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The Endonasal Endoscopic Approach to Pathologies of the Anterior Craniocervical Junction: Analytical Review of Cases Treated at Four European Neurosurgical Centres

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New Trends in Craniovertebral Junction Surgery

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 125))

Abstract

Supported by preliminary anatomical and clinical studies exploring the feasibility and usefulness of approaching many ventral pathologies of the craniocervical junction (CCJ) using the endoscopic endonasal approach, four European centres have joined forces to accumulate and share their growing surgical experience of this advanced technique. By describing the steps that led to the development and continuous refinement of this approach to the CCJ, this article delves deeply into an analysis of the cases operated on since 2010 at these four institutions, and discusses in detail the operative nuances that so far have allowed achievement of successful outcomes with excellent perioperative patient comfort and satisfactory long-term quality of life.

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References

  1. Jho HD, Carrau RL, McLaughlin MR, Somaza SC. Endoscopic transsphenoidal resection of a large chordoma in the posterior fossa. Acta Neurochir. 1997;139:343–8.

    Article  CAS  Google Scholar 

  2. Jho HD, Ha HG. Endoscopic endonasal skull base surgery: part 3. The clivus and posterior fossa. Minim Invasive Neurosurg. 2004;47:16–23.

    Article  Google Scholar 

  3. Crockard HA, Pozo JL, Ransford AO, Stevens JM, Kendall BE, Essigman WK. Transoral decompression and posterior fusion for rheumatoid atlanto-axial subluxation. J Bone Jt Surg Br. 1986;68:350–6.

    Article  CAS  Google Scholar 

  4. Crockard HA, Sen CN. The transoral approach for the management of intradural lesions at the craniovertebral junction: review of 7 cases. Neurosurgery. 1991;28:88–98.

    Article  CAS  Google Scholar 

  5. de Almeida JR, Zanation AM, Snyderman CH, Carrau RL, Prevedello DM, Gardner PA, Kassam AB. Defining the nasopalatine line: the limit for endonasal surgery of the spine. Laryngoscope. 2009;119(2):239–44.

    Article  Google Scholar 

  6. Dickman CA, Spetzler RF, Sonntag VK. Surgery of the craniovertebral junction. New York: Thieme; 1998.

    Google Scholar 

  7. Di Lorenzo N. Craniocervical junction malformation treated by transoral approach. A survey of 25 cases with emphasis on postoperative instability and outcome. Acta Neurochir. 1992;118:112–6.

    Article  Google Scholar 

  8. Donald PJ. Transoral approach to the clivus and upper cervical spine. In: Donald PJ, editor. Surgery of the skull base. Philadelphia: Lippincott-Raven; 1998. p. 507–32.

    Google Scholar 

  9. Hayakawa T, Kamikawa K, Ohnishi T, Yoshimine T. Prevention of postoperative complications after a transoral transclival approach to basilar aneurysms. J Neurosurg. 1981;54:699–703.

    Article  CAS  Google Scholar 

  10. Menezes AH, Graf CJ, Hibri N. Abnormalities of the craniovertebral junction with cervico-medullary compression. A rational approach to surgical treatment in children. Childs Brain. 1980;7:15–30.

    CAS  PubMed  Google Scholar 

  11. Shaha AR, Johnson R, Miller J, Milhorat T. Transoral–transpharyngeal approach to the upper cervical vertebrae. Am J Surg. 1993;166(4):336–40.

    Article  CAS  Google Scholar 

  12. Yang SY, Gao YZ. Clinical results of the transoral operation for lesions of the craniovertebral junction and its abnormalities. Surg Neurol. 1999;51(1):16–20.

    Article  CAS  Google Scholar 

  13. Cappabianca P, Alfieri A, de Divitiis E. Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg. 1998;41:66–73.

    Article  CAS  Google Scholar 

  14. Cappabianca P, Frank G, Pasquini E, de Divitiis O, Calbucci F. Extended endoscopic endonasal transsphenoidal approaches to the suprasellar region, planum sphenoidale and clivus. In: de Divitiis E, Cappabianca P, editors. Endoscopic endonasal transsphenoidal surgery. New York: Springer; 2003. p. 176–87.

    Chapter  Google Scholar 

  15. Alfieri A, Jho HD, Tschabitscher M. Endoscopic endonasal approach to the ventral cranio-cervical junction: anatomical study. Acta Neurochir (Wien). 2002;144(3):219–25.

