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Refinement of the Transoral Approach to Craniovertebral Junction Malformations

  • Paolo PerriniEmail author
  • Nicola Benedetto
  • Francesco Cacciola
  • Pasquale Gallina
  • Nicola Di Lorenzo
Chapter
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 125)

Abstract

Background: The transoral approach provides the most direct surgical corridor for treatment of congenital bony abnormalities that exert irreducible ventral compression of the cervicomedullary junction. In this paper, based on our experience with the transoral approach over the past three decades, we briefly describe the surgical strategies and the operative nuances that allow effective decompression of the craniovertebral junction (CVJ) while minimizing postoperative morbidity.

Methods: The surgical strategy is dictated by the type and severity of the malformation. Fibre-optic nasotracheal intubation obviates the necessity of preoperative tracheostomy, and avoidance of a soft-palate incision significantly reduces oropharyngeal morbidity. When feasible, the atlas-sparing technique minimizes postoperative instability. The transoral transatlas approach is generally required in patients with severe basilar invagination and allows wider exposure of the anterior CVJ at the price of a higher incidence of postoperative instability.

Conclusion: The transoral approach is extremely effective in providing excellent decompression of the anterior cervicomedullary junction in patients with fixed malformations. Tailoring the approach to the peculiar anatomy of each malformation reduces iatrogenic instability and minimizes postoperative complications.

Keywords

Transoral approach Craniovertebral junction Odontoidectomy Basilar invagination 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Paolo Perrini
    • 1
    Email author
  • Nicola Benedetto
    • 1
  • Francesco Cacciola
    • 2
  • Pasquale Gallina
    • 3
  • Nicola Di Lorenzo
    • 3
  1. 1.Department of NeurosurgeryAzienda Ospedaliero Universitaria Pisana (AOUP)PisaItaly
  2. 2.Neurosurgical DepartmentAzienda Ospedaliera Universitaria “Santa Maria alle Scotte”SienaItaly
  3. 3.Department of Neurosurgery, Tuscany School of NeurosurgeryUniversity of FlorenceFlorenceItaly

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