PURPOSE: Anterior decompression of the craniovertebral junction is reserved to patients with irreducible ventral bulbo-medullary lesions and rapidly deteriorating neurological functions. Classically performed through the transoral approach, the exposure of this region can be now achieved by a minimally invasive endonasal endoscopic approach (EEA). METHODS: Four patients with irreducible, anterior bulbo-medullary compression due to rheumatoid pannus and basilar invagination were enrolled. The imaged-guided EEA was used to resect the odontoid process, trying to preserve the C1 anterior arch. RESULTS: Neurological improvement and adequate bulbo-medullary decompression were obtained in all patients. In two cases, anterior C1 ring was preserved. These patients did not required a posterior fusion. CONCLUSIONS: Compared with the standard transoral technique, the EEA provides the same good exposure but with potentially less complications. The preservation of the anterior C1 arch can contribute to avoid cranial settling and posterior fusion with its related risk of subaxial instability.
PURPOSE: Anterior decompression of the craniovertebral junction is reserved to patients with irreducible ventral bulbo-medullary lesions and rapidly deteriorating neurological functions. Classically performed through the transoral approach, the exposure of this region can be now achieved by a minimally invasive endonasal endoscopic approach (EEA). METHODS: Four patients with irreducible, anterior bulbo-medullary compression due to rheumatoid pannus and basilar invagination were enrolled. The imaged-guided EEA was used to resect the odontoid process, trying to preserve the C1 anterior arch. RESULTS: Neurological improvement and adequate bulbo-medullary decompression were obtained in all patients. In two cases, anterior C1 ring was preserved. These patients did not required a posterior fusion. CONCLUSIONS: Compared with the standard transoral technique, the EEA provides the same good exposure but with potentially less complications. The preservation of the anterior C1 arch can contribute to avoid cranial settling and posterior fusion with its related risk of subaxial instability.
Authors: Jens Gempt; Jens Lehmberg; Astrid E Grams; Lars Berends; Bernhard Meyer; Michael Stoffel Journal: Eur Spine J Date: 2010-12-02 Impact factor: 3.134
Authors: Luigi M Cavallo; Andrea Messina; Paolo Cappabianca; Felice Esposito; Enrico de Divitiis; Paul Gardner; Manfred Tschabitscher Journal: Neurosurg Focus Date: 2005-07-15 Impact factor: 4.047
Authors: Sait Naderi; Neil R Crawford; M Stephen Melton; Volker K H Sonntag; Curtis A Dickman Journal: Neurosurg Focus Date: 1999-06-15 Impact factor: 4.047
Authors: Clinton J Baird; James E Conway; Daniel M Sciubba; Daniel M Prevedello; Alfredo Quiñones-Hinojosa; Amin B Kassam Journal: Neurosurgery Date: 2009-12 Impact factor: 4.654
Authors: Sien Hui Tan; Dharmendra Ganesan; Wan Z A Rusydi; Hari Chandran; Narayanan Prepageran; Vicknes Waran Journal: Eur Spine J Date: 2015-07-26 Impact factor: 3.134
Authors: M Re; M Iacoangeli; L Di Somma; L Alvaro; D Nasi; G Magliulo; F M Gioacchini; D Fradeani; M Scerrati Journal: Acta Otorhinolaryngol Ital Date: 2016-04-29 Impact factor: 2.124