    Article  CAS  Google Scholar 

  16. Baird CJ, Conway JE, Sciubba DM, Prevedello DM, Quiñones-Hinojosa A, Kassam AB. Radiographic and anatomic basis of endoscopic anterior craniocervical decompression: a comparison of endonasal, transoral, and transcervical approaches. Neurosurgery. 2009;65(6 Suppl):158–64.

    PubMed  Google Scholar 

  17. Cavallo LM, Cappabianca P, Messina A, Esposito F, Stella L, de Divitiis E, Tschabitscher M. The extended endoscopic endonasal approach to the clivus and cranio-vertebral junction: anatomical study. Childs Nerv Syst. 2007;23(6):665–71.

    Article  CAS  Google Scholar 

  18. Chibbaro S, Cornelius JF, Froelich S, Tigan L, Kehrli P, Debry C, Romano A, Herman P, George B, Bresson D. Endoscopic endonasal approach in the management of skull base chordomas—clinical experience on a large series, technique, outcome, and pitfalls. Neurosurg Rev. 2013;37(2):217–24.

    Article  Google Scholar 

  19. Choudhri O, Mindea SA, Feroze A, Soudry E, Chang SD, Nayak JV. Experience with intraoperative navigation and imaging during endoscopic transnasal spinal approaches to the foramen magnum and odontoid. Neurosurg Focus. 2014;36(3):E4.

    Article  Google Scholar 

  20. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus. 2005;19:E4.

    PubMed  Google Scholar 

  21. Fries G, Perneczky A. Endoscope-assisted brain surgery: part 2—analysis of 380 procedures. Neurosurgery. 1998;42(2):226–32.

    Article  CAS  Google Scholar 

  22. Kassam AB, Snyderman C, Gardner P, Carrau R, Spiro R. The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery. 2005;57:E213.

    PubMed  Google Scholar 

  23. La Corte E, Aldana PR, Ferroli P, Greenfield JP, Härtl R, Anand VK, Schwartz TH. The rhinopalatine line as a reliable predictor of the inferior extent of endonasal odontoidectomies. Neurosurg Focus. 2015;38(4):E16.

    Article  Google Scholar 

  24. McGirt MJ, Attenello FJ, Sciubba DM, Gokaslan ZL, Wolinsky JP. Endoscopic transcervical odontoidectomy for pediatric basilar invagination and cranial settling. Report of 4 cases. J Neurosurg Pediatr. 2008;1(4):337–42.

    Article  Google Scholar 

  25. Messina A, Bruno MC, Decq P, Coste A, Cavallo LM, de Divittis E, Cappabianca P, Tschabitscher M. Pure endoscopic endonasal odontoidectomy: anatomical study. Neurosurg Rev. 2007;30(3):189–94.

    Article  Google Scholar 

  26. Visocchi M, Di Martino A, Maugeri R, González Valcárcel I, Grasso V, Paludetti G. Videoassisted anterior surgical approaches to the craniocervical junction: rationale and clinical results. Eur Spine J. 2015;24(12):2713–23. https://doi.org/10.1007/s00586-015-3873-6.

    Article  PubMed  Google Scholar 

  27. Cavallo LM, Messina A, Cappabianca P, Esposito F, de Divitiis E, Gardner P, Tschabitscher M. Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus. 2005;19:E2.

    PubMed  Google Scholar 

  28. Aldana PR, Naseri I, La Corte E. The naso-axial line: a new method of accurately predicting the inferior limit of the endoscopic endonasal approach to the craniovertebral junction. Neurosurgery. 2012;71(2 Suppl Operative):ONS308–14.

    PubMed  Google Scholar 

  29. Chibbaro S, Gaillard S. Endoscopic endonasal odontoidectomy. In: Cappabianca P, Cavallo LM, de Divitiis O, Esposito F, editors. Midline skull base surgery. New York: Springer; 2016. p. 313–21.

    Chapter  Google Scholar 

  30. Goldschlager T, Härtl R, Greenfield JP, Anand VK, Schwartz TH. The endoscopic endonasal approach to the odontoid and its impact on early extubation and feeding. J Neurosurg. 2015;122(3):511–8. https://doi.org/10.3171/2014.9.JNS14733.

    Article  PubMed  Google Scholar 

  31. Gardner PA, Tormenti MJ, Pant H, Fernandez-Miranda JC, Snyderman CH, Horowitz MB. Carotid artery injury during endoscopic endonasal skull base surgery: incidence and outcomes. Neurosurgery. 2013;73(2 Suppl Operative):ONS261–70.

