Anatomical Description and Literature Review of the Endoscopic Endonasal Transclival Transodontoid Approach Combined with Endoscopic Transoral Decompression to the Anterior Craniovertebral Junction: A New Strategy

Abstract

Objective: To describe and evaluate the steps required to perform a combined endoscopic endonasal/transoral transclival transodontoid approach for anterior decompression of the craniovertebral junction.

Methods: The endoscopic endonasal transclival transodontoid approach combined with endoscopic transoral decompression was performed on 4 cadaveric specimens. Evaluation of this combined technique; a review of the literature; and the nuances, advantages, and pitfalls are reported.

Results: Adequate wide anterior decompression was achieved in all specimens. This combined approach allowed the preservation of the anterior arch of C1 without injuring the eustachian tube anatomy and avoiding internal carotid artery manipulation.

Conclusions: Mastery of both techniques allows for a safe and comfortable surgical corridor. The transoral and transnasal approaches should not be considered as either/or techniques, but rather as a complement to each other. However, as with all new or developing techniques, there is a steep learning curve, which requires ample training in the skull base laboratory.

Keywords: Basilar invagination; Craniocervical anomalies; Craniovertebral junction; Endoscopic endonasal transclival transodontoid approach; Transoral approach.