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Reyes Soto G, Ovalle Torres CS, Perez Terrazas J, Honda Partida K, Rosario Rosario A, Campero A, Baldoncini M, Ramirez MDJE, Montemurro N. Multiple Myeloma Treatment Challenges: A Case Report of Vertebral Artery Pseudoaneurysm Complicating Occipitocervical Arthrodesis and a Review of the Literature. Cureus 2023; 15:e49716. [PMID: 38161862 PMCID: PMC10757504 DOI: 10.7759/cureus.49716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Multiple myeloma is a hematological neoplasm that frequently affects the spinal column. Less than a fifth of this vertebral involvement corresponds to the cervical spine and cranio-cervical junction. When there is instability or neurological involvement due to compression or deformity, approaches for anterior decompression and occipitocervical stabilization are required. The correct managment of vertebral artery aneurysm associated with occipitocervical arthrodesis requires extensive knowledge of anatomy and pathology. We present a case of a vertebral pseudoaneurysm that occurred late after the resection of a C1-C2 vertebral body multiple myeloma lesion managed with endonasal endoscopic approach and posterior occipitocervical arthrodesis as well as a systematic review of the related literature. The patient recovered well, without major neurological deficits.
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Affiliation(s)
- Gervith Reyes Soto
- Neuroscience Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MEX
| | | | - Jorge Perez Terrazas
- Spine Surgery, National Autonomous University of Mexico (UNAM) Hospital General de Mexico, Mexico City, MEX
| | - Kaori Honda Partida
- Spine Surgery, National Autonomous University of Mexico (UNAM) Hospital General de Mexico, Mexico City, MEX
| | | | | | - Matias Baldoncini
- Neurosurgery, School of Medicine, University of Buenos Aires, Buenos Aires, ARG
- Neurosurgery, San Fernando Hospital, Buenos Aires, ARG
| | | | - Nicola Montemurro
- Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP) University of Pisa, Pisa, ITA
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Penner F, Di Perna G, Zenga F. Answer to the Letter to the Editor of V. Kumar et al. concerning "Endoscopic endonasal odontoidectomy: a long-term follow-up results for a cohort of 21 patients" by Penner F, De Marco R, Di Perna G, et al. (2022) Eur Spine J 31:2693-2703. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:745. [PMID: 36580147 DOI: 10.1007/s00586-022-07490-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 12/30/2022]
Affiliation(s)
- F Penner
- Unità di Chirurgia Vertebrale - Clinica Città di Bra, Strada Montenero, 1, 12042, Bra, Cuneo, Italy
| | - G Di Perna
- Unità di Chirurgia Vertebrale - Clinica Città di Bra, Strada Montenero, 1, 12042, Bra, Cuneo, Italy.
| | - F Zenga
- Unità di Chirurgia Vertebrale - Clinica Città di Bra, Strada Montenero, 1, 12042, Bra, Cuneo, Italy
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Marengo N, Di Perna G, Baldassarre BM, Cofano F, De Marco R, Zeppa P, Petrone S, Ajello M, Garbossa D, Zenga F. 3D-printed guides for cervical pedicle screw placement in primary spine tumor: Case report and technical description. Front Surg 2022; 9:1011846. [PMID: 36504577 PMCID: PMC9727165 DOI: 10.3389/fsurg.2022.1011846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/24/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction For spine surgeons, dealing with unstable cervical spine has been usually challenging, and this becomes more difficult when facing a primary craniovertebral junction tumor. Primary spine tumor surgery should always include column reconstruction in order to guarantee biomechanical stability of the spine, but surgeons should always be aware that instrumentations could create interferences with postoperative radiations. However, although carbon fiber instrumentations have started to be used in thoracolumbar oncology for few years, these options are still not available for cervical spine. In the reported case, the adopted strategy to obtain adequate column reconstruction was based on the idea of reducing the amount of titanium needed for posterior fixation and maximizing the distance between the radiation target and titanium rods. Case report and aim We present the case of a 53-year-old woman harboring a craniovertebral junction chordoma. A short occipito-C3 construct was selected. Specifically, titanium cervical pedicle screws were placed by using a new technology consisting in patient-tailored and customized 3D-printed guides. The aim of this case report is to determine the feasibility and safety of 3D-printed guides for cervical pedicle screw (CPS) positioning, even in the case of cervical spine tumor. Conclusion CPS could represent a good solution by providing strong biomechanical purchase and tailored 3D-printed guides could increase the safety and the accuracy of this challenging screw placement, even in oncological patients.
