scholarly journals Image-injected frameless stereotactic approach to the anterior craniovertebral junction

1999 ◽  
Vol 6 (6) ◽  
pp. E11 ◽  
Author(s):  
Timothy Ryken ◽  
Terrence Julien ◽  
Bruce Frankel ◽  
Greg Canute ◽  
John Haller ◽  
...  
Keyword(s):  
Craniovertebral Junction ◽  
Sufficient Accuracy ◽  
Field Of View ◽  
Operating Microscope ◽  
Registration Process ◽  
Transoral Odontoidectomy ◽  
Cervicomedullary Junction ◽  
Stereotactic Technique ◽  
Complex Anatomy ◽  
Cadaveric Model

Transoral odontoidectomy is often performed in the treatment of cervicomedullary junction disease. The operating microscope is frequently used to improve visualization in this narrow field of view. In the setting of complex anatomy or surgical revision the authors hypothesized that combining frameless stereotactic technique with intraoperative microscopy would improve the ability to visualize and identify intraoperative anatomy. In addition they believed that the ability to visualize the targeted region directly in the operating microscope "image injection" would be of particular interest in this setting, provided that sufficient accuracy for use could be obtained in the registration process. The authors assessed the efficacy of this approach in a cadaveric model and obtained sufficient accuracy to warrant use in the operating room. This technique was applied in the surgical management of a 56-year-old woman with rheumatoid arthritis who had undergone a previous decompressive transoral procedure. Subsequently she suffered progressive deterioration and was found to have residual bony compression of the anterior cervicomedullary junction. The authors performed decompressive surgery and obtained satisfactory results by using the image-injected technique, and the patient experienced subsequent clinical improvement. The authors conclude that the image-injected frameless stereotactic technique is of potential benefit, particularly in the narrow window of approach of the transoral odontoidectomy.

scholarly journals Intraoperative Computed Tomography Scanner-Guided Craniovertebral Junction Surgery in a Patient with an Occipitalized C1

2021 ◽  
Author(s):  
Mohammad Ashraf ◽  
Usman Ahmad Kamboh ◽  
Naveed Ashraf
Keyword(s):  
Craniovertebral Junction ◽  
Facet Joints ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Transoral Odontoidectomy ◽  
Posterior Subluxation ◽  
Lateral Mass Screws ◽  
Complex Surgery ◽  
Computed Tomography Scanner

AbstractCraniovertebral junction surgery is associated with unique difficulties. Type 2 odontoid fractures (Anderson and D Alonzo) have a great potential for nonunion and malunion. These fracture patients may require a circumferential decompression and fixation. The addition of intraoperative CT with neuronavigation greatly aids in craniovertebral junction surgery. We operated on a 59-year-old-male with a type 2 fracture with posterior subluxation of C1 anterior arch and a cranially displaced odontoid peg. First, a transoral odontoidectomy was performed followed by a craniocervical fixation. Occipital plates and C3–C4 lateral mass screws were used as C1 was discovered to be occipitalized intraoperatively and atlantoaxial facet joints could not be reduced as discovered by intraoperative CT resconstruction. Intraoperative CT scan was crucial to this circumferential decompression and fixation, allowed us to resect the odontoid peg safely and completely and to confirm adequate screw trajectory making this complex surgery easier for us and safer for the patient. The patient was discharged 4 months after admission with stable neurology. Intraoperative CT was fundamental to correct decision making.

ENDOSCOPIC IMAGE‐GUIDED TRANSORAL APPROACH TO THE CRANIOVERTEBRAL JUNCTION: AN ANATOMIC STUDY COMPARING SURGICAL EXPOSURE AND SURGICAL FREEDOM OBTAINED WITH THE ENDOSCOPE AND THE OPERATING MICROSCOPE

2009 ◽  
Vol 64 (suppl_5) ◽  
pp. ons437-ons444 ◽  
Author(s):  
Promod Pillai ◽  
Mirza N. Baig ◽  
Chris S. Karas ◽  
Mario Ammirati
Keyword(s):  
Soft Palate ◽  
Image Guidance ◽  
Odontoid Process ◽  
Posterior Pharyngeal Wall ◽  
Craniovertebral Junction ◽  
Craniocervical Junction ◽  
Transoral Approach ◽  
Operating Microscope ◽  
Microscopic Approach ◽  
Pharyngeal Wall

