Transoral approaches to the cervical spine

Area of Science:

• Neurosurgery and Spine Surgery
• Cranial Base Surgery
• Cervical Spine Anatomy

Background:

• Anterior approaches to the craniocervical junction are crucial for accessing the cranial base and upper cervical spine.
• The transoral-transpharyngeal approach is a well-established technique for surgical access to the anterior clivus, C1, and C2.
• This approach forms the basis for more complex jaw-splitting techniques.

Purpose of the Study:

• To discuss fundamental concepts, anatomy, and technical aspects of the transoral-transpharyngeal approach.
• To highlight its critical role in craniocervical junction surgery.
• To review emerging endoscopic alternatives.

Main Methods:

• Review of anatomical considerations for anterior craniocervical junction exposure.
• Discussion of perioperative management and surgical techniques for the transoral-transpharyngeal approach.
• Evaluation of endoscopic endonasal and transcervical approaches as alternatives.

Main Results:

• The transoral-transpharyngeal approach provides reliable access to the anterior craniocervical junction (clivus, C1, C2).
• Fundamental anatomical knowledge and technical proficiency are essential for successful outcomes.
• Endoscopic endonasal and transcervical approaches are emerging as viable, less invasive alternatives.

Conclusions:

• The transoral-transpharyngeal approach is considered the 'gold standard' for anterior cervical spine surgery.
• Continued experience with endoscopic techniques may lead to their increased adoption.
• Mastery of the transoral approach is foundational for advanced craniocervical junction surgery.