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Image-guided transoral surgery in childhood
Jessica Ternier1, Shabin M Joshi, Dominic N P Thompson
1Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Insights
Image guidance, or neuronavigation, is feasible for transoral surgery in children. This technique aids in navigating complex anatomy for safe and effective decompression of the neuraxis.
Area of Science:
- Neurosurgery
- Paediatric Surgery
- Medical Imaging
Background:
- Transoral surgery in children presents challenges due to small oropharyngeal size and distorted craniocervical anatomy.
- Immobilization of the craniocervical axis is crucial for successful transoral approaches in pediatric patients.
Observation:
- Neuronavigation was employed in six pediatric cases undergoing transoral surgery.
- Craniocervical junction immobilization and volumetric imaging preceded the neuronavigation-assisted procedure.
- Post-operative imaging evaluated the surgical resection extent.
Findings:
- Neuronavigation demonstrated good correlation with intraoperative findings, achieving the goal of neuraxis decompression in all cases.
- Post-operative imaging confirmed the surgeon's assessment of decompression.
- One patient experienced transient neurological deterioration; no mortality or wound complications occurred.
Implications:
- Intraoperative neuronavigation is a viable technique for transoral surgery in the pediatric population.
- The use of neuronavigation facilitates safe and predictable decompression in complex pediatric craniovertebral anatomy.
- Image guidance offers significant value in pediatric transoral surgical interventions.
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.
