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THE SURGICAL ANATOMY OF TRANSORAL APPROACH

Year 1999, Volume: 12 Issue: 4, 175 - 179, 03.12.2016

Abstract

Objective: The aim of this study is to obtain summarized description of the surgical anatomy of Transoral Approach (TOA) and to show the relationship between the important bony and ligamentous anatomical structures.
Material and Methods: To demonstrate the TOA, ten cadaveric head specimens filled with microfil were dissected. Metric measurements between the important anatomical structures were performed in twenty head specimens. Extended indications of the approach were discussed.
Results: In all specimens the TOA was successfully demonstrated. The Transoral Transpalatal Approach (TOTPA) is performed as a modification of TOA with the resection of the hard palate to reach the skull base. Some of the important metric measurements were as follows: 8.2 ± 0.2 cm between teeth and odontoid process; height of odontoid process: 2.4 ± 0.1 cm; height of arcus of C1 : 1.1 ± 0.1 cm; intercondylar distance: 2.2 ± 0.1 cm. The longest distance of the approach was with 11.2 ± 0.2 cm between the teeth and the vertebral arteries.
Conclusion: The TOA is a useful procedure for ventral and ventrolateral extradural and intradural lesions of craniovertebral junction. For a proper exposure the surgical anatomy of the region should be well known. For intradural approaches, specially designed instruments should be used.
Key Words: Craniovertebral junction, Surgical anatomy, Transoral approach

References

  • Miller E, Crockard HA. Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum, neurosurgery 1987;20:966-968.
  • Crockard HA, Sen Cn. The transoral approach for the management of intradural lesions of the craniovertebral junction: a review of 7 cases, neurosurgery 1991 ;28:88-98.
  • Crockard flA. Transoral approach to intradural/extradural tumors. In: Sekhar Ln, Janecka IP, eds. Surgery of cranial base tumors, new York: Raven Press, Ltd., 1993:225-234.
  • flayakawa T, Kamikawa K, Ohnishi T, Yoshimine T. Prevention of postoperative complications after a transoral transclival approach to basilar aneurysms. J neurosurg 1981;54:699-703.
  • Yamaura A, Makino ft, Isobe R, Takashima, T, nakamura T, Takemiya S. Repair of cerebrospinal fluid fistula following transoral transclival approach to a basilar aneurysm. J neurosurg 1979:50:834- 836.
  • Crockard t1A, Calder I, Ransford AO. One stage transoral decompression and posterior fixation in rheumatoid atlanto-axial subluxation: a technical note. J Bone Joint Surg (Br) 1990;72B:682-685.
  • Subin B, Liu JF, Marshall CiJ, fluang tlY, Ou Jtl, Xu QZ. Transoral anterior decompression and fusion of chronic irreducible atlantoaxial dislocation with spinal cord compression. Spine 1995:20:1233- 1240.
  • Scoville WB, Sherman 1J. Platybasia. Report of ten cases with comments on familial tendency, a special diagnostic sign, and the end results of operation. Ann Surg 1951,133:496,502.
  • Kanaval AB. Bullet located between the atlas and the base of the skull: Technique of removal through the mouth. Surg Clin Chicago 1919;1:361-366.
  • Apuzzo MLJ, Weiss Mfl, Lleiden JS. Transoral exposure of the atlantoaxial region, neurosurgery 1978;3:201-207.
  • Crockard 11A. The transoral approach to the base of the brain and upper cervical cord. Ann R Coll Surg Eng 1985:67:321-325.
  • Crockard HA, Bradford R. Transoral, transclival removal of a schwannoma anterior to the craniocervical
  • junction. J neurosurg 1985;62:293-295.
  • Crockard HA, Essigman WK, Stevens JM. Surgical treatment of cervical cord compression in rheumatoid arthritis. Ann Rheum Dis 1985:44:809- 816.
  • Oreenberg AD, Scoville WB, Davey LM. Transoral decompression of the atlanto-axial dislocation due to odontoid hypoplasia. Report of two cases. J neurosurg 1968;28:266-269.
  • Menezes AH, Qraf CJ, Hibri n. Abnormalities of the cranio-vertebral junction with cervico-medullary compression. Childs Brain 1980;7:15-30.
  • Mullan S, Haunton R, Hekmatpanah J, Vailati O. The use of an anterior approach to ventral placed tumors in the foramen magnum. J neurosurg 1966;24:536-543.
  • I 7. Pasztor E, Vajda J, Piffko P, Horvath M, Oador I. Transoral surgery for craniocervical space- occupying processes. J neurosurg 1984;60:276- 281.
  • Lorenzo nD. Transoral approach to extradural lesions of the lower clivus and upper cervical spine: An experience of 19 cases. neurosurgery 1989;24:37-42.
  • Pasztor E. Transoral approach to anterior brain stem compression. Acta neurochir (Wien) 1992; 118:7- 19.
  • Crockard HA, Koksel T, Watkin n. Transoral transclival clipping of anterior inferior cerebellar artery aneurysm using new rotating applier. Technical note. J neurosurg 1991;75:483-485.
  • Crumley RL, Qutin PH. Surgical access for clivus chordoma. Arch Otolaryngol Head neck Surg 1989,115:295-300.
  • Rikuchi H, Hakuba A, Baba M. Transoral approach for atlanto-axial dislocation. In illustrated techniques in microneuro surgery. Tokyo: lgaku- Shoin Medical Publishers. Inc. 1990:227-236.
  • Ringdom TT, nockels RP, Raplan MJ. Transoral- transpharyngeal approach to the craniocervical junction. Otolaryngol Head neck Surg
  • ,113:393-400.
  • Rlockner C, Rern O, Zierski J, Weber U. Microsurgical transoral decompression in disease of and injuries to the cranio-cervical junction. Orthopedics 1998;27:477-481.
  • Menezes A, VanOilder JC. Transoral- transpharyngeal approach to the anterior craniocervical junction. Ten-year experience with 72 patients. J neurosurg 1988:69:895-903.
  • Miller E, Crockard A. Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum, neurosurgery 1987:20:966-968.
  • Seifert V, Laszig R. Transoral transpalatal removal of a giant premesencephalic clivus chordoma. Acta neurochir (Wien) 1991;1 12:141-146.
  • Berkman MZ, iplik^ioglu AC. Transoral- transpharyngeal approach to extradural lesions of the craniovertebral junction. An experience of 22 cases. Marmara Med J 1998;11:137-142.
Year 1999, Volume: 12 Issue: 4, 175 - 179, 03.12.2016

