Türk Nöroşirürji Dergisi 2015 , Vol 25 , Num 2
Endoscopic Approach to the Craniovertebral Junction Lesions
Cihan İŞLER, Necmettin TANRIÖVER, Nurperi GAZİOĞLU, Galip Zihni SANUS
İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı, İstanbul Despite extensive use throughout several decades, transoral microsurgical decompression still stands as the gold standard technique for the ventral compression of the craniovertebral junction (CVJ). The initial report of ‘total endonasal extended endoscopic odontoidectomy for a ventral compression of the CVJ’ was published in 2005, and subsequently, further anatomical observations and small clinical series proved the eligibility of endoscopic endonasal approach (EEA) for use around the CVJ. Indeed, the EEA to CVJ may provide an adequate working corridor on the ventral surface of foramen magnum and the whole clivus, including the paraclival regions such as the extra- and intradural portions of the internal acoustic meatus, jugular and hypoglossal foramina. It is also possible to resect the upper two-thirds of the odontoid process via the EEA. In addition, any lesion at the lateral compartment of the dens – i.e. lateral masses of C1, occipital condyles – may be accessed and removed through the EEA to the CVJ. The EEA to the CVJ also seems to be as safe and effective as any posterolateral skull base approach to the tumoral lesions of lower clivus and anterior foramen magnum, irrespective of the extra- or intradural location of the lesion. We analyze and discuss the surgical technique of EEA to CVJ on the basis of the experience gained in 27 cases in this article. Anahtar Kelimeler : Endoscopic endonasal surgery, Skull base, Odontoidectomy