Visocchi M
Institute of Neurosurgery, Catholic University, Largo Gemelli, Rome, Italy.
Adv Tech Stand Neurosurg. 2011(37):97-110. doi: 10.1007/978-3-7091-0673-0_4.
At the present time, an update to the classical microsurgical transoral decompression is supported by the most recent literature dealing with the introduction of the endoscopy in spine surgery. In this paper, we present all the reported experience on the surgical approaches to anterior cranioveretebral junction (CVJ) compressive pathology managed by endoscopy. Surgical strategies dealing with decompressive procedures by using an open access, microsurgical technique, neuronavigation and endoscopy are summarized.Endoscopy represents a useful complement to the standard microsurgical approach to the anterior CVJ. Endoscopy can be used via transnasal, transoral and transcervical routes; it facilitates visualisation and better decompression without the need for soft palate splitting, hard palate resection, or extended maxillotomy. Although neuronavigation enhances orientation within the surgical field, intraoperative fluoroscopy helps to recognize residual compression.Under normal anatomical conditions, there appear to be no surgical limitations for the endoscopically assisted transoral approach compared with the pure endonasal and transcervical endoscopic approaches.The endoscope has a clear role as "support" to the standard transoral microsurgical approach since 30° angulated endoscopy increases the surgical area exposed over the posterior pharyngeal wall and the extent of the clivus.
目前，脊柱外科领域关于内镜应用的最新文献支持对经典显微外科经口减压术进行更新。在本文中，我们展示了所有已报道的关于采用内镜治疗颅颈交界区（CVJ）前方压迫性病变的手术方法的经验。总结了采用开放入路、显微外科技术、神经导航和内镜进行减压手术的策略。内镜是标准显微外科治疗CVJ前方病变方法的有益补充。内镜可通过经鼻、经口和经颈途径使用；它有助于可视化并实现更好的减压，而无需劈开软腭、切除硬腭或进行扩大上颌骨切开术。尽管神经导航可增强手术视野内的定位，但术中透视有助于识别残余压迫。在正常解剖条件下，与单纯经鼻和经颈内镜手术相比，内镜辅助经口手术似乎没有手术限制。自30°角内镜增加了咽后壁暴露的手术区域和斜坡范围以来，内镜作为标准经口显微手术方法的“辅助”作用明确。