Abstract

References

  • Miller E, Crockard HA. Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum, neurosurgery 1987;20:966-968.
  • Crockard HA, Sen Cn. The transoral approach for the management of intradural lesions of the craniovertebral junction: a review of 7 cases, neurosurgery 1991 ;28:88-98.
  • Crockard flA. Transoral approach to intradural/extradural tumors. In: Sekhar Ln, Janecka IP, eds. Surgery of cranial base tumors, new York: Raven Press, Ltd., 1993:225-234.
  • flayakawa T, Kamikawa K, Ohnishi T, Yoshimine T. Prevention of postoperative complications after a transoral transclival approach to basilar aneurysms. J neurosurg 1981;54:699-703.
  • Yamaura A, Makino ft, Isobe R, Takashima, T, nakamura T, Takemiya S. Repair of cerebrospinal fluid fistula following transoral transclival approach to a basilar aneurysm. J neurosurg 1979:50:834- 836.
  • Crockard t1A, Calder I, Ransford AO. One stage transoral decompression and posterior fixation in rheumatoid atlanto-axial subluxation: a technical note. J Bone Joint Surg (Br) 1990;72B:682-685.
  • Subin B, Liu JF, Marshall CiJ, fluang tlY, Ou Jtl, Xu QZ. Transoral anterior decompression and fusion of chronic irreducible atlantoaxial dislocation with spinal cord compression. Spine 1995:20:1233- 1240.
  • Scoville WB, Sherman 1J. Platybasia. Report of ten cases with comments on familial tendency, a special diagnostic sign, and the end results of operation. Ann Surg 1951,133:496,502.
  • Kanaval AB. Bullet located between the atlas and the base of the skull: Technique of removal through the mouth. Surg Clin Chicago 1919;1:361-366.
  • Apuzzo MLJ, Weiss Mfl, Lleiden JS. Transoral exposure of the atlantoaxial region, neurosurgery 1978;3:201-207.
  • Crockard 11A. The transoral approach to the base of the brain and upper cervical cord. Ann R Coll Surg Eng 1985:67:321-325.
  • Crockard HA, Bradford R. Transoral, transclival removal of a schwannoma anterior to the craniocervical
  • junction. J neurosurg 1985;62:293-295.
  • Crockard HA, Essigman WK, Stevens JM. Surgical treatment of cervical cord compression in rheumatoid arthritis. Ann Rheum Dis 1985:44:809- 816.
  • Oreenberg AD, Scoville WB, Davey LM. Transoral decompression of the atlanto-axial dislocation due to odontoid hypoplasia. Report of two cases. J neurosurg 1968;28:266-269.
  • Menezes AH, Qraf CJ, Hibri n. Abnormalities of the cranio-vertebral junction with cervico-medullary compression. Childs Brain 1980;7:15-30.
  • Mullan S, Haunton R, Hekmatpanah J, Vailati O. The use of an anterior approach to ventral placed tumors in the foramen magnum. J neurosurg 1966;24:536-543.
  • I 7. Pasztor E, Vajda J, Piffko P, Horvath M, Oador I. Transoral surgery for craniocervical space- occupying processes. J neurosurg 1984;60:276- 281.
  • Lorenzo nD. Transoral approach to extradural lesions of the lower clivus and upper cervical spine: An experience of 19 cases. neurosurgery 1989;24:37-42.