Abstract OBJECTIVE The transoral approach is the most direct and commonly used method to access the ventral craniocervical junction. Recently, an endonasal, endoscopic approach to the craniovertebral junction was proposed. We reasoned that the coupling of the endoscope with the direct transoral approach and image guidance could result in a minimally invasive, simple approach to the ventral craniovertebral junction. We investigated the potential usefulness of such an approach in a cadaver model. METHODS A direct transoral approach to the craniovertebral junction was performed using computed tomography-based image guidance in 9 fresh adult head specimens. Endoscopic odontoidectomy was performed in 5 specimens. In the remaining 4 specimens, the surgical working area and surgical freedom associated with an endoscopic and a microscopic approach to the ventral craniovertebral junction were evaluated and compared. In these 4 specimens, we also measured and compared the exposure of the clivus provided by the endoscope and by the operating microscope without splitting the soft palate. RESULTS With variously angled endoscopic assistance and image guidance, it was possible to tailor the excision of the anterior arch of the atlas and to precisely identify the odontoid process and its related ligaments intraoperatively, resulting in a complete and controlled odontoidectomy. The surgical area exposed over the posterior pharyngeal wall was significantly improved using the endoscope (606.5 ± 127.4 mm3) compared with the operating microscope (425.7 ± 100.8 mm3), without any compromise of surgical freedom (P < 0.05). The extent of the clivus exposed with the endoscope (9.5 ± 0.7 mm) without splitting the soft palate was significantly improved compared with that associated with microscopic approach (2.0 ± 0.4 mm) (P < 0.05). CONCLUSION With the aid of the endoscope and image guidance, it is possible to approach the ventral craniovertebral junction transorally with minimal tissue dissection, no palatal splitting, and no compromise of surgical freedom. In addition, the use of an angled-lens endoscope can significantly improve the exposure of the clivus without splitting the soft palate. An endoscope-assisted transoral approach is a direct and powerful tool for the treatment of surgical pathology at the craniovertebral junction.

Telescopic myringotomy and tube application

2000 ◽  
Vol 114 (8) ◽  
pp. 581-583 ◽  
Author(s):  
Kamal-Eldin Ahmed Abou-Elhamd
Keyword(s):  
General Anaesthesia ◽  
Otitis Media ◽  
Local Anaesthesia ◽  
Otitis Media With Effusion ◽  
Field Of View ◽  
Large Field ◽  
Operating Microscope ◽  
Tube Insertion ◽  
A New Technique ◽  
Tube Application

Otoendoscopy is a new technique in otological surgery. The traditional surgery for otitis media with effusion (OME) is myringotomy and tube insertion using an operating microscope. In 45 children and five adults presenting to our department with otitis media with effusion, rigid endoscopic myringotomy and grommet tube insertion were performed using 2.7 mm diameter and 0 and 30 angle telescopes under general anaesthesia for children and local anaesthesia for adults. The use of rigid endoscopes provides a large field of view, that is of excellent resolution and fidelity of colour as well as giving good side views. It can be performed in the out-patient clinic with little inconvenience to the patient and minimal risks.

scholarly journals Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior compression

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Xingwen Wang ◽  
Longbing Ma ◽  
Zhenlei Liu ◽  
Zan Chen ◽  
Hao Wu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Intraoperative Ct ◽  
Image Guided ◽  
Transoral Odontoidectomy ◽  
Accurate Localization ◽  
Indirect Decompression ◽  
Challenging Situation

Abstract Background Although the single-stage posterior realignment craniovertebral junction (CVJ) surgery could treat most of the basilar invagination (BI) and atlantoaxial dislocation (AAD), there are still some cases with incomplete decompression of the spinal cord, which remains a technique challenging situation. Methods Eleven patients were included with remained myelopathic symptoms after posterior correction due to incomplete decompression of the spinal cord. Transoral odontoidectomy assisted by image-guided navigation and intraoperative CT was performed. Clinical assessment and image measurements were performed preoperatively and at the most recent follow-up. Results Eleven patients were followed up for an average of 47 months. Symptoms were alleviated in 10 of 11 patients (90.9%). One patient died of an unknown reason 1 week after the transoral approach. The clinical and radiological parameters pre- and postoperatively were reported. Conclusion Transoral odontoidectomy as a salvage surgery is safe and effective for properly selected BI and AAD patients after inadequate indirect decompression from posterior distraction and fixation. Image-guided navigation and intraoperative CT can provide precise information and accurate localization during operation, thus enabling complete resection of the odontoid process and decompression of the spinal cord.

scholarly journals High cervical myelopathy due to bony craniovertebral junction anomalies (atlantoaxial dislocation) in pediatric population- clinical scoring system

2016 ◽  
Vol 52 (02) ◽  
pp. 131-138
Author(s):  
Raj Kumar
Keyword(s):  
Cervical Myelopathy ◽  
Scoring System ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Atlantoaxial Dislocation ◽  
Surgical Approaches ◽  
Lower Cranial Nerve ◽  
Complex Anatomy ◽  
Clinical Scoring ◽  
High Cervical

