Endonasal Endoscopic and Transoral Approaches to the Craniovertebral Junction and the Clival Region: A Comparative Anatomical Study

Alfio Spina, Filippo Gagliardi, Javier Abarca-Olivas, Michele Bailo, Nicola Boari, Pablo Gonzalez-Lopez, Cristian Gragnaniello, Anthony J. Caputy, Pietro Mortini

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Objective: Anterior craniovertebral junction (CVJ) surgery has continued to be one of the most debated neurosurgical topics. The transoral approach (TOA) has been considered the choice for this region. However, it has some limitations and a not negligible degree of surgery-related morbidity. With the advent of endoscopy, the endoscopic endonasal approach (EEA) was developed, which minimized morbidity and improved exposure. To the best of our knowledge, despite the extensive reported data, a comparative anatomical study has not been performed and no definitive consensus has been reached on the indications for both approaches. Methods: We compared the TOA and EEA to the CVJ using the previously described operability score (OS), calculated at 4 different targets: the C1 tubercle (C1), the lowest exposed point of the odontoid process (C2), the basion (BS) and the middle clivus (MC). The higher the OS for the selected targets, the more favorable the approach. Results: The TOA had higher OSs at the MC, C1, and C2 targets, and the EEA showed greater OSs at MC and C1. The TOA and EEA had similar OSs at the BS. These results have shown that the OS is more favorable at C1-C2 using the TOA and the OSs at the MC and BS were similar. Conclusions: The OS is an effective method to compare surgical approaches. The present study demonstrated the maximal exposure capability of the 2 approaches. The TOA seemed to be superior for lower targets and the EEA for upper targets. Because of the strong variability in the CVJ anatomy and pathological features, we suggest considering the OS as a further tool to better define the best surgical approach.

Original languageEnglish (US)
Pages (from-to)e116-e123
JournalWorld neurosurgery
Volume132
DOIs
StatePublished - Dec 2019
Externally publishedYes

Keywords

  • Clivus
  • Craniovertebral junction
  • Endoscopic endonasal approach
  • Operability score
  • Transoral approach

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint

Dive into the research topics of 'Endonasal Endoscopic and Transoral Approaches to the Craniovertebral Junction and the Clival Region: A Comparative Anatomical Study'. Together they form a unique fingerprint.

Cite this