Abstract
The craniovertebral junction (CVJ) has unique anatomical bone and neurovascular structure architecture. It not only separates the skull base from the subaxial cervical spine but also provides a special cranial flexion, extension and axial rotation pattern. Stability is provided by a complex combination of osseous and ligamentous supports, which allow a large degree of motion. Perfect knowledge of CVJ anatomy and physiology allows us to better understand instrumentation procedures of the occiput, atlas and axis, and the specific diseases that affect the region. Therefore, a review of the vascular, ligamentous and bony anatomy of the region, in relation to all possible surgical approaches to this anatomically unique segment of the cervical spine, appears to be absolutely mandatory in order to preview and to overcome possible anatomy-related complications of CVJ surgery; moreover, knowledge of the basic principles of instrumentation and of the kinematics of the region, since they interact with the anatomy, seems to be strategic in preoperative planning.
Historically considered a no man’s land, CVJ surgery, or the CVJ specialty, has recently attracted strong consideration as a symbol of challenging surgery as well as selective top-level qualifying surgery.
Although many years have passed since the beginning of this pioneering surgery, managing lesions situated in the anterior aspect of the CVJ still remains a challenging neurosurgical problem. Many studies are available in the literature, aiming to examine the microsurgical anatomy of both the anterior and posterior extradural and intradural aspects of the CVJ, as well as the differences in all possible surgical exposures obtained by the 360° approach philosophy. In this paper the author provides a short but quite complete at-a-glance tour of personal experience and publications and the more recent literature available.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Visocchi M. Advances in videoassisted anterior surgical approach to the craniovertebral junction. Adv Tech Stand Neurosurg. 2011;37:97–110.
Alfieri A, Jho HD, Tschabitscher M. Endoscopic edonasal approach to the ventral craniocervical junction: anatomical study. Acta Neurochir (Wien). 2002;144:219–25.
Visocchi M, Di Martino A, Maugeri R, González Valcárcel I, Grasso V, Paludetti G. Videoassisted anterior surgical approaches to the craniocervical junction: rationale and clinical results. Eur Spine J. 2015;24(12):2713–23. https://doi.org/10.1007/s00586-015-3873-6.
Visocchi M. Transnasal and transoral approach to the clivus and the craniovertebral junction. J Neurosurg Sci. 2015.
Visocchi M, Signorelli F, Liao C, Rigante M, Paludetti G, Barbagallo G, et al. Endoscopic endonasal approach for craniovertebral junction pathologies: myth and truth in clinical series and personal experience. World Neurosurg. 2017;101:122–9. https://doi.org/10.1016/j.wneu.2017.01.099.
Visocchi M, Signorelli F, Liao C, Rigante M, Paludetti G, Barbagallo G, et al. Transoral versus transnasal approach for craniovertebral junction pathologies: never say never. World Neurosurg. 2018;110:592–603. https://doi.org/10.1016/j.wneu.2017.05.125.
Visocchi M, Iacopino DG, Signorelli F, Olivi A, Maugeri R. Walk the line: the surgical highways to the craniovertebral junction in endoscopic approaches: a historical perspective. World Neurosurg. 2018;110:544–57. https://doi.org/10.1016/j.wneu.2017.06.125.
Visocchi M, Pappalardo G, Pileggi M, Signorelli F, Paludetti G, La Rocca G. Experimental endoscopic angular domains of transnasal and transoral routes to the craniovertebral junction. Light and shade. Spine. 2015;24(Suppl 4):S564–8. https://doi.org/10.1007/s00586-014-3720-1.
Visocchi M, Trevisi G, Iacopino DG, Tamburrini G, Caldarelli M, Barbagallo GM. Odontoid process and clival regeneration with Chiari malformation worsening after transoral decompression: an unexpected and previously unreported cause of “accordion phenomenon”. Eur Spine J. 2014;18:564–8.
Visocchi M, Della Pepa GM, Doglietto F, Esposito G, La Rocca G, Massimi L. Video-assisted microsurgical transoral approach to the craniovertebral junction: personal experience in childhood. Childs Nerv Syst. 2011;27:825–31.
Visocchi M. Videoassisted anterior surgical approaches to the craniocervical junction: rationale and clinical results. Eur Spine J. 2014;24(12):2713–23. https://doi.org/10.1007/s00586-015-3873-6.
Visocchi M, La Rocca G, Della Pepa GM, Stigliano E, Costantini A, Di Nardo F, et al. Anterior video-assisted approach to the craniovertebral junction: transnasal or transoral? A cadaver study. Acta Neurochir (Wien). 2014;156:285–92.
Wolinsky JP, Sciubba DM, Suk I, Gokaslan ZL. Endoscopic image-guided odontoidectomy for decompression of basilar invagination via a standard anterior cervical approach. Technical note. J Neurosurg Spine. 2007;6:184–91.
Visocchi M. Considerations on “endoscopic endonasal approach to the craniovertebral junction: the importance of the anterior C1 arch preservation or its reconstruction” [letter]. Acta Otorhinolaringol Ital. 2016;36:228–30. https://doi.org/10.14639/0392-100X-927.
Visocchi M, Di Rocco F, Meglio M. Craniocervical junction instability: instrumentation and fusion with titanium rods and sublaminar wires. Effectiveness and failures in personal experience. Acta Neurochir (Wien). 2003;145:265–72.
Visocchi M, Fernandez EM, Ciampini A, Di Rocco C. Reducible and irreducible os odontoideum treated with posterior wiring, instrumentation and fusion. Past or present? Acta Neurochir (Wien). 2009;151(10):1265–74.
Visocchi M, Pietrini D, Tufo T, Fernandez E, Di Rocco C. Pre-operative irreducible C1–C2 dislocations: intra-operative reduction and posterior fixation. The “always posterior strategy”. Acta Neurochir (Wien). 2009;151:551–9.
Visocchi M, Mattogno PP, Signorelli F, Zhong J, Iacopino G, Barbagallo G. Complications in craniovertebral junction instrumentation: hardware removal can be associated with long-lasting stability. Personal experience. Acta Neurochir Suppl. 2017;124:187–94. https://doi.org/10.1007/978-3-319-39546-3_29.
Babu RP, Sekhar LN, Wright DC. Extreme lateral transcondylar approach: technical improvements and lessons learned. J Neurosurg. 1994;81(1):49–59.
Sen CN, Sekhar LN. An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum. Neurosurgery. 1990;27(2):197–204.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Visocchi, M. (2019). Why the Craniovertebral Junction?. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_1
Download citation
DOI: https://doi.org/10.1007/978-3-319-62515-7_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-62514-0
Online ISBN: 978-3-319-62515-7
eBook Packages: MedicineMedicine (R0)