Massimiliano Visocchi1, Francesco Signorelli2, Chenlong Liao3, Mario Rigante4, Gaetano Paludetti4, Giuseppe Barbagallo5, Alessandro Olivi1. 1. Institute of Neurosurgery Catholic University of Rome, Rome, Italy. 2. Institute of Neurosurgery Catholic University of Rome, Rome, Italy. Electronic address: francesco.signorelli1984@gmail.com. 3. Department of Neurosurgery, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. 4. Institute of Otolaryngology, Catholic University of Rome, Rome, Italy. 5. Division of Neurosurgery, Department of Neurosciences, Policlinico "G.Rodolico" University Hospital, Catania, Italy.
Abstract
OBJECTIVE: For many years, the microsurgical transoral approach (TOA) has been accepted as the "gold standard" for the surgical treatment of a variety of congenital, developmental, and acquired pathologies affecting the craniovertebral junction. In the present study, we try to investigate both experimental and clinical fronts of such a challenging surgery, starting from the updated literature experience. TOA is actually presented as an "old-fashioned" surgical technique dealing with possible bacterial contamination, the need of postoperative nose gastric tube feeding for a week, the possible nasopharyngeal incompetence, and the postoperative tongue swelling. Otherwise, the endoscopic endonasal approach (EEA) appears strongly supported by the modern literature as the true "minimally invasive" procedure. METHODS: Our clinical experience deals with 23 anterior procedures in paediatric and adult patients (17 TOA and 6 EEA). We further report on our experimental cadaver laboratory study of 12 subjects. RESULTS: All the patients of TOA group but one were discharged after posterior procedures within two weeks and improved or remained unchanged after surgery and during the follow-up. No mayor complications occurred in TOA group. In EEA group two patients died for cerebrospinal fluid infection, for disease progression and for heart attack. CONCLUSION: Our and other available data suggest that no clear superiority of EEA over endoscopic TOA can be assessed so far; on the other hand, EEA can produce complications similar to TOA in craniovertebral junction surgery.
OBJECTIVE: For many years, the microsurgical transoral approach (TOA) has been accepted as the "gold standard" for the surgical treatment of a variety of congenital, developmental, and acquired pathologies affecting the craniovertebral junction. In the present study, we try to investigate both experimental and clinical fronts of such a challenging surgery, starting from the updated literature experience. TOA is actually presented as an "old-fashioned" surgical technique dealing with possible bacterial contamination, the need of postoperative nose gastric tube feeding for a week, the possible nasopharyngeal incompetence, and the postoperative tongue swelling. Otherwise, the endoscopic endonasal approach (EEA) appears strongly supported by the modern literature as the true "minimally invasive" procedure. METHODS: Our clinical experience deals with 23 anterior procedures in paediatric and adult patients (17 TOA and 6 EEA). We further report on our experimental cadaver laboratory study of 12 subjects. RESULTS: All the patients of TOA group but one were discharged after posterior procedures within two weeks and improved or remained unchanged after surgery and during the follow-up. No mayor complications occurred in TOA group. In EEA group two patients died for cerebrospinal fluid infection, for disease progression and for heart attack. CONCLUSION: Our and other available data suggest that no clear superiority of EEA over endoscopic TOA can be assessed so far; on the other hand, EEA can produce complications similar to TOA in craniovertebral junction surgery.
Authors: Patrick Haas; Till-Karsten Hauser; Kosmas Kandilaris; Marco Skardelly; Marcos Tatagiba; Sasan Darius Adib Journal: Front Surg Date: 2022-04-26