Endoscopically assisted transoral-transpharyngeal approach to the craniovertebral junction

We describe a series of seven consecutive patients treated with endoscopically assisted transoral surgery for decompression of high cervical and clival abnormalities.

Seven endoscopically assisted transoral procedures were performed at the University of Florida from September 1999 to April 2000 for irreducible compression at the cervicomedullary junction. The abnormalities encountered were primary basilar invagination from congenital craniovertebral junction malformation (two cases), irreducible rheumatoid cranial settling (one case), secondary basilar invagination caused by migration of odontoid fracture fragments (one case), pseudogout granulation mass (one case), clivus chordoma (one case), and Chiari malformation with associated basilar invagination (one case).

Successful decompression was achieved in all seven patients. There were no adverse neurological sequelae. One patient died from a perioperative myocardial infarction. At a mean clinical follow-up of 6.16 months, neurological status was noted to be stable or improved in all remaining patients.

Endoscopically assisted transoral surgery represents an emerging alternative to standard microsurgical techniques for transoral approaches to the anterior cervicomedullary junction. Used in conjunction with intraoperative fluoroscopy, it provides a safe method for anterior decompression of the cervicomedullary junction without the need for extensive soft palate splitting, hard palate resection, or extended maxillotomy. Experience is required with greater numbers of patients and long-term follow-up to further validate this promising technique.