Endoscopic endonasal approach to the cranio-cervical junction
Epublication WebSurg.com, Mar 2012;12(03). URL: http://websurg.com/doi/lt03encornelius001
There exists a variety of pathological processes involving the craniocervical junction (CCJ): tumors (e.g. primary bone tumors, chordomas, metastases), infections (e.g. tuberculoma), malformations and rheumatoid arthritis. Instability—either induced by the pathology itself or after surgery— is often associated with these diseases and has to be addressed. For a long time, the transoral approach (TOA) has been the gold standard for anterior surgical decompression at the CCJ. Over the last years, the endoscopic endonasal approach (EEA) has become a valuable alternative. In order to work efficiently and safely via the EEA, there are some prerequisites: a thorough knowledge of the endoscopic anatomy, careful preoperative planning based on radiology, adequate endoscopic technique (ideally a team of neurosurgeons and ENT specialists), dedicated endoscopic instrumentation and intraoperative navigation and the ability to perform occipitocervical stabilization. Finally, for successful patient management, it is crucial to learn about the possibilities and limits of this approach - or when to choose it and when not.