Pure endoscopic endonasal odontoidectomy: anatomical study |
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Authors: | Andrea Messina Maria Carmela Bruno Philippe Decq Andre Coste Luigi Maria Cavallo Enrico de Divittis Paolo Cappabianca Manfred Tschabitscher |
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Institution: | (1) Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy;(2) Service de Neurochirurgie, Hopital Henri-Mondor, Assistance Publique-Hopitaux de Paris, Creteil, France;(3) Service d’ORL et de Chirurgie Cervico-Faciale, Hopitaux Intercommunal et H. Mondor, Creteil, France;(4) Center of Anatomy and Cell Biology, Microsurgical and Endoscopic Anatomy, Medical University of Vienna, Vienna, Austria |
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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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Keywords: | Endoscopy Odontoid process Cranio-vertebral junction |
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