    PubMed  Google Scholar 

  32. Nayak JV, Gardner PA, Vescan AD, Carrau RL, Kassam AB, Snyderman CH. Experience with the expanded endonasal approach for resection of the odontoid process in rheumatoid disease. Am J Rhinol. 2007;21(5):601–6.

    Article  Google Scholar 

  33. Frank G, Pasquini E, Mazzatenta D. Extended sphenoidal approach. J Neurosurg. 2001;95:917–8.

    CAS  PubMed  Google Scholar 

  34. Iacoangeli M, Gladi M, Alvaro L, Di Rienzo A, Specchia N, Scerrati M. Endoscopic endonasal odontoidectomy with anterior C1 arch preservation in elderly patients affected by rheumatoid arthritis. Spine J. 2013;13(5):542–8. https://doi.org/10.1016/j.spinee.2013.01.043.

    Article  PubMed  Google Scholar 

  35. Laufer I, Greenfield JP, Anand VK, Hartl R, Schwartz TH. Endonasal endoscopic resection of the odontoid process in a non achondroplastic dwarf with juvenile rheumatoid arthritis: feasibility of the approach and utility of the intraoperative Iso-C three-dimensional navigation. Case report. J Neurosurg Spine. 2008;8(4):376–80.

    Article  Google Scholar 

  36. Perez-Orribo L, Little AS, Lefevre RD, Reyes PR, Newcomb AG, Prevedello DM, Roldan H, Nakaji P, Dickman CA, Crawford NR. Biomechanical evaluation of the craniovertebral junction after anterior unilateral condylectomy: implications for endoscopic endonasal approaches to the cranial base. Neurosurgery. 2013;72(6):1021–30. https://doi.org/10.1227/NEU.0b013e31828d6231.

    Article  PubMed  Google Scholar 

  37. Ponce-Gomez JA, Ortega-Porcayo LA, Soriano-Barón HE, Sotomayor-González A, Arriada-Mendicoa N, Gómez-Amador JL, Palma-Díaz M, Barges-Coll J. Evolution from microscopic transoral to endoscopic endonasal odontoidectomy. Neurosurg Focus. 2014;37(4):E15.

    Article  Google Scholar 

  38. Singh H, Grobelny BT, Harrop J, Rosen M, Lober RM, Evans J. Endonasal access to the upper cervical spine, part one: radiographic morphometric analysis. J Neurol Surg B Skull Base. 2013;74(3):176–84. https://doi.org/10.1055/s-0033-1342923.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Zenga F, Pacca P, Tardivo V, Pennacchietti V, Garbossa D, Pecorari G, Ducati A. Endoscopic endonasal approach to the odontoid pathologies. World Neurosurg. 2016;89:394–403. https://doi.org/10.1016/j.wneu.2016.02.011.

    Article  PubMed  Google Scholar 

  40. Zenga F, Marengo N, Pacca P, Pecorari G, Ducati A. C1 anterior arch preservation in transnasal odontoidectomy using three-dimensional endoscope: a case report. Surg Neurol Int. 2015;6:192. https://doi.org/10.4103/2152-7806.172696.

    Article  PubMed  PubMed Central  Google Scholar 

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Competing Interests

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France

    Salvatore Chibbaro, Mario Ganau, Helene Cebula, Beniamino Nannavecchia, Julien Todeschi & Francois Proust

  2. Department of Neurosurgery, Parma University Hospital, Parma, Italy

    Antonio Romano

  3. ENT, Strasbourg University Hospital, Strasbourg, France

    Christian Debry

  4. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Alessandro Olivi & Massimiliano Visocchi

  5. Department of Neurosurgery, Foch Hospital, Paris, France

    Stephane Gaillard

Authors
  1. Salvatore Chibbaro
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  2. Mario Ganau
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  9. Alessandro Olivi
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  10. Stephane Gaillard
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  11. Massimiliano Visocchi
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Editor information

Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Institute of Neurosurgery, Rome, Italy

    Massimiliano Visocchi

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No financial support was received for this work.

All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Chibbaro, S. et al. (2019). The Endonasal Endoscopic Approach to Pathologies of the Anterior Craniocervical Junction: Analytical Review of Cases Treated at Four European Neurosurgical Centres. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_28

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  • DOI: https://doi.org/10.1007/978-3-319-62515-7_28

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62514-0

  • Online ISBN: 978-3-319-62515-7

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