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Combined transnasal and transoral endoscopic approaches to the craniovertebral junction
IH El-Sayed1, J-C Wu2, CP Ames3, G Balamurali4, PV Mummaneni3
1 Department of Otololaryngology-Head and Neck Surgery, University of California, San Francisco, USA
2 Department of Neurosurgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, UCSF Spine Center, University of California, San Francisco, San Francisco, USA
3 Department of Neurosurgery, UCSF Spine Center, University of California, San Francisco, San Francisco, USA
4 Department of Neurosurgery, UCSF Spine Center, University of California, San Francisco, USA; Salford Royal Hospitals, Manchester, England
Correspondence Address:
J-C Wu
UCSF Department of Neurosurgery, 505 Parnassus Avenue M-780, San Francisco, CA 94143, USA; Department of Neurosurgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-8237.65481
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Objectives: To describe and evaluate a new technique of a combined endoscope-assisted transnasal and transoral approach to decompress the craniovertebral junction. Materials and Methods: A retrospective cohort of patients requiring an anterior decompression at the craniovertebral junction over a 12-month period was studied. Eleven patients were identified and included in the study. Eight of the patients had an endoscopic approach [endonasal (2), endooral (2), and combined (4)]. Four of the 8 patients in the endoscopic group had a prior open transoral procedure at other institutions. These 8 patients were compared with a contemporary group of 3 patients who had an open, transoral-transpalatal approach. Charts, radiographic images, and pathologic diagnosis were reviewed. We evaluated the following issues: airway obstruction, dysphagia, velopharyngeal insufficiency (VPI), length of hospital stay (LOS), adequate decompression, and the need for revision surgery. Results: Adequate anterior decompression was achieved in all the patients. The endoscopic cohort had a reduced LOS (P = 0.014), reduced need for prolonged intubation/tracheotomy (P =0.024) and a trend toward reduced VPI (P = 0.061) when compared with the open surgery group. None of the patients required a revision surgery. Conclusion: Proper choice of endoscopic transnasal, transoral, or combined approaches allows anterior decompression at the craniovertebral junction, while avoiding the need to split the palate. A combined transnasal-transoral approach appears to reduce procedure-related morbidity compared with open, transoral, and transpalatal surgeries. |
