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Pure endoscopic endonasal odontoidectomy: anatomical study.

Messina A, Bruno MC, Decq P, Coste A, Cavallo LM, de Divittis E, Cappabianca P, Tschabitscher M - Neurosurg Rev (2007)

Bottom Line: Access to the cranio-vertebral junction was possible using a lower trajectory, when compared to that necessary for the sellar region.The choana is entered and the mucosa of the rhinopharynx is dissected and transposed in the oral cavity in order to expose the cranio-vertebral junction and to obtain a mucosal flap useful for the closure.The anterior arch of the atlas and the odontoid process of C2 are removed, thus exposing the dura mater.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.

ABSTRACT
Different disorders may produce irreducible atlanto-axial dislocation with compression of the ventral spinal cord. Among the surgical approaches available for a such condition, the transoral resection of the odontoid process is the most often used. The aim of this anatomical study is to demonstrate the possibility of an anterior cervico-medullary decompression through an endoscopic endonasal approach. Three fresh cadaver heads were used. A modified endonasal endoscopic approach was made in all cases. Endoscopic dissections were performed using a rigid endoscope, 4 mm in diameter, 18 cm in length, with 0 degree lenses. Access to the cranio-vertebral junction was possible using a lower trajectory, when compared to that necessary for the sellar region. The choana is entered and the mucosa of the rhinopharynx is dissected and transposed in the oral cavity in order to expose the cranio-vertebral junction and to obtain a mucosal flap useful for the closure. The anterior arch of the atlas and the odontoid process of C2 are removed, thus exposing the dura mater. The endoscopic endonasal approach could be a valid alternative to the transoral approach for anterior odontoidectomy.

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a The mucosa of the rhinopharynx has been incised in order to create a mucosal flap. b The muscles longus capitis and colli have been dissected together with the mucosa in order to expose the cranio-vertebral junction. (ET Eustachian tube, Rphx rhinopharinx, NS nasal septum, iwsphs inferior wall of sphenoid sinus, C clivus, aom atlanto-occipital membrane, C1 atlas, mmf muscle-mucosal flap)
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Fig2: a The mucosa of the rhinopharynx has been incised in order to create a mucosal flap. b The muscles longus capitis and colli have been dissected together with the mucosa in order to expose the cranio-vertebral junction. (ET Eustachian tube, Rphx rhinopharinx, NS nasal septum, iwsphs inferior wall of sphenoid sinus, C clivus, aom atlanto-occipital membrane, C1 atlas, mmf muscle-mucosal flap)

Mentions: In order to expose the cranio-vertebral junction the mucosa of rhinopharynx was incised along its lateral limits at the edge with the ostia of the Eustachian tube and along the inferior wall of the sphenoid sinus superiorly (see Fig. 2a). The mucosa, the longus capitis and longus colli muscles were gently dissected downward as a single layer, thus creating a muscle-mucosal flap (see Figs. 2b and 3). Proceeding from the inferior wall of the sphenoid sinus to the soft palate of the lower clivus, the atlanto-occipital membrane, the anterior arch of C1 and the body of C2 were visualized.Fig. 2


Pure endoscopic endonasal odontoidectomy: anatomical study.

Messina A, Bruno MC, Decq P, Coste A, Cavallo LM, de Divittis E, Cappabianca P, Tschabitscher M - Neurosurg Rev (2007)

a The mucosa of the rhinopharynx has been incised in order to create a mucosal flap. b The muscles longus capitis and colli have been dissected together with the mucosa in order to expose the cranio-vertebral junction. (ET Eustachian tube, Rphx rhinopharinx, NS nasal septum, iwsphs inferior wall of sphenoid sinus, C clivus, aom atlanto-occipital membrane, C1 atlas, mmf muscle-mucosal flap)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2279160&req=5

Fig2: a The mucosa of the rhinopharynx has been incised in order to create a mucosal flap. b The muscles longus capitis and colli have been dissected together with the mucosa in order to expose the cranio-vertebral junction. (ET Eustachian tube, Rphx rhinopharinx, NS nasal septum, iwsphs inferior wall of sphenoid sinus, C clivus, aom atlanto-occipital membrane, C1 atlas, mmf muscle-mucosal flap)
Mentions: In order to expose the cranio-vertebral junction the mucosa of rhinopharynx was incised along its lateral limits at the edge with the ostia of the Eustachian tube and along the inferior wall of the sphenoid sinus superiorly (see Fig. 2a). The mucosa, the longus capitis and longus colli muscles were gently dissected downward as a single layer, thus creating a muscle-mucosal flap (see Figs. 2b and 3). Proceeding from the inferior wall of the sphenoid sinus to the soft palate of the lower clivus, the atlanto-occipital membrane, the anterior arch of C1 and the body of C2 were visualized.Fig. 2

Bottom Line: Access to the cranio-vertebral junction was possible using a lower trajectory, when compared to that necessary for the sellar region.The choana is entered and the mucosa of the rhinopharynx is dissected and transposed in the oral cavity in order to expose the cranio-vertebral junction and to obtain a mucosal flap useful for the closure.The anterior arch of the atlas and the odontoid process of C2 are removed, thus exposing the dura mater.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.

ABSTRACT
Different disorders may produce irreducible atlanto-axial dislocation with compression of the ventral spinal cord. Among the surgical approaches available for a such condition, the transoral resection of the odontoid process is the most often used. The aim of this anatomical study is to demonstrate the possibility of an anterior cervico-medullary decompression through an endoscopic endonasal approach. Three fresh cadaver heads were used. A modified endonasal endoscopic approach was made in all cases. Endoscopic dissections were performed using a rigid endoscope, 4 mm in diameter, 18 cm in length, with 0 degree lenses. Access to the cranio-vertebral junction was possible using a lower trajectory, when compared to that necessary for the sellar region. The choana is entered and the mucosa of the rhinopharynx is dissected and transposed in the oral cavity in order to expose the cranio-vertebral junction and to obtain a mucosal flap useful for the closure. The anterior arch of the atlas and the odontoid process of C2 are removed, thus exposing the dura mater. The endoscopic endonasal approach could be a valid alternative to the transoral approach for anterior odontoidectomy.

Show MeSH
Related in: MedlinePlus