How to Perform Transoral Approaches

Abstract

While transsphenoidal surgery was developed almost a century ago, it was the detailed anatomical studies, procedure, specific instrumentation and masterful teaching of Jules Hardy in Montreal in the 1960s that finally launched it as a standard neurosurgical procedure. Strange then, that an approach through an adjacent orifice met such (emotional) resistance, with fears of infection, bleeding and wound complications deterring many neurosurgeons. There had been isolated reports of removal of a bullet (Kanaval 1917) and tumors, but the technique did not come of age until ready access to neuroimaging defined clearly the anatomy and pathology of the ventral craniovertebral junction [5]. Again it has been the development of appropriate retractors and specific instruments which has allowed the procedure to be within the standard armamentarium of skull base and high cervical spinal surgeons. Pioneers in the field have been Arnold Menezes (Iowa), who put his early ENT training to good effect, and Hiroshi Abe (Sapporo). In the UK, it was a far-sighted orthopaedic surgeon, George Bonney, who successfully decompressed posttraumatic deformities at the atlantoaxial joint.