The endoscopic endonasal approach to cranio-cervical junction: the complete panel

Area of Science:

• Neurosurgery
• Otolaryngology
• Anatomy

Background:

• The Cranio Cervical Junction (CCJ) is a complex anatomical region.
• Surgical access to the ventral CCJ has historically been challenging.
• The Endoscopic Endonasal Approach (EEA) emerged as a less invasive alternative.

Purpose of the Study:

• To provide a comprehensive summary of the Endoscopic Endonasal Approach (EEA) to the Cranio Cervical Junction (CCJ).
• To review the evolution, feasibility criteria, limitations, anatomical landmarks, indications, and biomechanical aspects of the EEA to CCJ.
• To consolidate current knowledge on EEA for ventral CCJ pathologies.

Main Methods:

• Comprehensive literature search (March 2002 - June 2015) categorized by surgical technique, anatomy, indications, and biomechanics.
• Step-by-step demonstration of the EEA using cadaveric specimens.
• Review of 61 articles and one poster.

Main Results:

• The EEA was first described in 2002 and first used for odontoidectomy in 2005.
• Key indications include rheumatoid pannus of the odontoid and basilar invagination.
• Various anatomical lines (NPL, SN-HP, NAxL, RPL) aid in predicting feasibility.
• Craniocervical fusion may be unnecessary after <75% occipital condyle removal.
• C1-C2 fusion via EEA is a possibility.

Conclusions:

• The EEA to the CCJ represents a significant advancement in minimally invasive surgery.
• It offers a less complicated alternative to the transoral approach for ventral CCJ access.
• When feasible, EEA is the preferred approach for ventral CCJ pathologies.