Transoral - transpharyngeal approach to extradural lesions of the craniovertebral junction: An experience of 22 cases

Abstract

Objective: The transoral-transpharyngeal approach to ventrally placed lesions of the craniovertebral junction has become a well accepted technique for relieving ventral cervicomedullary compression. The purpose of this study is to review the clinical aspects and results obtained with the surgical treatment of patients with craniovertebral junction lesions who have been treated over the past five years in our department and specific features of the transoral - transpharyngeal procedure have been emphasized.

Material and Methods: We report 22 patients undergoing transoral-transpharyngeal approach for pathology of the craniovertebral junction. Of these 22 patients, 9 had congenital malformations of the craniovertebral junction and 13 had acquired lesions; 5 had trauma, 4 had tumors and 4 had infections.

Results: Sixteen of 22 patients in this series were male, 6 were female. The median age of the group was 38 years. For the first 6 patients we used tracheotomy as a routine procedure. The rest of the patients were operated without tracheotomy. Except for a single case of supurative infection in the posterior pharyngeal wall leading to sepsis and death, no patients had postoperative complications. Eighteen of the patients required surgical stabilization in addition to anterior decompressive surgery; 8 had posterior wire fusion and bone graft, 10 had posterior fusion using plate-screw or plate-wire and in four cases there was need for an additional posterior decompressive surgery. At the end of these surgical procedures 18 patients had improvements in their preoperative symptoms and neurological findings, 3 patients’ postoperative neurological outcomes did not change and 1 patient died because of a supurative infection leading to sepsis.

Conclusion: Transoral-transpharyngeal approach is the suitable way for craniovertebral junction ventral

pathologies’ operations because it is simple, effective and safe, it provides ventral decompression and direct intervention to the lesion.

Keywords

• Craniovertebral junction,Operative technique,Transoral approach

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