Skip to main content
SpringerLink
Log in

Craniocervical junction malformation treated by transoral approach. A survey of 25 cases with emphasis on postoperative instability and outcome

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

An experience with 25 consecutive cases of craniocervical junction (CCJ) malformations operated upon via the transoral route is reported. Twenty-two patients also underwent posterior occipitocervical stabilization with alloplastic material and in only one patient was transoral odontoidectomy and fusion with bone autograph performed.

Indication for the transoral route consisted of an irreducible ventral compression of the cervicobulbar junction by the abnormal bone complex.

Two patients died during the early postoperative period and the remaining 23 survivors were followed for an average of 3.5 years: 17 of these showed marked improvement and 5 a stabilization of the neurological disturbances. A further patient, who refused posterior stabilization, eventually died because of progressive cranial settling.

Long-term results have shown this approach to be decisive in the surgical management of well-selected CCJ anomalies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Apuzzo MLJ, Weiss MH, Heiden JS (1978) Transoral exposure of the atlanto-axial region. Neurosurgery 3: 201–207

    PubMed  Google Scholar 

  2. Bonney G, Williams JPR (1985) Transoral approach to the upper cervical spine. A report of 16 cases. J Bone Joint Surg [Br] 67 B: 691–698

    Google Scholar 

  3. Cantore GP, Guidetti B, Moscatelli G (1969) A new antibiotic “mastic” in neurosurgery. 4th International Congress of Neurological Surgery, 9th International Congress of Neurology, New York, New York, September 20–27, 1969. Excerpta Medica International Congress Series, No 193, p 46

  4. Cantore GP, Guidetti B, Delfini R (1987) Neurosurgical use of human dura mater sterilized by gamma rays and stored in alcohol: long-term results. J Neurosurg 66: 93–95

    PubMed  Google Scholar 

  5. Crockard HA (1985) The transoral approach to the base of the brain and upper cervical cord. Ann R Coll Surg Engl 67: 321–325

    PubMed  Google Scholar 

  6. Crockard HA, Pozo JL, Ransford AO, Stevens JM, Kendal BE, Essigman WK (1986) Transoral decompression and posterior fusion for rheumatoid atlanto-axial subluxation. J Bone Joint Surg [Br] 68 B: 350–356

    Google Scholar 

  7. Delandsheer JM, Caron JP, Jomin M (1977) Voie trans-buccopharyngee et malformations de la charniere cervico-occipitale. Neurochirurgie 23: 276–278

    PubMed  Google Scholar 

  8. Derome P, Caron JP, Hurt M (1977) Indications de la voie transbucco-pharyngee et malformations de la charniere cranio-vertebrale. Neurochirurgie 23: 282–285

    PubMed  Google Scholar 

  9. Di Lorenzo N, Bozzå L, Antonelli M,et al (1981) Arnold-Chiari malformations detected by unenhanced multiplanar CT scan. Surg Neurol 16: 340–345

    PubMed  Google Scholar 

  10. Di Lorenzo N, Fortuna A, Guidetti B (1982) Cranio-vertebral junction malformations. Clinicoradiological findings, long-term results, and surgical indications in 63 cases. J Neurosurg 57: 603–608

    PubMed  Google Scholar 

  11. Di Lorenzo N, Palatinsky E, Bardella L,et al (1987) Benign osteoblastoma of the clivus removed by transoral approach: case report. Neurosurgery 20: 52–55

    PubMed  Google Scholar 

  12. Di Lorenzo N, Fortuna A (1987) High cervical (C2–C3) spondylogenetic myelopathy treated by transoral approach: case report. J Neurosurg Sci 31: 71–74

    PubMed  Google Scholar 

  13. Di Lorenzo N (1989) Transoral approach to extradural lesions of the lower clivus and upper cervical spine: an experience of 19 cases. Neurosurgery 24: 37–42

    PubMed  Google Scholar 

  14. Fang HSY, Ong GB (1962) Direct anterior approach to the upper cervical spine. J Bone Joint Surg (Am) 44-A: 1588–1604

    Google Scholar 

  15. Gilsbach J, Eggert HR (1983) Transoral operations for craniospinal malformations. Neurosurgery Rev 6: 199–209

    Google Scholar 

  16. Greenberg AD, Scoville WB, Davey LM (1968) Transoral decompression of atlanto-axial dislocation due to odontoid hypoplasia. J Neurosurg 28: 266–269

