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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 dens has been drilled. b After removal of the odontoid process the transverse ligament and the underling tectorial membrane are visible. (iwsphs inferior wall of sphenoid sinus, ET Eustachian tube, dm dura mater, D dens)
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Fig6: a The dens has been drilled. b After removal of the odontoid process the transverse ligament and the underling tectorial membrane are visible. (iwsphs inferior wall of sphenoid sinus, ET Eustachian tube, dm dura mater, D dens)

Mentions: Reintroducing the endoscope into the nasal cavity, the anterior arch of the atlas was removed and the dens with the apical and alar ligaments were exposed (see Fig. 5a,b). The dens was then thinned with a microdrill, separated from the alar and apical ligaments, and finally removed (see Fig. 6a,b).Fig. 5


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 dens has been drilled. b After removal of the odontoid process the transverse ligament and the underling tectorial membrane are visible. (iwsphs inferior wall of sphenoid sinus, ET Eustachian tube, dm dura mater, D dens)
© Copyright Policy
Related In: Results  -  Collection

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

Fig6: a The dens has been drilled. b After removal of the odontoid process the transverse ligament and the underling tectorial membrane are visible. (iwsphs inferior wall of sphenoid sinus, ET Eustachian tube, dm dura mater, D dens)
Mentions: Reintroducing the endoscope into the nasal cavity, the anterior arch of the atlas was removed and the dens with the apical and alar ligaments were exposed (see Fig. 5a,b). The dens was then thinned with a microdrill, separated from the alar and apical ligaments, and finally removed (see Fig. 6a,b).Fig. 5

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