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Endoscopic Endonasal Approach to the Odontoid Pathologies.
Zenga, Francesco; Pacca, Paolo; Tardivo, Valentina; Pennacchietti, Valentina; Garbossa, Diego; Pecorari, Giancarlo; Ducati, Alessandro.
Afiliación
  • Zenga F; Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.
  • Pacca P; Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy. Electronic address: paolopacca84@gmail.com.
  • Tardivo V; Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.
  • Pennacchietti V; Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.
  • Garbossa D; Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.
  • Pecorari G; 1st ENT Division, Department of Surgical Sciences, University of Torino, Genova, Italy.
  • Ducati A; Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.
World Neurosurg ; 89: 394-403, 2016 May.
Article en En | MEDLINE | ID: mdl-26868425
BACKGROUND: Surgical anterior decompression represents the treatment of choice for symptomatic irreducible ventral craniovertebral junction (CVJ) compression. With the refinement of the endoscopic techniques, the endonasal route has been proposed as alternative to the classic transoral approach to CVJ. Some reports assess the effectiveness and safety of endoscopic endonasal approaches to CVJ pathologies. MATERIALS AND METHODS: From July 2011 to February 2014, 12 patients with symptomatic nonreducible ventral spinal cord compression underwent purely 3-dimensional endoscopic endonasal odontoidectomy in our department. The surgical technique is described. RESULTS: A good brainstem-medullary decompression was achieved in all patients. In 10 of 12 patients the endotracheal tube was removed just after the procedure with good recovery of the respiratory function. We report no cases of velopharyngeal insufficiency. In 5 of 12 patients the preservation of C1 anterior was achieved, without the need for posterior cervical fixation. DISCUSSION AND CONCLUSIONS: Endoscopic endonasal odontoidectomy has proven to be safe and effective in selected patients. Soft and hard palate preservation dramatically reduces the risk of postoperative velopharyngeal insufficiency. Moreover, the endonasal endoscopic approach provides a direct access to the dens. Three-dimensional high-definition endoscope, laser, and ultrasound bony curettes revealed to be useful tools for this approach that, however, remains a demanding one.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Compresión de la Médula Espinal / Descompresión Quirúrgica / Endoscopía / Apófisis Odontoides Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2016 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Compresión de la Médula Espinal / Descompresión Quirúrgica / Endoscopía / Apófisis Odontoides Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2016 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos