The aim of this study is to review our experience with the transoral surgical management of anterior craniovertebral junction (CVJ) lesions with particular attention to the decision making and to the indication for a consecutive stabilization. During 10 years (1998-2007), 52 consecutive patients presenting exclusively fixed anterior compression at the cervicomedullary junction underwent transoral surgery. Mean age was 55.85 years (range 17-75 years). Encountered lesions were: malformation (32 cases), rheumatoid arthritis (11 cases), tumor (5 cases) or trauma (4 cases). A total of 79% of patients presented with chronic/recurrent headache (cranial and/or high-cervical pain), 73% with varying degrees of quadrip aresis, and 29% with lower cranial nerve deficits. All of the patients but two, with posterior stabilization performed elsewhere, underwent synchronous anterior decompression and posterior occipitocervical fixation. Adjuncts to the transoral approach (Le Fort I with or without splitting of the palate), tailored to the local anatomy and to the extension of the lesions, were performed in seven cases. Follow-up ranged between 4 and 96 months. Of 35 patients with severe preoperative neurological deficits, 33 improved. The remaining 15 patients who presented with mild symptoms, healed throughout the follow-up. Perioperative mortality occurred in two cases and surgical morbidity in eight cases (dural laceration, cerebrospinal fluid leak with meningitis, malocclusion, oral wound dehiscence and occipital wound infection). Delayed instability occurred in one patient because of cranial settling of C2 vertebral body. A successful surgery achieving a stable decompression at the CVJ is an expertise demanding procedure. It requires accurate preoperative evaluation and, appropriate choice of decompression technique and stabilization instruments. Enlarged transoral approaches (despite higher morbidity) are a supportive means in cases of severe basilar invagination, cranial extension of the lesion or limited jaw mobility. © 2009 Springer-Verlag.

Craniovertebral junction lesions: Our experience with the transoral surgical approach

Perrini P.;
2009-01-01

Abstract

The aim of this study is to review our experience with the transoral surgical management of anterior craniovertebral junction (CVJ) lesions with particular attention to the decision making and to the indication for a consecutive stabilization. During 10 years (1998-2007), 52 consecutive patients presenting exclusively fixed anterior compression at the cervicomedullary junction underwent transoral surgery. Mean age was 55.85 years (range 17-75 years). Encountered lesions were: malformation (32 cases), rheumatoid arthritis (11 cases), tumor (5 cases) or trauma (4 cases). A total of 79% of patients presented with chronic/recurrent headache (cranial and/or high-cervical pain), 73% with varying degrees of quadrip aresis, and 29% with lower cranial nerve deficits. All of the patients but two, with posterior stabilization performed elsewhere, underwent synchronous anterior decompression and posterior occipitocervical fixation. Adjuncts to the transoral approach (Le Fort I with or without splitting of the palate), tailored to the local anatomy and to the extension of the lesions, were performed in seven cases. Follow-up ranged between 4 and 96 months. Of 35 patients with severe preoperative neurological deficits, 33 improved. The remaining 15 patients who presented with mild symptoms, healed throughout the follow-up. Perioperative mortality occurred in two cases and surgical morbidity in eight cases (dural laceration, cerebrospinal fluid leak with meningitis, malocclusion, oral wound dehiscence and occipital wound infection). Delayed instability occurred in one patient because of cranial settling of C2 vertebral body. A successful surgery achieving a stable decompression at the CVJ is an expertise demanding procedure. It requires accurate preoperative evaluation and, appropriate choice of decompression technique and stabilization instruments. Enlarged transoral approaches (despite higher morbidity) are a supportive means in cases of severe basilar invagination, cranial extension of the lesion or limited jaw mobility. © 2009 Springer-Verlag.
Mouchaty, H.; Perrini, P.; Conti, R.; Di Lorenzo, N.
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1044552
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? 8
  • Scopus 47
  • ???jsp.display-item.citation.isi??? 46
social impact