Summary
The transoral surgical approach is the most direct operative approach to pathology ventral to the brain stem and superior spinal cord. This approach is useful in the treatment of extradural compressive cervicomedullary lesions in selected patients.
Twenty-nine patients with ventral extradural brain stem or cervical cord compressive lesions who were treated via the transoral surgical approach are presented. Their evaluation, treatment, and long-term outcome will be reviewed (median follow-up, 24 months). Specific features of the transoral procedure, including intraoperative monitoring, methods of retraction, and microsurgical techniques that contributed to minimal operative morbidity (3%) and zero operative mortality, will be discussed.
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References
Blazier CJ, Hadley MN, Spetzler RF (1986) The transoral surgical approach to craniovertebral pathology. J Neurosci Nurs 18 (2): 57–62
Crockard HA (1985) The transoral approach to the base of the brain and upper cervical cord. Ann R Coll Surg Engl 67: 321–325
Croft TJ, Brodkey JS, Nulsen FE (1972) Reversible spinal cord trauma: A model for electrical monitoring of spinal cord function. J Neurosurg 36: 402–406
Dastur KD, Wadia NH, Desai AD et al (1965) Medullospinal compression due to atlanto-axial dislocation and sudden haematomyelia during decompression. Brain 88: 897
Drake CG (1973) Management of aneurysms of posterior circulation. In: Youmans JR (ed) Neurological surgery, vol 2. WB Saunders, Philadelphia London Toronto, pp 787–806
Hadley MN, Sonntag VKH, Amos MR, Hodak JA, Lopez LJ (1987) Three-dimensional computed tomography in the diagnosis of vertebral column pathological conditions. Neurosurgery 21: 186–192
Hadley NM, Spetzler RF (1986) The transoral surgical approach to the craniocervical junction. In: Samii M (ed) Surgery in and around the brain stem and third ventricle. Springer, Heidelberg, pp 467–475
Hadley MN, Martin NA, Spetzler RF, Sonntag VKH, Johnson PC (1988) Comparative transoral dural closure techniques: A canine model. Neurosurgery 22: 392–397
Masferrer R, Hadley MN, Bloomfield S, Spetzler RF, Sonntag VKH (1985) Transoral microsurgical resection of the odontoid process. BNI Quarterly 1 (3): 34–40
Menezes AH, VanGilder JC, Graf CJ, McDonnell DE (1980) Craniocervical abnormalities: A comprehensive surgical approach. J Neurosurg 53: 444–445
Owen MP, Brown RH, Spetzler RF, Nash CL Jr, Brodkey JS, Nulsen FE (1979) Excision of intramedullary arteriovenous malformation using intraoperative spinal cord monitoring. Surg Neurol 12: 271–276
Selman WR, Spetzler RF, Brown R (1981) The use of intra-operative fluoroscopy and spinal cord monitoring for transoral microsurgical odontoid resection. Clin Orthop 154: 51–56
Spetzler RF (1983) Transoral approach to the upper cervical spine. In: Evarts CM (ed) Surgery of the musculoskeletal system. Churchill Livingstone, New York, pp 4: 19–4: 24
Spetzler RF, Selman WR, Nash CL, Brown RH (1979) Transoral microsurgical odontoid resection and spinal cord monitoring. Spine 4 (6): 506–510
Stevens JM, Kendall BE, Crockard HA (1986) The spinal cord in rheumatoid arthritis with clinical myelopathy: A computed myelographic study. J Neurol Neurosurg Psychiatry 49: 140–151
Stratford J (1957) Myelopathy caused by atlanto-axial dislocation. J Neurosurg 14: 97
Thompson H (1970) Transpharyngeal fusion of the upper cervical spine. Proc R Soc Med 63: 893
VanGilder JC, Menezes AH (1982) Craniovertebral abnormalities and their treatment. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques. Grune and Stratton, New York, pp 1221–1235
Yamaura A, Makino H, Isobe K, Takashima T, Nakamura T, Takemiya S (1979) Repair of cerebrospinal fluid fistula following transoral transclival approach to a basilar aneurysm. J Neurosurg 50: 834–836
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© 1988 Springer-Verlag
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Spetzler, R.F., Hadley, M.N., Sonntag, V.K.H. (1988). The Transoral Approach to the Anterior Superior Cervical Spine. A Review of 29 Cases. In: Isamat, F., Jefferson, A., Loew, F., Symon, L. (eds) Proceedings of the 8th European Congress of Neurosurgery, Barcelona, September 6–11, 1987. Acta Neurochirurgica, vol 43. Springer, Vienna. https://doi.org/10.1007/978-3-7091-8978-8_16
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DOI: https://doi.org/10.1007/978-3-7091-8978-8_16
Publisher Name: Springer, Vienna
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