Giuseppe Maria Della Pepa Egidio Stigliano Alessandro Costantini Francesco Di Nardo Giulio Maira
Publish Date: 2013/10/26
Volume: 156, Issue: 2, Pages: 285-292
Abstract
Endoscopy represents both an alternative and useful complement to the standard microsurgical approach to the anterior craniovertebral junction CVJ Nevertheless few studies provide an experimental comparison between transnasal and transoral endoscopic control on CVJ We compared the surgical exposition angle and the working channel volume of both the transnasal and transoral approaches in the cadaverThe transoral endoscopic surgical exposition was wider compared with the transnasal in anterior and lateral projections1in the sagittal plane both in vertical exposition transnasal inferior to transoral from 589 to 7648 average 3589 and in vertical surgical angle from 22 to 7742 average 5653 2in the coronal plane both in coronal exposition transnasal inferior to transoral from 5077 to 8388 average 7034 and in coronal surgical angle from 6558 to 8671 average 7670 The sagittal surgical domain was found to spanning from the inferior third of the clivus to C3 with the transoral and from the middle third of the clivus to the nasopalatal line NPL with the transnasal approach The overlapping surgical domain area was found to be the inferior third of the clivusThe endoscope assisted transoral approach allows a better surgical control of the CVJ It provides a better CVJ exposure in sagittal and transverse planes providing a larger working channel and an easier manoeuvrability The transnasal approach is limited in caudal direction down to the NPL otherwise the transoral approach is limited in the rostral direction with a maximum to the foramen magnum in normal specimen In every individual case pros and cons of the appropriate approach have to be taken into account as well as the choice of a combined transnasal and transoral approaches strategy
Keywords: