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

  • Paolo Pacca
  • Valentina Tardivo
  • Giancarlo Pecorari
  • Diego Garbossa
  • Alessandro Ducati
  • Francesco Zenga
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 125)


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.


Odontoidectomy Endoscopic Endonasal approach CVJ stability Anatomical study 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Paolo Pacca
    • 1
    • 2
  • Valentina Tardivo
    • 1
  • Giancarlo Pecorari
    • 3
  • Diego Garbossa
    • 1
  • Alessandro Ducati
    • 1
  • Francesco Zenga
    • 1
  1. 1.Division of Neurosurgery, Department of NeurosciencesUniversity of TurinTurinItaly
  2. 2.SC Neurochirurgia U, Presidio Molinette Dipartimento di Neuroscienze e Salute Mentale, Città della Salute e della ScienzaTurinItaly
  3. 3.1st ENT Division, Department of Surgical SciencesUniversity of TurinTurinItaly

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