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C1 anterior arch preservation in transnasal odontoidectomy using three-dimensional endoscope: A case report.

Zenga F, Marengo N, Pacca P, Pecorari G, Ducati A - Surg Neurol Int (2015)

Bottom Line: After surgery, a dynamic X-ray scan showed no difference in CVJ motility in comparison with the preoperative one.The stereoscopic perception augmented the precision of the surgical gesture in the deep field.This affects the preservation of the C1 anterior arch because of the presence of critical structures that are exposed to potential damage if not displayed.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosciences, Molinette University Hospital, Via Cherasco 15, 10126 Torino, Italy.

ABSTRACT

Background: The transoral ventral corridor is the most common approach used to reach the craniovertebral junction (CVJ). Over the last decade, many case reports have demonstrated the transnasal corridor to the odontoid peg represents a practicable route to remove the tip of the odontoid process. The biomechanical consequences of the traditional odontoidectomy led to the necessity of a cervical spine stabilization. Preserving the inferior portion of the C1 anterior arch should prevent instability.

Case description: This is the first report in which the technique to remove the tip of the odontoid while preserving the C1 anterior arch is described by means of a three-dimensional (3D) endoscope. A 53-year-old man underwent a transnasal 3D endoscopic approach because of a complex CVJ malformation. The upper-medial portion of the C1 anterior arch was removed preserving its continuity, and the odontoidectomy was performed. After surgery, a dynamic X-ray scan showed no difference in CVJ motility in comparison with the preoperative one.

Conclusions: The stereoscopic perception augmented the precision of the surgical gesture in the deep field. The importance of a 3D view relates to the depth of field, which a two-dimensional endoscopy cannot provide. This affects the preservation of the C1 anterior arch because of the presence of critical structures that are exposed to potential damage if not displayed.

No MeSH data available.


Related in: MedlinePlus

Preoperative dynamic cervical spine X-ray showing no instability of the craniovertebral junction ((a) static, (b) hyperextension, (c) hyperflexion)
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Figure 2: Preoperative dynamic cervical spine X-ray showing no instability of the craniovertebral junction ((a) static, (b) hyperextension, (c) hyperflexion)

Mentions: A 53-year-old man with a long-lasting history of objective vertigo and neck pain accessed to emergency care because of a severe headache, disabling vertiginous crisis with falls, increasing neck pain also in lateral head movements and decline in health-related quality of life. Clinical examination showed hyperreflexia in lower limbs, diffuse burning paresthesia of the four limbs, bilateral Babinski sign, and downbeat nystagmus. Magnetic resonance imaging (MRI) and computed tomography (CT) scans showed a complex CVJ malformation with the basilar impression and radiological signs of myelopathy at the C2 level [Figure 1]. Furthermore, a dynamic cervical spine X-ray proved that there was no instability in flexion and extension movements of the CVJ [Figure 2].


C1 anterior arch preservation in transnasal odontoidectomy using three-dimensional endoscope: A case report.

Zenga F, Marengo N, Pacca P, Pecorari G, Ducati A - Surg Neurol Int (2015)

Preoperative dynamic cervical spine X-ray showing no instability of the craniovertebral junction ((a) static, (b) hyperextension, (c) hyperflexion)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697203&req=5

Figure 2: Preoperative dynamic cervical spine X-ray showing no instability of the craniovertebral junction ((a) static, (b) hyperextension, (c) hyperflexion)
Mentions: A 53-year-old man with a long-lasting history of objective vertigo and neck pain accessed to emergency care because of a severe headache, disabling vertiginous crisis with falls, increasing neck pain also in lateral head movements and decline in health-related quality of life. Clinical examination showed hyperreflexia in lower limbs, diffuse burning paresthesia of the four limbs, bilateral Babinski sign, and downbeat nystagmus. Magnetic resonance imaging (MRI) and computed tomography (CT) scans showed a complex CVJ malformation with the basilar impression and radiological signs of myelopathy at the C2 level [Figure 1]. Furthermore, a dynamic cervical spine X-ray proved that there was no instability in flexion and extension movements of the CVJ [Figure 2].

Bottom Line: After surgery, a dynamic X-ray scan showed no difference in CVJ motility in comparison with the preoperative one.The stereoscopic perception augmented the precision of the surgical gesture in the deep field.This affects the preservation of the C1 anterior arch because of the presence of critical structures that are exposed to potential damage if not displayed.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosciences, Molinette University Hospital, Via Cherasco 15, 10126 Torino, Italy.

ABSTRACT

Background: The transoral ventral corridor is the most common approach used to reach the craniovertebral junction (CVJ). Over the last decade, many case reports have demonstrated the transnasal corridor to the odontoid peg represents a practicable route to remove the tip of the odontoid process. The biomechanical consequences of the traditional odontoidectomy led to the necessity of a cervical spine stabilization. Preserving the inferior portion of the C1 anterior arch should prevent instability.

Case description: This is the first report in which the technique to remove the tip of the odontoid while preserving the C1 anterior arch is described by means of a three-dimensional (3D) endoscope. A 53-year-old man underwent a transnasal 3D endoscopic approach because of a complex CVJ malformation. The upper-medial portion of the C1 anterior arch was removed preserving its continuity, and the odontoidectomy was performed. After surgery, a dynamic X-ray scan showed no difference in CVJ motility in comparison with the preoperative one.

Conclusions: The stereoscopic perception augmented the precision of the surgical gesture in the deep field. The importance of a 3D view relates to the depth of field, which a two-dimensional endoscopy cannot provide. This affects the preservation of the C1 anterior arch because of the presence of critical structures that are exposed to potential damage if not displayed.

No MeSH data available.


Related in: MedlinePlus