Endoscopic approaches to the craniovertebral junction and odontoid process

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Skull Base Surgery

Background:

• The traditional microsurgical transoral approach for craniovertebral junction (CVJ) decompression, while direct, presents significant morbidities.
• Advancements in endoscopic techniques have revolutionized skull base surgery, offering reduced morbidity and enhanced outcomes.
• Endoscopic approaches are increasingly adopted for CVJ ventral decompression, necessitating technical refinements.

Purpose of the Study:

• To describe technical modifications for an endoscopic endonasal approach to the craniovertebral junction.
• To evaluate the feasibility and advantages of this minimally invasive technique for CVJ decompression.

Main Methods:

• Endoscopic insertion via the endonasal corridor provides a panoramic view from the sphenoid to the C2 vertebra.
• Image guidance systems are utilized for precise resection guidance.
• The technique involves soft palate retraction, mucosal flap utilization for access and reconstruction, and tailored decompression via nasal or oral corridors.

Main Results:

• The modified endoscopic technique significantly reduces surgical morbidity by avoiding palatal splitting, leading to improved postoperative healing.
• Enhanced surgical exposure and a wider perspective facilitate effective decompression of the craniovertebral junction.
• A learning curve is associated with mastering this advanced endoscopic approach.

Conclusions:

• This modified endoscopic approach represents a valuable, minimally invasive addition to the surgical armamentarium for craniovertebral junction and odontoid process pathologies.
• Judicious application of this technique can lead to favorable patient outcomes.