Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA.
World Neurosurg. 2010 Dec;74(6):583-602. doi: 10.1016/j.wneu.2010.06.033.
The study compared the endoscopic anatomy of the transnasal and transoral approaches to the craniovertebral junction (CVJ).
Structures examined and compared with both the straight and angled telescopes in 10 cadaveric specimens included the pharyngeal walls and adjacent musculature, resected anterior arch of the axis and odontoid, cruciform, axial, and apical ligaments, clival and dural openings, and the intradural exposure.
There is considerable overlap at the pharyngeal level in the structures that can be viewed by the transoral and transnasal routes. The transoral approach provides a wider corridor with less restricted manipulation of instruments than the transnasal approach, but the transnasal approach provides a better view of the clivus, upper part of the CVJ, and the structures posterior to the removed odontoid and anterior arch of C1. Combining the two approaches provides significantly better access to the midline anterior CVJ than either approach alone, allows the scopes to be advanced in one cavity and the surgical instruments in the other cavity, and reduces the need to split the palate, tongue, or mandible in order to reach the target area. The transnasal approach also allows access to the superior part of the occipital condyles, paraclival areas, and hypoglossal canals without removal of the condyles, but these structures can be exposed by the transoral route only after at least partial removal of the condyles.
The endoscopic transoral and transnasal approaches to the CVJ should be viewed as complementary routes as opposed to strict alternatives.
本研究比较了经鼻和经口入路到达颅颈交界区（CVJ）的内镜解剖结构。
在 10 具尸体标本中，使用直型和角度型内镜检查和比较了咽壁和相邻肌肉、切除的枢椎前弓和齿状突、十字形、枢轴和尖韧带、斜坡和硬脑膜开口以及硬脑膜内暴露情况。
在经口和经鼻入路都能观察到的咽腔水平，结构之间有相当大的重叠。经口入路提供了更宽的通道，与经鼻入路相比，器械的操作限制较少，但经鼻入路提供了更好的斜坡、CVJ 上部以及切除的齿状突和 C1 前弓后方结构的视野。两种方法的结合比单独使用任何一种方法都能更好地到达中线前 CVJ，允许内镜在一个腔室内推进，手术器械在另一个腔室内推进，并减少为到达目标区域而分裂腭、舌或下颌的需要。经鼻入路还允许进入枕骨髁的上部、颅旁区和舌下神经管，而无需切除髁，但这些结构只能在至少部分切除髁后才能通过经口入路暴露。
内镜经鼻和经口入路到达 CVJ 应被视为互补的途径，而不是严格的替代途径。