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Affiliation(s)
- Nicola Marengo
- Department of Neuroscience “Rita Levi Montalcini,” Neurosurgery Unit, University of Turin, Turin, Italy,Skull Base and Pituitary Surgery Unit, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Giuseppe Di Perna
- Department of Neuroscience “Rita Levi Montalcini,” Neurosurgery Unit, University of Turin, Turin, Italy,Spine Surgery Unit, Casa di Cura Clinica Città di Bra, Bra, Italy
| | - Bianca Maria Baldassarre
- Department of Neuroscience “Rita Levi Montalcini,” Neurosurgery Unit, University of Turin, Turin, Italy,Skull Base and Pituitary Surgery Unit, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Fabio Cofano
- Department of Neuroscience “Rita Levi Montalcini,” Neurosurgery Unit, University of Turin, Turin, Italy,Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
| | - Raffaele De Marco
- Department of Neuroscience “Rita Levi Montalcini,” Neurosurgery Unit, University of Turin, Turin, Italy,Skull Base and Pituitary Surgery Unit, AOU Città Della Salute e Della Scienza, Turin, Italy,Correspondence: Raffaele De Marco
| | - Pietro Zeppa
- Department of Neuroscience “Rita Levi Montalcini,” Neurosurgery Unit, University of Turin, Turin, Italy
| | - Salvatore Petrone
- Department of Neuroscience “Rita Levi Montalcini,” Neurosurgery Unit, University of Turin, Turin, Italy,Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
| | - Marco Ajello
- Department of Neuroscience “Rita Levi Montalcini,” Neurosurgery Unit, University of Turin, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience “Rita Levi Montalcini,” Neurosurgery Unit, University of Turin, Turin, Italy
| | - Francesco Zenga
- Skull Base and Pituitary Surgery Unit, AOU Città Della Salute e Della Scienza, Turin, Italy
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Penner F, De Marco R, Di Perna G, Portonero I, Baldassarre B, Garbossa D, Zenga F. Endoscopic endonasal odontoidectomy: a long-term follow-up results for a cohort of 21 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2693-2703. [PMID: 35859067 DOI: 10.1007/s00586-022-07308-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/29/2022] [Accepted: 06/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic endonasal odontoidectomy (EEO) has been described as a potential approach for craniovertebral junction (CVJ) disease which could cause anterior bulbomedullary compression and encroaching. Due to the atlantoaxial junction's uniqueness and complex biomechanics, treating CVJ pathologies uncovers the challenge of preventing C1-C2 instability. A large series of patients treated with endonasal odontoidectomy is reported, analyzing the feasibility and necessity of whether or not to perform posterior stabilization. Furthermore, the focus is on the long-term follow-up, especially those whom only underwent partial C1 arch preservation without posterior fixation. METHODS This study is a retrospective analysis of patients with ventral spinal cord compression for non-reducible CVJ malformation, consecutively treated with EEO from July 2011 to March 2019. Postoperative dynamic X-ray and CT scans were obtained in each case in order to document CVJ decompression as well as to exclude instability. The anterior atlas-dens interval, posterior atlas-dens interval and C1-C2 total lateral overhang were measured as a morphological criteria to determine upper cervical spine stability. RESULTS Twenty-one patients (11:10 F:M) with a mean age of 60.6 years old at the time of surgery (range 34-84 years) encountered the inclusion criteria. For all 21 patients, a successful decompression was achieved at the first surgery. In 11 patients, the partial C1 arch integrity did not require a posterior cervical instrumentation on the bases of postoperative and constant follow-up radiological examination. In 13 cases, an improvement of motor function was recorded at the time of discharge. Only one patient had further motor function improvement at follow-up. Among the patients that did not show any significant motor change at discharge, 4 patients showed an improvement at the last follow-up. CONCLUSIONS The outcomes, even in C1 arch preservation without posterior fixation, are promising, and it could be said that the endonasal route potentially represents a valid option to treat lesions above the nasopalatine line.
