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The Endoscopic Endonasal Approach to Craniovertebral Junction Pathologies: Surgical Skills and Anatomical Study

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New Trends in Craniovertebral Junction Surgery

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 125))

Abstract

Introduction: Surgical anterior decompression is the treatment of choice for symptomatic irreducible ventral craniovertebral junction (CVJ) compression. Along with the classic transoral approach, the endoscopic endonasal approach has evolved and is gaining growing success.

Materials and Methods: In this work we discuss the surgical technique, give a complete step-by-step description of dissection of the craniovertebral junction and report a specific case of endoscopic endonasal odontoidectomy with use of a high-definition (HD) three-dimensional (3D) endoscope.

Discussion: The extended endonasal approach exploits an anatomical corridor to the odontoid process, involving only a small incision in the nasopharynx and sparing palate integrity. The most important limitation of the technique is 2D visualization, which hinders correct recognition of anatomical structures.

Conclusion: The endoscopic endonasal route to the odontoid process has proven to be a feasible, safe and well-tolerated procedure. Anatomical study is very important for better understanding of the 3D anatomy of the CVJ and relation of critical neurovascular structures to specific bony and muscular landmarks.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Neurosciences, University of Turin, Turin, Italy

    Paolo Pacca, Valentina Tardivo, Diego Garbossa, Alessandro Ducati & Francesco Zenga

  2. SC Neurochirurgia U, Presidio Molinette Dipartimento di Neuroscienze e Salute Mentale, Città della Salute e della Scienza, Turin, Italy

    Paolo Pacca

  3. 1st ENT Division, Department of Surgical Sciences, University of Turin, Turin, Italy

    Giancarlo Pecorari

Authors
  1. Paolo Pacca
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  2. Valentina Tardivo
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  3. Giancarlo Pecorari
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  4. Diego Garbossa
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  5. Alessandro Ducati
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  6. Francesco Zenga
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Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Institute of Neurosurgery, Rome, Italy

    Massimiliano Visocchi

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Pacca, P., Tardivo, V., Pecorari, G., Garbossa, D., Ducati, A., Zenga, F. (2019). The Endoscopic Endonasal Approach to Craniovertebral Junction Pathologies: Surgical Skills and Anatomical Study. 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_5

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  • DOI: https://doi.org/10.1007/978-3-319-62515-7_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62514-0

  • Online ISBN: 978-3-319-62515-7

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