    PubMed  Google Scholar 

  17. Hadley MN, Spetzler RF, Sonntag VK (1989) The transoral approach to the superior cervical spine. A review of 53 cases of extradural cervicomedullary compression. J Neurosurg 71: 16–23

    PubMed  Google Scholar 

  18. Han JS, Benson JE, Yoon YS (1984) Magnetic Resonance imaging in the spinal column and craniovertebral junction. Radiol Clin North Am 22: 805–827

    PubMed  Google Scholar 

  19. Hawkes RC, Holland GN, Moore WS,et al (1983) Craniovertebral junction pathology: assessment by NMR. AJNR 4: 232–233

    PubMed  Google Scholar 

  20. La Masters DL, Watanabe TI, Chambers EF,et al (1982) Multiplanar metrizamide enhanced CT imaging of the foramen magnum. AJNR 3: 485–494

    PubMed  Google Scholar 

  21. Louis R (1982) Chirurgie du Rachis. Anatomie Chirurgicale et Voies d'Abord. Springer, Berlin Heidelberg New York

    Google Scholar 

  22. MacAfee PC, Bohlman HH, Ducker T,et al (1986) Failure of stabilization of the spine with methylmethacrylate. A retrospective analysis of 24 cases. J Bone Joint Surg [Am] 68 A: 1145–1157

    Google Scholar 

  23. Menezes AH, VanGilder JC, Graf CJ,et al (1980) Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 53: 444–455

    PubMed  Google Scholar 

  24. Menezes AH, Vangilder JC (1988) Transoral-transpharyngeal approach to the anterior craniocervical junction. Ten-year experience with 72 patients. J Neurosurg 69: 895–903

    PubMed  Google Scholar 

  25. Mullan S, Nauton R, Hekmat-Panah J,et al (1968) The use of an anterior approach to ventrally palced tumours in the foramen magnum and vertebral column. J Neurosurg 24: 536–543

    Google Scholar 

  26. O'Laoire SA, Thomas DGT (1982) Transoral approach to the cervical spine: report of four cases. J Neurol Neurosurg Psychiatry 45: 60–63

    PubMed  Google Scholar 

  27. Pang D, Wilberger JE (1980) Traumatic atlanto-occipital dislocation with survival: case report and review. Neurosurgery 7: 503–508

    PubMed  Google Scholar 

  28. Pasztor E, Vajda J, Piffko P,et al (1984) Transoral surgery of craniocervical space-occupying processes. J Neurosurg 60: 276–281

    PubMed  Google Scholar 

  29. Smoker WRK, Keyes WD, Dun VD,et al (1986) MRI versus conventional radiology examinations in the evaluation of the craniovertebral and cervicomedullary junction. Radiographics 6: 953–994

    PubMed  Google Scholar 

  30. Spetzeler RF, Selman WR, Nash CL Jr,et al (1979) Transoral microsurgical odontoid resection and spinal cord monitoring. Spine 4: 506–510

    PubMed  Google Scholar 

  31. Thompson H (1970) Transpharyngeal fusion of the upper cervical spine. Proc R Soc Med 63: 893–896

    PubMed  Google Scholar 

  32. Van Gilder JC (1989) Comment to the papter quoted in ref. 13. Neurosurgery 24: 37–42

    PubMed  Google Scholar 

  33. Verbiest H (1977) Indications et possibilites de la voie transbucco-pharyngee. Neurochirurgie 23: 513–516

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Sciences, Neurosurgery, University of Rome “La Sapienza”, Rome, Italy

    N. Di Lorenzo M.D.

Authors
  1. N. Di Lorenzo M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Di Lorenzo, N. Craniocervical junction malformation treated by transoral approach. A survey of 25 cases with emphasis on postoperative instability and outcome. Acta neurochir 118, 112–116 (1992). https://doi.org/10.1007/BF01401296

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01401296

Keywords

Search

Navigation