BackgroundSurgical procedures in the craniovertebral junction (CVJ) suffer from specific challenges due to the proximity between the cranium and spine containing the critical neurovascular structures and the brainstem, respectively. Owing to the complex transitional zone, it is highly challenging for classic surgical approaches to practically acquire the additional exposure to neurovascular structures of the CVJ. Inspired by these facts, we explore the feasibility of an endoscopy-assisted high anterior cervical approach in the CVJ.MethodsTo explore the feasibility of an endoscopy-assisted approach, we quantitatively assessed the surgical corridor and extent of exposure of the CVJ in 6 cadaveric specimens using 0° and 30° endoscopes.ResultsThe applied endoscopes provided adequate exposure to neurovascular structures and the brainstem in the CVJ. Notably, the resection of the anterior arch of C1 is avoided in minimal anterior clivectomy. Further, improved exposure of the CVJ is obtained after removing the odontoid.ConclusionAn endoscope-assisted high anterior cervical approach in the CVJ significantly preserved the cervical spine stability while minimalizing the risk of neurovascular injury within the surgical corridor.

中文翻译：

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颅椎交界处 (CVJ) 内窥镜辅助高位颈前入路

背景由于颅骨和脊柱之间分别包含关键的神经血管结构和脑干，因此颅椎交界处 (CVJ) 的外科手术面临着特殊的挑战。由于过渡区复杂，经典手术方法实际上获得对 CVJ 神经血管结构的额外暴露是极具挑战性的。受这些事实的启发，我们探讨了在 CVJ 中采用内窥镜辅助高位颈前入路的可行性。方法为了探索内窥镜辅助入路的可行性，我们定量评估了 6 具尸体标本中 CVJ 的手术通道和暴露程度使用 0° 和 30° 内窥镜。结果应用的内窥镜充分暴露了 CVJ 中的神经血管结构和脑干。值得注意的是，在最小的前斜坡切除术中避免了 C1 前弓的切除。此外，在去除齿状突后，CVJ 的暴露得到改善。结论 CVJ 中的内窥镜辅助高位颈前入路显着保持了颈椎稳定性，同时将手术通道内神经血管损伤的风险降至最低。