The Anterior Endoscopic Transcervical Approach: A Cadaveric Study on Anatomical Challenges and Surgical Limitations...

To investigate the anatomical characteristics, procedural constraints, and technical details of anterior endoscopic transcervical approach (AETCA) through cadaveric dissection.

Nine human cadaver heads, transected at the C6-C7 level and preserved in 10% formalin for no less than 4 weeks, were utilized. A 0° endoscope and surgical drills were used for odontoid removal. The resection extent was determined through volumetric analysis using CT scans performed before and after the procedure. Fluoroscopy was employed for orientation, and volumetric measurements were used to assess the resection outcomes.

Across the specimens, the average resection rate of the dens was 54%. Complete removal was achieved in two cases, subtotal in another two, and partial in five. The use of angled drills yielded significantly greater resection compared to flat-ended variants. No significant vascular or neurological injuries were noted. In seven cases, the resection extended to the odontoid's posterior wall. Challenges included the narrow and elongated operative corridor and difficulty maintaining midline orientation; however, these were addressed with the assistance of a custom-designed tubular trocar.

AETCA offers notable benefits, such as reduced risk of postoperative infections, shorter hospitalization, and decreased morbidity and healthcare expenditure. The study underscores the importance of technical expertise and enhanced instrumentation in achieving successful outcomes, particularly for complete odontoid removal while preserving adjacent anatomy. AETCA emerges as a viable and safer alternative for odontoidectomy, enhancing procedural efficiency. These findings contribute to the understanding of anatomical and technical factors relevant to the approach, supporting its clinical adoption and potentially shortening the learning curve.