Sadeh Morteza, Mansour Hadeel, Iqbal Javed, Gonzales-Portillo Gabriel, Souter John, Neckrysh Sergey, Callahan Nicholas, Atwal Gursant
Neurosurgery, University of Illinois at Chicago, Chicago, USA.
Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, USA.
Cureus. 2025 Oct 7;17(10):e94046. doi: 10.7759/cureus.94046. eCollection 2025 Oct.
The transoral approach (TOA) to the craniovertebral junction (CVJ) provides direct midline access to ventral compressive pathologies but remains associated with notable technical challenges and complications. We present our institution's case series of rare CVJ pathologies, highlighting operative nuances and patient outcomes. Three extremely rare and complex CVJ cases, including Klippel-Feil syndrome with severe stenosis, anterior spinal artery aneurysm, and ventral cervicomedullary pial arteriovenous malformation, undergoing tailored transoral interventions were retrospectively analyzed for technical details, outcomes, and complications. Successful ventral decompression was achieved in all cases. Unique operative techniques, including transmandibular and transpalatal osteotomies, were critical for accessing these rare lesions. Complications, including cerebrospinal fluid leakage, prolonged dysphagia, and staged posterior fusion, underscored the surgical complexity. At the six-month follow-up, all patients showed neurological stability or improvement. The TOA remains an essential technique for the management of ventral CVJ pathology, particularly in cases where posterior or endonasal approaches are insufficient. Optimal outcomes are achieved through detailed preoperative planning, multidisciplinary collaboration, and vigilant management of approach-related complications. This series illustrates the ongoing role of TOA in the management of rare and technically demanding CVJ pathologies where alternative methods may prove inadequate
经口入路（TOA）治疗颅颈交界区（CVJ）疾病可直接经中线入路处理腹侧压迫性病变，但仍存在显著的技术挑战和并发症。我们展示了本机构关于罕见CVJ疾病的病例系列，重点介绍手术细节和患者预后。回顾性分析了3例极其罕见且复杂的CVJ病例，包括伴有严重狭窄的Klippel-Feil综合征、脊髓前动脉动脉瘤以及腹侧颈髓软膜动静脉畸形，这些病例均接受了量身定制的经口干预，并对其技术细节、预后和并发症进行了分析。所有病例均成功实现了腹侧减压。独特的手术技术，包括经下颌骨和经腭骨截骨术，对于处理这些罕见病变至关重要。并发症包括脑脊液漏、吞咽困难延长和分期后路融合，凸显了手术的复杂性。在六个月的随访中，所有患者的神经功能均保持稳定或有所改善。经口入路仍然是处理CVJ腹侧病变的重要技术，特别是在后路或鼻内镜入路不足的情况下。通过详细的术前规划、多学科协作以及对入路相关并发症的密切管理可实现最佳预后。本病例系列说明了经口入路在处理罕见且技术要求高的CVJ病变中的持续作用，而其他方法可能被证明是不足的
