Transcervical, retropharyngeal odontoidectomy - Anatomical considerations

Area of Science:

• Neurosurgery
• Anatomy
• Surgical Techniques

Background:

• Anterior craniocervical junction lesions present significant challenges in neurosurgery.
• Posterior approaches may offer indirect decompression, but direct ventral decompression via odontoidectomy is often necessary.
• Existing anterior approaches like transoral and endoscopic endonasal routes have limitations and risks.

Purpose of the Study:

• To evaluate the feasibility and advantages of a novel anterior retropharyngeal approach for accessing the odontoid process.
• To explore this approach for direct decompression of the craniocervical junction.

Main Methods:

• A paramedian skin incision was made below the submandibular gland in two cadaveric specimens.
• Dissection proceeded through subcutaneous tissue, platysma, and superficial fascia.
• The plane between the vascular sheath and pharyngeal structures was entered, leading to the prevertebral plane for cranial dissection.

Main Results:

• The anterior, submandibular retropharyngeal approach was successfully performed on cadavers.
• Key anatomical structures, including the carotid artery and cranial nerves IX, X, and XII, were identified.
• The approach demonstrated wide exposure, avoidance of oropharyngeal contamination, and potential for cerebrospinal fluid fistula repair.

Conclusions:

• The anterior retropharyngeal approach is a feasible technique for craniocervical junction access.
• This method offers advantages such as wide exposure and reduced contamination.
• Adequate anatomical knowledge and surgical proficiency are crucial for optimal outcomes, with further research needed to understand anatomical variations and minimize risks.