J Minim Invasive Spine Surg Tech.  2023 Apr;8(1):21-27. 10.21182/jmisst.2023.00612.

Endoscopic Approach for A Difficult Cervical Area: Fully Endoscopic Uniportal Transcervical Approach for Ventral Pathologies of the Craniovertebral Junction

• Ohara Y
• Uchikado H
• Hara T
• Nojiri H
• Abe E
• Kikuchi N
• Kimura T

• KMID: 2562207
• DOI: http://doi.org/10.21182/jmisst.2023.00612

Abstract

Objective
Various pathologies can occur at the craniovertebral junction (CVJ). Posterior decompression with occipitocervical fixation can improve many of these conditions, but anterior decompression is required in some cases. Anterior decompression of a CVJ lesion is very difficult to perform. The transoral approach has been considered the gold standard, but it has the disadvantage of a deep and limited operative field, and many complications are associated with this procedure. Three endoscopic approaches (transoral, transnasal, and transcervical) have been reported previously. Transcervical endoscopic odontoidectomy is a familiar approach for spinal surgeons and can be performed using a uniportal full-endoscopic spinal surgery system.
Methods
As described in the present study, 12 patients underwent surgery, and their clinical records were reviewed retrospectively.
Results
All patients had good recovery without complications.
Conclusion
Fully endoscopic uniportal transcervical odontoidectomy has many advantages for ventral pathologies of the CVJ. In particular, it can avoid heat injury despite drilling very close to the brainstem in deep closed lesions.

Keyword

Craniovertebral junction; FESS; Odontoidectomy