Skip to main content
SpringerLink
Log in

Craniovertebral Junction Surgical Approaches: State of Art

  • Chapter
  • First Online:
Advances and Technical Standards in Neurosurgery

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 50))

  • 83 Accesses

Abstract

Surgical approaches directed toward craniovertebral junction (CVJ) can be addressed to the ventral, dorsal, and lateral aspects through a variety of 360° surgical corridors Herein, we report features, advantages, and limits of the updated technical support in CVJ surgery in clinical setting and dissection laboratories enriched by our preliminary surgical results of the simultaneous application of O-arm intraoperative neuronavigation and imaging system along with the 3D-4K EX in TOA for the treatment of CVJ pathologies.

In the past 4 years, eight patients harboring CVJ compressive pathologies underwent one-step combined anterior neurosurgical decompression and posterior instrumentation and fusion technique with the aid of exoscope and O-arm. In our equipped Cranio-Vertebral Junction Laboratory, we use fresh cadavers (and injected “head and neck” specimens) whose policy, protocols, and logistics have already been elucidated in previous works. Five fresh-frozen adult specimens were dissected adopting an FLA. In these specimens, a TOA was also performed, as well as a neuronavigation-assisted comparison between transoral and transnasal explorable distances.

A complete decompression along with stable instrumentation and fusion of the CVJ was accomplished in all the cases at the maximum follow-up (mean: 25.3 months). In two cases, the O-arm navigation allowed the identification of residual compression that was not clearly visible using the microscope alone. In four cases, it was not possible to navigate C1 lateral masses and C2 isthmi due to the angled projection unfitting with the neuronavigation optical system, so misleading the surgeon and strongly suggesting changing surgical strategy intraoperatively. In another case (case 4), it was possible to navigate and perform both C1 lateral masses and C2 isthmi screwing, but the screw placement was suboptimal at the immediate postoperative radiological assessment. In this case, the hardware displacement occurred 2 months later requiring reoperation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Visocchi M. Why the craniovertebral junction? Acta Neurochir Suppl. 2019;125:3–8.

    Article  PubMed  Google Scholar 

  2. Signorelli F, Stumpo V, Oliva A, Pascali VL, Olivi A, Visocchi M. Mastering craniovertebral junction surgical approaches: the dissection laboratory experience at the catholic university of Rome. Acta Neurochir Suppl. 2019;125:13–5.

    Article  PubMed  Google Scholar 

  3. Kassam AB, Snyderman C, Gardner P, Carrau R, Spiro R. The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery. 2005;57:E213.

    PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. Ricciardi L, Mattogno PP, Olivi A, Sturiale CL. Exoscope era: next technical and educational step in microneurosurgery. World Neurosurg. 2019;128:371–3.

    Article  PubMed  Google Scholar 

  7. Lauretti L, D’Alessandris QG, Rigante M, Ricciardi L, Mattogno PP, Olivi A. O-arm in endonasal endoscopic cranial base surgery: technical note on initial feasibility. World Neurosurg. 2018;117:103–8.

    Article  PubMed  Google Scholar 

  8. 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 (Phila Pa 1976). 2016;41:669–77.

    Article  PubMed  Google Scholar 

  9. Signorelli F, Olivi A, De Giorgio F, Pascali VL, Visocchi M. A 360° approach to the craniovertebral junction in a cadaveric laboratory setting: historical insights, current, and future perspectives in a comparative study. World Neurosurg. 2020;140:564–73. https://doi.org/10.1016/j.wneu.2020.04.058. PMID: 32797988.

    Article  PubMed  Google Scholar 

  10. Signorelli F, Pisciotta W, Stumpo V, Ciappetta P, Olivi A, Visocchi M. The extreme lateral approach to the craniovertebral junction: an anatomical study. Acta Neurochir Suppl. 2019;125:175–8. https://doi.org/10.1007/978-3-319-62515-7_26. PMID: 30610320.

    Article  PubMed  Google Scholar 

  11. Signorelli F, Pace M, Stumpo V, Ciappetta P, Costantini A, Olivi A, Visocchi M. Endoscope-assisted far lateral approach to the craniovertebral junction with neuronavigation: a cadaver laboratory experience. Acta Neurochir Suppl. 2019;125:165–9. https://doi.org/10.1007/978-3-319-62515-7_24. PMID: 30610318.

    Article  PubMed  Google Scholar 

  12. Signorelli F, Costantini A, Stumpo V, Conforti G, Olivi A, Visocchi M. Transoral approach to the craniovertebral junction: a neuronavigated cadaver study. Acta Neurochir Suppl. 2019;125:51–5. https://doi.org/10.1007/978-3-319-62515-7_8. PMID: 30610302.

    Article  PubMed  Google Scholar 

  13. Visocchi M, La Rocca G, Della Pepa GM, Stigliano E, Costantini A, Di Nardo F, Maira G. Anterior video-assisted approach to the craniovertebral junction: transnasal or transoral? A cadaver study. Acta Neurochir (Wien). 2014;156(2):285–92. https://doi.org/10.1007/s00701-013-1910-y. Epub 2013 Oct 26. PMID: 24158245.

