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Transoral Approach
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    TERMINOLOGY

    • Abbreviations

      • Craniovertebral junction (CVJ)
      • Basilar invagination (BI)
    • Definitions

      • Transoral approach: Decompression of CVJ from anterior aspect of the spine for irreducible anterior compression
        • Many different pathologies
          • Basilar invagination
          • Atlas assimilation
          • Os odontoideum
          • Tumor
          • Trauma
          • Rheumatoid arthritis
          • Osteomyelitis
      • Basilar invagination: Odontoid abnormally prolapses into foramen magnum (normal quality bone)
        • Several etiologies: Basiocciput hypoplasia, occipital condyle hypoplasia, achondroplasia, C0-C1 assimilation
          • 25-35% have neural axis abnormalities such as Chiari malformation or syrinx
      • Basilar impression: Acquired form of basilar invagination with softened bone quality
        • Paget disease, osteomalacia, hyperparathyroidism, osteogenesis imperfecta
      • Cranial settling: CVJ abnormality associated with rheumatoid arthritis

    PRE-PROCEDURE

    • Indications

      • Pre-Procedure Imaging

        • Getting Started

          PROCEDURE

          • Procedure Steps

            • Alternative Procedures/Therapies

              OUTCOMES

              • Complications

                Selected References

                1. El-Sayed IH et al: Combined transnasal and transoral endoscopic approaches to the craniovertebral junction. J Craniovertebr Junction Spine. 1(1):44-8, 2010
                2. Hsu W et al: Transoral approaches to the cervical spine. Neurosurgery. 66(3 Suppl):119-25, 2010
                3. Lee A et al: Endoscopic transnasal approach to the craniocervical junction. Skull Base. 20(3):199-205, 2010
                4. Lee JY et al: Da Vinci Robot-assisted transoral odontoidectomy for basilar invagination. ORL J Otorhinolaryngol Relat Spec. 72(2):91-5, 2010
                5. Wang X et al: The single transoral approach for Os odontoideum with irreducible atlantoaxial dislocation. Eur Spine J. 19 Suppl 2:S91-5, 2010
                6. Youssef AS et al: Extended transoral approaches: surgical technique and analysis. Neurosurgery. 66(3 Suppl):126-34, 2010
                7. Mouchaty H et al: Craniovertebral junction lesions: our experience with the transoral surgical approach. Eur Spine J. 18 Suppl 1:13-9, 2009
                8. Liu JK et al: Transoral approach and extended modifications for lesions of the ventral foramen magnum and craniovertebral junction. Skull Base. 18(3):151-66, 2008
                9. Menezes AH: Surgical approaches: postoperative care and complications "transoral-transpalatopharyngeal approach to the craniocervical junction". Childs Nerv Syst. 24(10):1187-93, 2008
                10. Tun K et al: A neurosurgical view of anatomical evaluation of anterior C1-C2 for safer transoral odontoidectomy. Eur Spine J. 17(6):853-6, 2008
                11. Menezes AH et al: Surgical approaches to the craniovertebral junction. Clin Neurosurg. 41:187-203, 1994
                Related Anatomy
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                Related Differential Diagnoses
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                References
                Tables

                Tables

                KEY FACTS

                • Terminology

                  TERMINOLOGY

                  • Abbreviations

                    • Craniovertebral junction (CVJ)
                    • Basilar invagination (BI)
                  • Definitions

                    • Transoral approach: Decompression of CVJ from anterior aspect of the spine for irreducible anterior compression
                      • Many different pathologies
                        • Basilar invagination
                        • Atlas assimilation
                        • Os odontoideum
                        • Tumor
                        • Trauma
                        • Rheumatoid arthritis
                        • Osteomyelitis
                    • Basilar invagination: Odontoid abnormally prolapses into foramen magnum (normal quality bone)
                      • Several etiologies: Basiocciput hypoplasia, occipital condyle hypoplasia, achondroplasia, C0-C1 assimilation
                        • 25-35% have neural axis abnormalities such as Chiari malformation or syrinx
                    • Basilar impression: Acquired form of basilar invagination with softened bone quality
                      • Paget disease, osteomalacia, hyperparathyroidism, osteogenesis imperfecta
                    • Cranial settling: CVJ abnormality associated with rheumatoid arthritis

                  PRE-PROCEDURE

                  • Indications

                    • Pre-Procedure Imaging

                      • Getting Started

                        PROCEDURE

                        • Procedure Steps

                          • Alternative Procedures/Therapies

                            OUTCOMES

                            • Complications

                              Selected References

                              1. El-Sayed IH et al: Combined transnasal and transoral endoscopic approaches to the craniovertebral junction. J Craniovertebr Junction Spine. 1(1):44-8, 2010
                              2. Hsu W et al: Transoral approaches to the cervical spine. Neurosurgery. 66(3 Suppl):119-25, 2010
                              3. Lee A et al: Endoscopic transnasal approach to the craniocervical junction. Skull Base. 20(3):199-205, 2010
                              4. Lee JY et al: Da Vinci Robot-assisted transoral odontoidectomy for basilar invagination. ORL J Otorhinolaryngol Relat Spec. 72(2):91-5, 2010
                              5. Wang X et al: The single transoral approach for Os odontoideum with irreducible atlantoaxial dislocation. Eur Spine J. 19 Suppl 2:S91-5, 2010
                              6. Youssef AS et al: Extended transoral approaches: surgical technique and analysis. Neurosurgery. 66(3 Suppl):126-34, 2010
                              7. Mouchaty H et al: Craniovertebral junction lesions: our experience with the transoral surgical approach. Eur Spine J. 18 Suppl 1:13-9, 2009
                              8. Liu JK et al: Transoral approach and extended modifications for lesions of the ventral foramen magnum and craniovertebral junction. Skull Base. 18(3):151-66, 2008
                              9. Menezes AH: Surgical approaches: postoperative care and complications "transoral-transpalatopharyngeal approach to the craniocervical junction". Childs Nerv Syst. 24(10):1187-93, 2008
                              10. Tun K et al: A neurosurgical view of anatomical evaluation of anterior C1-C2 for safer transoral odontoidectomy. Eur Spine J. 17(6):853-6, 2008
                              11. Menezes AH et al: Surgical approaches to the craniovertebral junction. Clin Neurosurg. 41:187-203, 1994