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Affiliation(s)
- Federica Penner
- Section of Neurosurgery, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Raffaele De Marco
- Section of Neurosurgery, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Giuseppe Di Perna
- Section of Neurosurgery, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Irene Portonero
- Section of Neurosurgery, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Bianca Baldassarre
- Section of Neurosurgery, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Diego Garbossa
- Section of Neurosurgery, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Francesco Zenga
- Section of Neurosurgery, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
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Heller RS, Glaspy T, Mhaskar R, Bhadelia R, Heilman CB. Endoscopic Endonasal Versus Transoral Odontoidectomy for Non-Neoplastic Craniovertebral Junction Disease: A Case Series. Oper Neurosurg (Hagerstown) 2021; 21:380-385. [PMID: 34460927 DOI: 10.1093/ons/opab303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Odontoidectomy is a challenging yet effective operation for decompression of non-neoplastic craniovertebral junction disease. Though both the endoscopic endonasal approach (EEA) and the transoral approach (TOA) have been discussed in the literature, there remain few direct comparisons between the techniques. OBJECTIVE To evaluate the perioperative outcomes of EEA vs TOA odontoidectomy. METHODS A retrospective review of all cases undergoing odontoidectomy by either the EEA or TOA was performed. Attention was paid to the need for prolonged nutritional support, prolonged respiratory support, and hospitalization times. RESULTS During the study period between 2000 and 2018, 25 patients underwent odontoid process resection (18 TOA and 7 EEA). The most common indication for surgery was basilar invagination. Hospital length of stay, intensive care unit length of stay, and intubation days were all significantly shorter in the EEA group compared to the TOA group (P < .01, P = .01, P < .01, respectively). Prolonged nutritional support in the form of a gastrostomy tube was required in 5 patients and tracheostomy was required in 4 patients; all of these underwent odontoidectomy by the TOA. There was no statistical difference in neurological outcomes between the EEA and TOA groups (P = .17). CONCLUSION Odontoidectomy can be performed safely through both the EEA and TOA. The results of this study suggest the EEA has shorter hospitalizations and a lower probability of requiring prolonged nutritional support. These advantages are likely the results of decreased oropharyngeal mucosa disruption as compared to the TOA.
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Affiliation(s)
- Robert S Heller
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.,Department of Neurosurgery and Brain Repair, Tampa General Hospital, University of South Florida, Tampa, Florida, USA
| | - Tyler Glaspy
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
| | - Rafeeque Bhadelia
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Carl B Heilman
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Yagnik KJ, Pinheiro-Neto CD, Peris-Celda M. Commentary: Endoscopic Endonasal Versus Transoral Odontoidectomy for Non-Neoplastic Craniovertebral Junction Disease: A Case Series. Oper Neurosurg (Hagerstown) 2021; 21:E465-E466. [PMID: 34624884 DOI: 10.1093/ons/opab352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Karan J Yagnik
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Carlos D Pinheiro-Neto
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Bai J, Li M, Xiong Y, Shen Y, Liu C, Zhao P, Cao L, Gui S, Li C, Zhang Y. Endoscopic Endonasal Surgical Strategy for Skull Base Chordomas Based on Tumor Growth Directions: Surgical Outcomes of 167 Patients During 3 Years. Front Oncol 2021; 11:724972. [PMID: 34631554 PMCID: PMC8493096 DOI: 10.3389/fonc.2021.724972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background Skull base chordomas (SBCs) are rare malignant bone tumors with dismal long-term local control. Endoscopic endonasal surgeries (EESs) are increasingly adopted to resect SBCs recently. Gross total resection (GTR) favors good outcomes. However, the SBCs often invade the skull base extensively and hide behind vital neurovascular structures; the tumors were challenging to remove entirely. To improve the GTR, we established a surgical strategy for EES according to the tumor growth directions. Methods A total of 112 patients with SBCs from 2018 to 2019 were classified into the derivation group. We retrospectively analyzed their radiologic images and operation videos to find the accurate tumor locations. By doing so, we confirmed the tumor growth directions and established a surgical strategy. Fifty-five patients who were operated on in 2020 were regarded as the validation group, and we performed their operations following the surgical strategy to verify its value. Results In the derivation group, 78.6% of SBCs invade the dorsum sellae and posterior clinoid process region. 62.5% and 69.6% of tumors extend to the left and right posterior spaces of cavernous ICA, respectively. 59.8% and 61.6% of tumors extend to the left and right posterior spaces of paraclival and lacerum ICA (pc-la ICA), respectively. 30.4% and 28.6% of tumors extended along the left and right petroclival fissures that extend toward the jugular foramen, respectively. 30.4% of tumors involved the foramen magnum and craniocervical junction region. The GTR was achieved in 60.8% of patients with primary SBCs in the derivation group. Based on the tumors’ growth pattern, pituitary transposition and posterior clinoidectomy techniques were adopted to resect tumors that hid behind cavernous ICA. Paraclival ICA transposition was used when the tumor invaded the posterior spaces of pc-la ICA. Lacerum fibrocartilage resection and eustachian tube transposition may be warranted to resect the tumors that extended to the jugular foramen. GTR was achieved in 75.0% of patients with primary SBCs in the validation group. Conclusion Besides the midline clival region, the SBCs frequently grow into the eight spaces mentioned above. The surgical strategy based on the growth pattern contributes to increasing the GTR rate.
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Affiliation(s)
- Jiwei Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Mingxuan Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yujia Xiong
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yutao Shen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chunhui Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Songbai Gui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuzhong Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yazhuo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders Brain Tumor Center, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Key Laboratory of Central Nervous System Injury Research, Capital Medical University, Beijing, China
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Shkarubo AN, Nikolenko VN, Chernov IV, Andreev DN, Shkarubo MA, Chmutin KG. [Anatomy of anterior craniovertebral junction in endoscopic transnasal approach]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:46-53. [PMID: 32759926 DOI: 10.17116/neiro20208404146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Modern achievements in endoscopic technologies ensure extending the indications for endoscopic transnasal approach in skull base surgery. Knowledge on topographic anatomy of craniovertebral junction is a prerequisite for surgical interventions in this area. Transnasal endoscopic surgery of craniovertebral junction is a relatively new field. Therefore, this manuscript and similar anatomical studies are extremely important for neurosurgeons.
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Affiliation(s)
| | - V N Nikolenko
- Sechenov First Moscow State Medical University, Moscow, Russia.,Lomonosov Moscow State University, Moscow, Russia
| | - I V Chernov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - D N Andreev
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - K G Chmutin
- People's Friendship University of Russia, Moscow, Russia
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de Notaris M, Corrivetti F, Catapano G. Three-Dimensional versus 2-Dimensional Endoscopic Third Ventriculostomy: Surgical Results of a Preliminary Comparative Study. World Neurosurg 2020; 141:e530-e536. [PMID: 32497846 DOI: 10.1016/j.wneu.2020.05.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Three-dimensional (3-D) endoscopes have been widely used for a large variety of approaches in neurosurgical practice. However, in the last decade, 3-D scopes were barely used for ventricular surgery. In this study, we illustrated our preliminary experience with a 3-D endoscope for third ventriculostomy using new dedicated endoscopic equipment. METHODS Over a 12-month period, a high-definition 3-D endoscopic third ventriculostomy (ETV) was performed in 14 patients with obstructive hydrocephalus. Patients were followed prospectively and compared retrospectively with a matched group of 16 similar patients who underwent ETV with a standard 2-dimensional (2-D) endoscope. Surgical outcome and intra- and postoperative course were retrospectively reviewed. RESULTS 3-D ETV provided excellent surgical results, and no significant difference was shown in terms of outcome, complication, and length of hospitalization between the 2 groups. Moreover, operative time (minutes) was significantly shorter in the 3-D group than the 2-D ETV group (19.9 ± 4.8 vs. 22.9 ± 1.4, respectively; P < 0.05), and the use of the 3-D endoscope provided subjective improvements of depth perception, hand-eye coordination, and surgeon comfort. CONCLUSIONS Our preliminary study clearly demonstrated the effectiveness of 3-D ETV and provided a significant reduction of operative time. Depth information from the 3-D scope appears to facilitate rapid and stable ETV maneuvers, representing a critical development that may become a valuable tool for neuroendoscopy.
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Affiliation(s)
- Matteo de Notaris
- Department of Neuroscience, Neurosurgery Operative Unit, "San Pio" Hospital, Benevento, Italy.
| | - Francesco Corrivetti
- Department of Neuroscience, Neurosurgery Operative Unit, "San Pio" Hospital, Benevento, Italy
| | - Giuseppe Catapano
- Division of Neurosurgery, Department of Neurological Sciences, Ospedale del Mare, Naples, Italy
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Shkarubo AN, Nikolenko VN, Chernov IV, Andreev DN, Shkarubo MA, Chmutin KG, Sinelnikov MY. Anatomical Aspects of the Transnasal Endoscopic Access to the Craniovertebral Junction. World Neurosurg 2019; 133:e293-e302. [PMID: 31520764 DOI: 10.1016/j.wneu.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Interest in endoscopic transnasal access has increased with continued technological advances in endoscopic technology. The goals of this study were to review the normal anatomy in transnasal endoscopic neurosurgery and outline the anatomical basis for an expanded surgical approach. Defining anatomical aspects of surgical endoscopy helps guide the surgeon by defining normal anatomy of the access vector. METHODS This anatomic study was conducted on 15 adult male cadaver specimens using various microsurgical tools and endoscopic instruments and 1 intraoperative case. The vasculature was injected with colored silicone to aid visualization. Different transnasal approach techniques were used, with angles of endoscope access at 0°, 30°, 45°, and 70° accordingly for extensive anatomical mapping. RESULTS The proximity of critical structures is different in each approach degree. A full understanding of the possible structures to be met during transnasal access is described. As a result of the study, anatomical aspects and important structures were outlined, and a surgical protocol was defined for minimal risk access in respect to normal anatomy of the area. CONCLUSIONS Thorough knowledge of topographic anatomy of the craniovertebral junction is required for performing minimal-risk surgical intervention in this region. It is important to know all anatomical aspects of the transnasal approach in order to reduce the risk of damage to vital structures. Transnasal endoscopic surgery of the craniovertebral junction is a relatively new direction in neurosurgery; therefore, anatomical studies such as the one described in this article are extremely important for the development of this access method.
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Affiliation(s)
- Alexey Nikolaevich Shkarubo
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation; Department of Neurosurgery, RUDN University, Moscow, Russian Federation; Department of Neurosurgery, N.N. Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russian Federation.
| | - Vladimir Nikolaevich Nikolenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation; Department of Anatomy, Lomonosov Moscow State University, Moscow, Russian Federation
| | - Ilia Valerievich Chernov
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Dmitry Nikolaevich Andreev
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Mikhail Alekseevich Shkarubo
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | | | - Mikhail Yegorovich Sinelnikov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
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