Congenital lesions of the craniovertebral junction (CVJ) had long gone unrecognized. It was only after Chamberlain’s seminal radiographic investigations in 1939 that basilar invagination and the other bony abnormalities of the CVJ were considered for antemortem diagnosis and treatment.1 These lesions were initially managed by a posterior osteodural craniocervical decompression with dismal overall clinical results.2-4 In fact, when a irreducible, cranially translated, or posteriorly dislocated odontoid peg compresses the cervicomedullary junction ventrally, posterior decompression alone cannot be relied on to improve the prognosis of patients. In such a particular anatomical scenario, the posterior approach can provide only partial decompression, usually leading to an increase in ventral cervicomedullary junction compression.5 The transoral approach (TOA) originally described by Kanavel in 19176 and subsequently refined through the contributions of many different pioneers4,7-11 can be regarded today as the standard approach for the treatment of irreducible anterior abnormalities that compress the cervicomedullary junction. Over time, the value of a straight anterior approach to extradural lesions of CVJ has been widely accepted, and variations of the TOA including the maxillary dropdown procedures have been described in patients with severe basilar invaginations or in cases of limited jaw mobility. 5,8,12 In this chapter, we describe the pearl and pitfalls of a standard TOA for CVJ malformations and the circumstances in which the TOA requires additional posterior craniocervical decompression.
Lesions of the Foramen Magnum (Transoral and Foramen Magnum Decompression)
PERRINI, PAOLO;
2017-01-01
Abstract
Congenital lesions of the craniovertebral junction (CVJ) had long gone unrecognized. It was only after Chamberlain’s seminal radiographic investigations in 1939 that basilar invagination and the other bony abnormalities of the CVJ were considered for antemortem diagnosis and treatment.1 These lesions were initially managed by a posterior osteodural craniocervical decompression with dismal overall clinical results.2-4 In fact, when a irreducible, cranially translated, or posteriorly dislocated odontoid peg compresses the cervicomedullary junction ventrally, posterior decompression alone cannot be relied on to improve the prognosis of patients. In such a particular anatomical scenario, the posterior approach can provide only partial decompression, usually leading to an increase in ventral cervicomedullary junction compression.5 The transoral approach (TOA) originally described by Kanavel in 19176 and subsequently refined through the contributions of many different pioneers4,7-11 can be regarded today as the standard approach for the treatment of irreducible anterior abnormalities that compress the cervicomedullary junction. Over time, the value of a straight anterior approach to extradural lesions of CVJ has been widely accepted, and variations of the TOA including the maxillary dropdown procedures have been described in patients with severe basilar invaginations or in cases of limited jaw mobility. 5,8,12 In this chapter, we describe the pearl and pitfalls of a standard TOA for CVJ malformations and the circumstances in which the TOA requires additional posterior craniocervical decompression.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
