The Technique of Transoral Odontoidectomy
The transoral approach to the craniovertebral junction is an excellent surgical technique for treating ventral midline extradural compressive pathology. The target region is reached by an approach crossing the oral cavity through the open mouth (“transora
- PDF / 1,075,080 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 31 Downloads / 163 Views
The Technique of Transoral Odontoidectomy P. J. ApOSTOLlDES, A. GIANCARLO VISHTEH, and V. K. H. SONNTAG
3. 1
Terminology
3·3 History
The transoral approach to the craniovertebral junction is an excellent surgical technique for treating ventral midline extradural compressive pathology. The target region is reached by an approach crossing the oral cavity through the open mouth ("transoral").
The approach was described first by Kanavel in 1917 [15]. Since then, and especially since the application of the surgical microscope, the approach has been described by many authors mainly for the extirpation and treatment of extradurallesions [2,7,8,11,13,17,22].
3·2 Surgical Principle
3·4 Advantages
The transoral operation provides direct midline access to the ventral craniovertebral junction to facilitate decompression of the lower brain stern and upper cervical spinal cord. The surgical exposure typically extends from the inferior third of the c1ivus to the top of the C3 vertebra (Fig. 3.1) and is limited primarily by the patient's ability to open his or her mouth. The standard transoral exposure can be extended superiorly with a transpalatal or transmaxillary approach [2-4,6, 16-23], or inferiorly with a mandibulotomy and median glossotomy (Fig. 3.1a) [2,7,14,16-20].
It is the direct and unobstructed way to the anterior
Reprinted with permission from W. B. Saunders
Fig.3.1. a Routine trans oral exposure. This exposure may be increased superiorly with a transpalatal extension or inferiorly with a transmandibular extension. b Sagittal view showing routine transoral exposure with normal and pathological anatomy (inset). (Reprinted with permission from the Barrow Neurological Institute)
a
H. M. Mayer (ed.), Minimally Invasive Spine Surgery © Springer-Verlag Berlin Heidelberg 2000
part of the craniocervical junction. The anterior bony structures (inferior third of the c1ivus, anterior arch of Cl, anterior part of C2 and C3) can be exposed by dissection of the posterior wall of the pharynx. The apex of the odontoid process, as well as of the anterior part of the foramen magnum can be exposed after resection of the anterior arch of Cl. 3·5 Disadvantages The approach is limited by the surgical corridor which can be provided by the open mouth. There is a considerable risk of severe complications such as infection
12
CHAPTER
3
The Technique ofTransoral Odontoidectomy
with or without involvement of the meninges, disturbances of wound healing, cerebrospinal fluid (CSF) leakage as well as complications arising from trauma to the uvula and soft palate. In patients with rheumatoid arthritis, the approach is occasionally limited by the inability to sufficiently open the mouth (>2.5 cm) due to rheumatoid arthritis of the mandibular joints. 3. 6
Indications and Contraindications
The primary indication for a trans oral procedure is an irreducible midline extradural lesion that compresses the cervicomedullary junction. A trans oral procedure may also be required on occasion to obtain a tissue diagnosis or to debride an in
Data Loading...