    Article  PubMed  Google Scholar 

  14. Langer DJ, White TG, Schulder M, Boockvar JA, Labib M, Lawton MT. Advances in intraoperative optics: a brief review of current exoscope platforms. Oper Neurosurg (Hagerstown). 2019;19:84.

    Article  Google Scholar 

  15. Sack J, Steinberg JA, Rennert RC, Hatefi D, Pannell JS, Levy M, et al. Initial experience using a high-definition 3-dimensional exoscope system for microneurosurgery. Oper Neurosurg (Hagerstown). 2018;14:395–401.

    Article  PubMed  Google Scholar 

  16. Ariffin MHM, Ibrahim K, Baharudin A, Tamil AM. Early experience, setup, learning curve, benefits, and complications associated with exoscope and three-dimensional 4K hybrid digital visualizations in minimally invasive spine surgery. Asian Spine J. 2020;14:59–65.

    Article  PubMed  Google Scholar 

  17. Crosetti E, Arrigoni G, Manca A, Caracciolo A, Bertotto I, Succo G. 3D exoscopic surgery (3Des) for transoral oropharyngectomy. Front Oncol. 2020;10:16.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mamelak AN, Drazin D, Shirzadi A, Black KL, Berci G. Infratentorial supracerebellar resection of a pineal tumor using a high definition video exoscope (VITOM®). J Clin Neurosci. 2012;19:306–9.

    Article  PubMed  Google Scholar 

  19. Shirzadi A, Mukherjee D, Drazin DG, Paff M, Perri B, Mamelak AN, et al. Use of the video telescope operating monitor (VITOM) as an alternative to the operating microscope in spine surgery. Spine (Phila Pa 1976). 2012;37:E1517–23.

    Article  PubMed  Google Scholar 

  20. Visocchi M, Mattogno PP, Ciappetta P, Barbagallo G, Signorelli F. Combined transoral exoscope and OArm-assisted approach for craniovertebral junction surgery: light and shadows in single-center experience with improving technologies. J Craniovertebr Junction Spine. 2020;11(4):293–9. https://doi.org/10.4103/jcvjs.JCVJS_176_20. Epub 2020 Nov 26. PMID: 33824559; PMCID: PMC8019117.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Farah K, Coudert P, Graillon T, Blondel B, Dufour H, Gille O, et al. Prospective comparative study in spine surgery between O-arm and airo systems: efficacy and radiation exposure. World Neurosurg. 2018;118:e175–84.

    Article  PubMed  Google Scholar 

  22. Knafo S, Mireau E, Bennis S, Baussart B, Aldea S, Gaillard S. Operative and perioperative durations in O-arm vs. C-arm fluoroscopy for lumbar instrumentation. Oper Neurosurg (Hagerstown). 2018;14:273–8.

    Article  PubMed  Google Scholar 

  23. Chotay S, Kshettry VR, Ammirati M. Endoscopic assisted microsurgical techniques at the craniovertebral junction: 4 illustrative cases and literature review. Clin Neurol Neurosurg. 2014;121:1–9.

    Article  Google Scholar 

  24. Guan MW, Wang JY, Feng DX, et al. Anatomical study of endoscope-assisted far lateral keyhole approach to the ventral craniocervical region with neuronavigational guidance. Chin Med J. 2013;126:1707–10.

    Article  PubMed  Google Scholar 

  25. Hayashi N, Cohen AR. Endoscope-assisted farlateral transcondylar approach to the skull base. Minim Invasive Neurosurg. 2002;45:132–5.

    Article  CAS  PubMed  Google Scholar 

  26. Anichini GBD, Evins A, Santoro A, Stieg PE, Bernardo A. 3D endoscope-assisted anatomy of the foramen magnum and cranio-vertebral junction through a far lateral approach: a technical note. In: Congress of neurological surgeons annual meeting. 2012.

    Google Scholar 

  27. Sekhar LN, Ramanathan D. Evolution of far lateral and extreme lateral approaches to the skull base. World Neurosurg. 2012;77:617–8.

    Article  PubMed  Google Scholar 

  28. Kshettry VR, Chotai S, Hou J, Lamki T, Ammirati M. Successful resection of anterior and anterolateral lesions at the craniovertebral junction using a simple posterolateral approach. J Clin Neurosci. 2013;4:616–22.

    Google Scholar 

  29. Velat GJ, Spetzler RF. The far-lateral approach and its variations. World Neurosurg. 2012;77:619–20.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy

    Massimiliano Visocchi & Francesco Signorelli

Authors
  1. Massimiliano Visocchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Signorelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Signorelli .

Editor information

Editors and Affiliations

  1. International Neuroscience Institute, Hannover, Germany

    Concezio Di Rocco

Rights and permissions

Reprints and permissions

Copyright information

© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Visocchi, M., Signorelli, F. (2024). Craniovertebral Junction Surgical Approaches: State of Art. In: Di Rocco, C. (eds) Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 50. Springer, Cham. https://doi.org/10.1007/978-3-031-53578-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-53578-9_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-53577-2

  • Online ISBN: 978-3-031-53578-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation