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Endoscopic approach to the upper cervical spine and clivus: an anatomical study of the upper limits of the transoral corridor

  • Clinical Article - Neurosurgical Anatomy
  • Published:
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Abstract

Background

Recent advances in endoscopic techniques have allowed minimally invasive approaches to the cranio-vertebral junction (CVJ) through the oropharynx (ETA) in addition to the transnasal approach (EEA). These minimally invasive endoscopic techniques allow for increased surgical exposure using no visible incisions, with a potential less morbidity. The ability to know preoperatively the limit of the ETA is vital for the surgical planning in order to better address CVJ pathology. The aim of the present study is to determine the anatomical limits of endoscopic dissection of the skull base and upper cervical spine through the transoral corridor and the superior limit reached by adopting this approach.

Methods

Six fresh-frozen adult cadaver heads were dissected adopting ETA preserving the hard and soft palate. The most superior extent of the exposure was dissected. Post-operative CT scans were performed to confirm the superior extent.

Results

The superior most limit of dissection corresponded to the sphenoid-occipital junction, where the basilar portion of the occipital bone joins with the sphenoid bone’s body. This ranged from 12.7 to 18.9 mm above the line of the hard palate. This was achieved without having to transgress any of the palatine structures.

Conclusions

The sphenoid-occipital junction represents the rostral limit of endoscopic transoral approach to the lower skull base and CVJ area. This approach is limited superiorly by the orientation of the hard palate and mouth aperture and lower dentition due to the linear nature of the endoscope. Using the endoscope for this approach can allow for a more superior exposure than the traditional open transoral approach.

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Acknowledgments

The authors are grateful to Dee Grant, RN, CNOR, for her expertise and invaluable assistance during the cadaver dissection; Saswata Roy, MD for his assistance in the surgical exposure; and to Carlos Guillermo Campos for his great help in graphics.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, University of Florida College of Medicine Jacksonville and Wolfson Children’s Hospital, Jacksonville, FL, USA

    Emanuele La Corte & Philipp R. Aldana

  2. Department of Health Sciences, University of Milan and Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy

    Emanuele La Corte

Authors
  1. Emanuele La Corte
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  2. Philipp R. Aldana
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Correspondence to Philipp R. Aldana.

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Conflict of interest

The authors declare no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper. This study was supported in part by the Medtronic Foundation.

Ethical standards

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The manuscript does not contain clinical studies or patient data. All persons gave their informed consent prior to their inclusion in the study.

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La Corte, E., Aldana, P.R. Endoscopic approach to the upper cervical spine and clivus: an anatomical study of the upper limits of the transoral corridor. Acta Neurochir 159, 633–639 (2017). https://doi.org/10.1007/s00701-017-3103-6

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  • DOI: https://doi.org/10.1007/s00701-017-3103-6

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