Abstract
Background
Fully endoscopic transoral approaches (FETOA) constitute a reasonable option for the treatment of middling compressive pathology that involve the craniocervical junction and higher cervical levels.
Methods
We describe, step by step, the FETOA for the treatment of upper cervical lesions. More specifically, the ones that are located between C1 and C3. A giant anterior C1–C2 osteophyte resection will be used as an illustration of these approaches.
Conclusions
This technique represents a minimally invasive treatment option for these kinds of high cervical lesions. It offers optimal visualization, maximizing the resection of these lesions and decreasing the morbidity and mortality.
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References
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Keypoints
• Delimiting surgical level around the skull base and cervical spine is useful for establishing the best approach for each pathology.
• FETOA is treatment option for upper cervical lesions and craniocervical junction pathology, providing a panoramic visualization of the surgical field and optimal range of maneuver.
• Pathology expansion superior to low clivus or inferior to C3 makes it difficult to perform a complete resection by a FETOA.
• Anatomical knowledge is determinant in order to achieve a complete resection without deficits or complications.
• If working close to the VA is required, we would strongly recommend an alternative laterocervical approach.
• FETOA avoids aggressive manipulation of uvula and soft palate and its possible complications.
• Careful hemostasis and closure of oropharyngeal mucosa is required to avoid postoperative complications.
• NGT feeding must be used to prevent healing problems during the first three postoperative days.
• Even with complete surgical resection, long-term follow-up is recommended because ACOs recurrence can be seen in a considerable number of cases.
• FETOA should be performed by a multidisciplinary team.
We declare that this work is unpublished and not presented at a conference. It strictly followed all ethical procedures and it has not been submitted to any other journal for publication.
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Electronic supplementary material
This video describes step by step the fully endocopic transoral approach (FETOA) for the treatment of upper cervical lesions. We use the case of a giant C1-C2 osteophyte resection as an illustration of this approach.
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Sanromán-Álvarez, P., González-Vargas, P., Rodríguez-Fernández, J.L. et al. Fully endoscopic transoral resection of high cervical osteophyte. How I do it?. Acta Neurochir 162, 131–134 (2020). https://doi.org/10.1007/s00701-019-04147-1
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DOI: https://doi.org/10.1007/s00701-019-04147-1