  • Pasztor E. Transoral approach to anterior brain stem compression. Acta neurochir (Wien) 1992; 118:7- 19.
  • Crockard HA, Koksel T, Watkin n. Transoral transclival clipping of anterior inferior cerebellar artery aneurysm using new rotating applier. Technical note. J neurosurg 1991;75:483-485.
  • Crumley RL, Qutin PH. Surgical access for clivus chordoma. Arch Otolaryngol Head neck Surg 1989,115:295-300.
  • Rikuchi H, Hakuba A, Baba M. Transoral approach for atlanto-axial dislocation. In illustrated techniques in microneuro surgery. Tokyo: lgaku- Shoin Medical Publishers. Inc. 1990:227-236.
  • Ringdom TT, nockels RP, Raplan MJ. Transoral- transpharyngeal approach to the craniocervical junction. Otolaryngol Head neck Surg
  • ,113:393-400.
  • Rlockner C, Rern O, Zierski J, Weber U. Microsurgical transoral decompression in disease of and injuries to the cranio-cervical junction. Orthopedics 1998;27:477-481.
  • Menezes A, VanOilder JC. Transoral- transpharyngeal approach to the anterior craniocervical junction. Ten-year experience with 72 patients. J neurosurg 1988:69:895-903.
  • Miller E, Crockard A. Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum, neurosurgery 1987:20:966-968.
  • Seifert V, Laszig R. Transoral transpalatal removal of a giant premesencephalic clivus chordoma. Acta neurochir (Wien) 1991;1 12:141-146.
  • Berkman MZ, iplik^ioglu AC. Transoral- transpharyngeal approach to extradural lesions of the craniovertebral junction. An experience of 22 cases. Marmara Med J 1998;11:137-142.
There are 30 citations in total.

Details

Journal Section Original Research
Authors

İbrahim Ziyal This is me

Ferruh Gezen This is me

Publication Date December 3, 2016
Published in Issue Year 1999 Volume: 12 Issue: 4

Cite

APA Ziyal, İ., & Gezen, F. (2016). THE SURGICAL ANATOMY OF TRANSORAL APPROACH. Marmara Medical Journal, 12(4), 175-179.
AMA Ziyal İ, Gezen F. THE SURGICAL ANATOMY OF TRANSORAL APPROACH. Marmara Med J. June 2016;12(4):175-179.
Chicago Ziyal, İbrahim, and Ferruh Gezen. “THE SURGICAL ANATOMY OF TRANSORAL APPROACH”. Marmara Medical Journal 12, no. 4 (June 2016): 175-79.
EndNote Ziyal İ, Gezen F (June 1, 2016) THE SURGICAL ANATOMY OF TRANSORAL APPROACH. Marmara Medical Journal 12 4 175–179.
IEEE İ. Ziyal and F. Gezen, “THE SURGICAL ANATOMY OF TRANSORAL APPROACH”, Marmara Med J, vol. 12, no. 4, pp. 175–179, 2016.
ISNAD Ziyal, İbrahim - Gezen, Ferruh. “THE SURGICAL ANATOMY OF TRANSORAL APPROACH”. Marmara Medical Journal 12/4 (June 2016), 175-179.
JAMA Ziyal İ, Gezen F. THE SURGICAL ANATOMY OF TRANSORAL APPROACH. Marmara Med J. 2016;12:175–179.
MLA Ziyal, İbrahim and Ferruh Gezen. “THE SURGICAL ANATOMY OF TRANSORAL APPROACH”. Marmara Medical Journal, vol. 12, no. 4, 2016, pp. 175-9.
Vancouver Ziyal İ, Gezen F. THE SURGICAL ANATOMY OF TRANSORAL APPROACH. Marmara Med J. 2016;12(4):175-9.