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Video-assisted microsurgical transoral approach to the craniovertebral junction: personal experience in childhood
Massimiliano Visocchi1, Giuseppe Maria Della Pepa, Francesco Doglietto
1Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
Insights
Endoscopic transoral surgery offers a minimally invasive approach for pediatric craniovertebral junction decompression. This technique enhances visualization and reduces the need for extensive surgical splitting, improving outcomes for young patients.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Anterior craniovertebral junction (CVJ) compressive abnormalities require surgical intervention.
- Traditional open approaches can involve significant morbidity, especially in pediatric patients.
Purpose of the Study:
- To evaluate the feasibility and efficacy of endoscopic video-assisted transoral surgery for anterior CVJ decompression in pediatric patients.
- To assess the role of neuronavigation in this specific surgical approach.
Main Methods:
- A retrospective analysis of 3 pediatric patients (ages 11-15) who underwent transoral decompression for CVJ abnormalities.
- Utilized a combination of open access, microsurgical techniques, neuronavigation, and endoscopy (30-degree and angled-lens).
Main Results:
- Complete CVJ decompression was achieved in all cases.
- The endoscope identified residual compression missed by microscopy alone.
- Angled-lens endoscopes improved clival exposure without soft palate splitting.
Conclusions:
- Endoscopically assisted transoral surgery is a viable and emerging alternative for anterior CVJ decompression in pediatric patients.
- This approach, combined with microsurgery and neuronavigation, allows for better decompression with reduced invasiveness.
- The transoral video-assisted microsurgical approach is recommended as a gold standard, particularly for pediatric cases.
Purpose:
This paper outlines the perspectives of transoral craniosurgery for anterior craniovertebral junction (CVJ) compressive abnormalities in the specific subset of paediatric patients. In particular we analyzed the opportunity for endoscopic video-assisted approach to the CVJ along with neuronavigation for anterior decompression by the transoral approach in paediatric patients.
Methods:
Among 30 patients ranging 6-78 years undergoing CVJ decompressive procedures, we operated transorally 3 paediatric patients (ranging 11-15 years) by using open access, microsurgical technique, neuronavigation, and endoscopy.
Results:
The microscope was the main stone of the transoral procedure; a complete CVJ decompression was accomplished in all the cases by using the 30-degree endoscope that allowed to identify residual compression not clearly visible by using the microscope alone. The use of an angled-lens endoscope can significantly improve the exposure of the clivus without splitting the soft palate.
Conclusions:
Endoscopically assisted transoral surgery represents an emerging alternative to the standard microsurgical approach to the anterior CVJ. Used in conjunction with traditional microsurgery and intraoperative fluoroscopy, endoscopy provides information for a better decompression with a reduced need for extensive soft-palate splitting, no need for hard-palate resection, or extended maxillotomy. Transoral video-assisted microsurgical approach should be considered the gold standard especially in the paediatric patient.