Abstract
Objective
The study aims to report a preliminary experience of image guidance during transoral surgery in a paediatric population. In paediatric practice, the small size of the oropharynx and the distortion of the craniocervical junction anatomy (whether congenital or acquired) are both factors that may compromise the transoral approach. Prior immobilisation of the craniocervical axis by virtue of posterior fixation or external halo body orthosis permits the use of intra-operative image guidance to navigate this region.
Method
Neuronavigation was used during transoral surgery in six paediatric cases. Preliminary immobilisation of the craniocervical junction was ensured in all patients. Volumetric imaging was then obtained prior to the transoral procedure which was then carried out using neuronavigation assistance (Stealth Station Medtronic). Early post-operative imaging was obtained in each case to assess the extent of the surgical resection.
Results
Neuronavigation was found to correlate well with the intra-operative findings and, in all cases, the surgical objective, decompression of the neuraxis, was achieved. Post-operative imaging reflected the operating surgeon’s perception regarding the extent of the decompression. In one case, there was a transient neurological deterioration; there was no mortality and no instances of wound-related complications or cerebrospinal fluid leakage.
Conclusion
Intraoperative neuronavigation during transoral surgery is feasible in the paediatric population. In this unusual patient population, the technique appears to be of value in negotiating complex anatomy and achieving a safe and predictable decompression.
Similar content being viewed by others
References
Crockard HA (1985) The transoral approach to the base of the brain and upper cervical cord. Ann R Coll Surg Engl 67(5):321–325
Hadley MN, Spetzler RF, Sonntag VK (1989) The transoral approach to the superior cervical spine. A review of 53 cases of extradural cervicomedullary compression. J Neurosurg 71(1):16–23
Kaibara T, Hurlbert RJ, Sutherland GR (2001) Intraoperative magnetic resonance imaging-augmented transoral resection of axial disease. Neurosurg Focus 10(2):E4
Menezes AH, VanGilder JC (1988) Transoral–transpharyngeal approach to the anterior craniocervical junction. Ten-year experience with 72 patients. J Neurosurg 69(6):895–903
Pollack IF, Welch W, Jacobs GB, Janecka IP (1995) Frameless stereotactic guidance. An intraoperative adjunct in the transoral approach for ventral cervicomedullary junction decompression. Spine 20(2):216–220
Ryken T, Julien T, Frankel B, Canute G, Haller J, Rosenbaum A (1999) Image-injected frameless stereotactic approach to the anterior craniovertebral junction. Neurosurg Focus 6(6):e9
Tuite GF, Veres R, Crockard HA, Sell D (1996) Pediatric transoral surgery: indications, complications, and long-term outcome. J Neurosurg 84(4):573–583
Uff C, Thompson D (2007) Transoral surgery in the paediatric population. Childs Nerv Syst 23(9):1077
Ugur HC, Kahilogullari G, Attar A, Caglar S, Savas A, Egemen N (2006) Neuronavigation-assisted transoral–transpharyngeal approach for basilar invagination—two case reports. Neurol Med Chir (Tokyo) 46(6):306–308
Veres R, Bagó A, Fedorcsák I (2001) Early experiences with image-guided transoral surgery for the pathologies of the upper cervical spine. Spine 26(12):1385–1388
Vougioukas VI, Hubbe U, Schipper J, Spetzger U (2003) Navigated transoral approach to the cranial base and the craniocervical junction: technical note. Neurosurgery 52(1):247–250
Welch WC, Subach BR, Pollack IF, Jacobs GB (1997) Frameless stereotactic guidance for surgery of the upper cervical spine. Neurosurgery 40(5):958–963
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ternier, J., Joshi, S.M. & Thompson, D.N.P. Image-guided transoral surgery in childhood. Childs Nerv Syst 25, 563–568 (2009). https://doi.org/10.1007/s00381-008-0803-5
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-008-0803-5