Craniovertebral junction 360°: A combined microscopic and endoscopic anatomical study

Area of Science:

• Neurosurgery
• Anatomy
• Surgical Approaches

Background:

• The craniovertebral junction (CVJ) presents complex surgical challenges due to its critical neurovascular structures.
• A thorough three-dimensional anatomical understanding is essential for safe and effective surgical interventions in the CVJ region.

Purpose of the Study:

• To elucidate the combined microscopic and endoscopic anatomy of the CVJ.
• To identify critical neurovascular structures in relation to bony and muscular landmarks.
• To evaluate different surgical corridors for accessing the CVJ.

Main Methods:

• Eight fresh-frozen cadaveric heads were utilized.
• Stepwise dissections were performed from anterior, posterior, and lateral approaches.
• Anterior approaches were conducted endoscopically, while posterior and lateral approaches used microscopy.

Main Results:

• Three primary surgical corridors (anterior, posterior, lateral) were identified for CVJ access.
• Key bony and muscular landmarks were detailed for each approach, aiding in navigation.
• The study delineated the course of the vertebral artery and lower cranial nerves.

Conclusions:

• Advances in endoscopic and microscopic techniques facilitate access to CVJ lesions and anomalies.
• A combined microscopic and endoscopic approach enhances anatomical understanding.
• This knowledge may inform the development of novel, combined surgical strategies for the CVJ.