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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

Dynamic X-ray with anterior atlas-dens interval and posterior atlas-dens interval performed before discharge showed no instability of the craniovertebral junction
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Figure 4: Dynamic X-ray with anterior atlas-dens interval and posterior atlas-dens interval performed before discharge showed no instability of the craniovertebral junction

Mentions: Immediately after surgery, a dynamic X-ray scan was performed: The anterior atlas-dens interval (AADI), posterior atlas-dens interval (PADI), and C1–C2 total lateral overhang were measured as morphological criteria to determine the upper cervical spine stability.[123537] AADI and PADI remained stable after surgery, and the total C1–C2 overhang was no more than 7 mm, thus demonstrating no difference in CVJ motility compared with the preoperative radiographic pictures [Figure 4]. Therefore, we did not proceed to posterior cervical stabilization, postponing the eventual decision in light of the clinical status in the follow-up.


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)

Dynamic X-ray with anterior atlas-dens interval and posterior atlas-dens interval performed before discharge showed no instability of the craniovertebral junction
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Dynamic X-ray with anterior atlas-dens interval and posterior atlas-dens interval performed before discharge showed no instability of the craniovertebral junction
Mentions: Immediately after surgery, a dynamic X-ray scan was performed: The anterior atlas-dens interval (AADI), posterior atlas-dens interval (PADI), and C1–C2 total lateral overhang were measured as morphological criteria to determine the upper cervical spine stability.[123537] AADI and PADI remained stable after surgery, and the total C1–C2 overhang was no more than 7 mm, thus demonstrating no difference in CVJ motility compared with the preoperative radiographic pictures [Figure 4]. Therefore, we did not proceed to posterior cervical stabilization, postponing the eventual decision in light of the clinical status in the follow-up.

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