Pushing the boundaries of endoscopic surgery: the extended transodontoid approach for craniovertebral junction pathologies. Comprehensive technique description and comparative result.

Autor: Yasuda ME; Division of Neurosurgery, School of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada. ezequielyasuda@gmail.com.; Division of Neurosurgery, Hospital de Clinicas 'Jose de San Martin, University of Buenos Aires, Buenos Aires, Argentina. ezequielyasuda@gmail.com., Nguyen T; Division of Otolaryngology and Head & Neck Surgery, McMaster University, Hamilton, Canada., Moore J; Division of Neurosurgery, School of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada., Sommer D; Division of Otolaryngology and Head & Neck Surgery, McMaster University, Hamilton, Canada., Reddy K; Division of Neurosurgery, School of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
Jazyk: angličtina
Zdroj: Acta neurochirurgica [Acta Neurochir (Wien)] 2024 Nov 22; Vol. 166 (1), pp. 472. Date of Electronic Publication: 2024 Nov 22.
DOI: 10.1007/s00701-024-06356-9
Abstrakt: Introduction: The craniovertebral junction (CVJ) is susceptible to diverse pathologies. While the transoral-transpharyngeal approach has been the primary method for addressing anterior CVJ conditions, it carries significant morbidity. Endoscopic endonasal approach (EEA), has emerged as a Minimally invasive option. However, EEA has potential limitations in providing adequate caudal exposure. This study aims to evaluate the feasibility of enhancing caudal exposure to the endoscopic transodontoid (TO) approach by drilling the posterior part of the central hard palate, thus achieving an extended endoscopic approach to odontoid (ETO) and to compare the accuracy of predictive lines, (Nasopalatine line (NPL), Nasoaxial line (NAxL), and Rhinopalatine line (RPL)) in predicting the caudal limit of the approach.
Methods: Eight cadaveric specimens underwent pre and post-endoscopic dissection measurements. The distance resected (DR), and inferior exposure of C2 posterior wall (PW) were measured and compared between TO and ETO. Furthermore, multivariable logistic regression was utilized to assess the predictive line values for DR.
Results: Implementation of the ETO resulted in a significant increase in mean DR (8.6 mm, 52% improvement, p-value 0.03381), and the inferior exposure of the PW increased by 5.31 mm (p-value 6.063e-05, 37% greater exposure). The linear multivariable regression analysis indicated significant positive associations between NAxL, RPL and DR after TO. However, these associations were not seen for ETO.
Conclusion: The ETO proved superior to the traditional approach, providing improved caudal exposure and distance resected. While NPL and NAxL demonstrated predictive value for the TO, their utility was somewhat limited in the ETO.
Competing Interests: Declarations. Ethical approval: The project was approved by the institutional review board. HiREB Project number: 15695. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
Databáze: MEDLINE
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