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Acta Neurochirurgica
Published in: Acta Neurochirurgica 6/2014

01-06-2014 | How I Do it - Spine

Transoral approach to extradural non-neoplastic lesions of the craniovertebral junction

Authors: Paolo Perrini, Nicola Benedetto, Nicola Di Lorenzo

Published in: Acta Neurochirurgica | Issue 6/2014

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Abstract

Background

The transoral approach allows for an unobstructed anterior view of the craniovertebral junction from the lower clivus to C1 and C2. It can be applied to a heterogeneous spectrum of pathological lesions involving this area including craniovertebral junction malformations, atlanto-axial synovial cysts, pseudoarthrosis following odontoid fractures, selected cases of retro-odontoid pannus, and vertical translocation in rheumatoid patients.

Methods

Microsurgical strategy is dictated by the nature and site of the target lesion. Atlas preservation during transoral approach (atlas-sparing technique) minimizes postoperative instability and is suitable for the majority of extradural non-neoplastic lesions of the craniovertebral junction. The transoral trans-atlas approach allows for a wider exposure of the anterior craniovertebral junction, but at the price of a higher incidence of postoperative instability; it is usually required in patients with severe basilar invagination or irreducible vertical translocation in rheumatoid arthritis.

Conclusions

The transoral corridor is an effective route to approach a variety of anterior extradural lesions of the craniovertebral junction. Tailoring the approach to each specific lesion provides the needed exposure whilst limiting postoperative instability.
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Metadata
Title
Transoral approach to extradural non-neoplastic lesions of the craniovertebral junction
Authors
Paolo Perrini
Nicola Benedetto
Nicola Di Lorenzo
Publication date
01-06-2014
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 6/2014
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-014-2057-1

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