Pacca Paolo, Tardivo Valentina, Pecorari Giancarlo, Garbossa Diego, Ducati Alessandro, Zenga Francesco
Division of Neurosurgery, Department of Neurosciences, University of Turin, Turin, Italy.
SC Neurochirurgia U, Presidio Molinette Dipartimento di Neuroscienze e Salute Mentale, Città della Salute e della Scienza, Turin, Italy.
Acta Neurochir Suppl. 2019;125:25-36. doi: 10.1007/978-3-319-62515-7_5.
Surgical anterior decompression is the treatment of choice for symptomatic irreducible ventral craniovertebral junction (CVJ) compression. Along with the classic transoral approach, the endoscopic endonasal approach has evolved and is gaining growing success.
In this work we discuss the surgical technique, give a complete step-by-step description of dissection of the craniovertebral junction and report a specific case of endoscopic endonasal odontoidectomy with use of a high-definition (HD) three-dimensional (3D) endoscope.
The extended endonasal approach exploits an anatomical corridor to the odontoid process, involving only a small incision in the nasopharynx and sparing palate integrity. The most important limitation of the technique is 2D visualization, which hinders correct recognition of anatomical structures.
The endoscopic endonasal route to the odontoid process has proven to be a feasible, safe and well-tolerated procedure. Anatomical study is very important for better understanding of the 3D anatomy of the CVJ and relation of critical neurovascular structures to specific bony and muscular landmarks.
手术前路减压是有症状的不可复位性腹侧颅颈交界区（CVJ）压迫的首选治疗方法。除了经典的经口入路，内镜鼻内入路也在不断发展并取得了越来越多的成功。
在这项工作中，我们讨论了手术技术，对颅颈交界区的解剖进行了完整的逐步描述，并报告了一例使用高清（HD）三维（3D）内镜进行内镜鼻内齿状突切除术的具体病例。
扩大鼻内入路利用了一条通向齿状突的解剖通道，仅在鼻咽部做一个小切口，保留了腭的完整性。该技术最重要的局限性是二维可视化，这妨碍了对解剖结构的正确识别。
内镜鼻内到达齿状突的途径已被证明是一种可行、安全且耐受性良好的手术。解剖学研究对于更好地理解CVJ的三维解剖结构以及关键神经血管结构与特定骨骼和肌肉标志的关系非常重要。
