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Journal of Neurosurgical Sciences 2015 Mar 04

language: English

Transnasal andtransoral approach to the clivus and the craniovertebral junction

Visocchi M.

Institute of Neurosurgery, Catholic University, Rome, Italy


Endoscopy represents a useful complement to the standard microsurgical approach to the anterior cranioveretebral junction CVJ and can be used by transnasal, transoral and transcervical routes; it provides information for a better decompression with no need for soft palate splitting, hard palate resection, or extended maxillotomy. Although neuronavigation allows a better orientation on the surgical field, intraoperative fluoroscopy helps to recognize residual compression.
Virtually, in normal anatomic conditions, no surgical limitations exist for endoscopically assisted transoral approach, compared with the pure endonasal and transcervical endoscopic approaches.
According to the personal experience in the cadaver lab, the endoscope deserves an interesting role as “support” to the standard transoral microsurgical approach, since 30° angulated endoscopy strongly increase the surgical area exposed over the posterior pharyngeal wall and the extent of the clivus. Moreover, compared to the pure transnasal endoscopic procedure, it deserves the main role due to the wider linear and angled surgical route exposure.

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