SUMMARYBony craniovertebral junction anomalies are rare anomalies to cause high cervical myelopathy. Atlantoaxial dislocation (congenital) is one of the commonest bony anomaly in children presenting with high cervical compression. It is relatively common in India with an incidence of 5-8 / 1000. When the distance of atlas (anterior arch) is more than 3mm ( 4 mm children) from odontoid process, it is called as Atlantoaxial dislocation (AAD) resulting into bony compression of high cervical cord. The patients may present with quadriparesis, sensory impairment in all limbs along with lower cranial nerve involvement. Because of lower medullary involvement the respiratory compromises are also frequent, posing a threat to life. Complex anatomy of foramen magnum, plethora of clinical conditions and atypical surgical approaches are responsible for poor outcome in these children. A new clinical scoring system for myelopathy was evolved in order to have an objective and precise grading of these cases preoperatively and postoperatively. The need of precise scoring system was felt to have reproducibility and easy applicability in children of craniovertebral junction anomalies in order to fetch even minimal improvement or deterioration following complex surgery. Motor functions, gait, sensory, sphincteric, respiratory function & spasticity were the parameters included in study of scoring system. This study was done in 177 operated cases of AAD (67 patients, below 14 years of age included for statistical analysis). Their detailed clinical & radiological evaluation was done preoperatively & postoperatively. The Kumar & Kalra high cervical myelopathy grading system was thus, introduced in literature. System was easy to use, interpret and was more sensitive to the changes in neurological status. It helped neurosurgeons and neurologists globally to evaluate and prognosticate the cases of Atlantoaxial dislocation.

Cervicomedullary junction decompression in a case of Marshall-Smith syndrome

1991 ◽  
Vol 75 (2) ◽  
pp. 317-319 ◽  
Author(s):  
Conrad T. E. Pappas ◽  
Harold L. Rekate
Keyword(s):  
Cervical Spine ◽  
Brain Stem ◽  
Rare Condition ◽  
Craniovertebral Junction ◽  
Content Type ◽  
Cervicomedullary Junction ◽  
First Child ◽  
Bone Abnormalities ◽  
Fine Print

✓ The case is reported of a 2-year-old boy born with Marshall-Smith syndrome who had difficulty in swallowing and who exhibited spasticity and quadriparesis due to compression of the medulla and cervical spine. This is the first child with this rare condition reported to have brain-stem compression from bone abnormalities at the craniovertebral junction and who has required surgery.

Endoscopic transoral surgery for craniovertebral junction anomalies

2006 ◽  
Vol 5 (4) ◽  
pp. 367-373 ◽  
Author(s):  
Mazhar Husain ◽  
Manu Rastogi ◽  
Bal Krishna Ojha ◽  
Anil Chandra ◽  
Deepak K. Jha
Keyword(s):  
Minimally Invasive ◽  
Soft Tissues ◽  
Craniovertebral Junction ◽  
Transoral Surgery ◽  
Surgical Trauma ◽  
Psychological Burden ◽  
Endoscopic Techniques ◽  
Microsurgical Decompression ◽  
Complex Anatomy ◽  
Lower Clivus

✓Craniovertebral junction (CVJ) anomalies continue to be challenging for neurosurgeons because of the complex anatomy of this region. To date, microsurgical decompression via a transoral route is the standard treatment for anteriorly located compressive lesions of the cervicomedullary junction (CMJ). The results obtained by minimizing surgical trauma are fewer complications, shorter hospital stays, and reduced overall psychological burden. Endoscopic surgery is becoming a leading modality in minimally invasive neurosurgical treatment. The authors performed surgery in 11 patients with irreducible osseous dislocations resulting from CVJ abnormality during a 2-year period. Anterior CMJ decompression was achieved in all patients by performing neuroendoscopically controlled transoral excision of bone and soft tissues. The surgical technique and results will be discussed. The use of the endoscope offers several advantages in cases requiring a transoral approach to the lower clivus and atlantoaxial region. The use of minimally invasive endoscopic techniques has the potential to reduce the need for a wider cranial base opening and to decrease postoperative complications.

scholarly journals Unusual Location of a Second Mesiobuccal Canal in the Maxillary First Molar managed with the Aid of Cone-beam Computed Tomography

2016 ◽  
Vol 1 (1) ◽  
pp. 35-38
Author(s):  
N Velmurugan ◽  
R Randhya ◽  
Sathish Sundar ◽  
Dinesh Kowsky ◽  
Buvaneshwari Arul
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Cone Beam Computed Tomography ◽  
Cone Beam ◽  
Operating Microscope ◽  
Unusual Location ◽  
Computed Tomography Images ◽  
Complex Anatomy ◽  
Posttreatment Apical Periodontitis ◽  
Second Mesiobuccal Canal

ABSTRACT Introduction The purpose of this article was to emphasize the importance of understanding root canal anatomy and its variations for successful endodontic treatment. Methods This case report presents the detection and endodontic management of eccentrically placed second mesiobuccal (MB) canal in maxillary first molar with the help of dental operating microscope and cone-beam computed tomography (CBCT) scanning. Results Cone-beam computed tomography images showed broad MB root with second MB canal located closer to palatal orifice. Conclusion This report describes a variation in canal location and complex anatomy of maxillary first molar with posttreatment apical periodontitis which was managed successfully with the aid of dental operating microscope and CBCT. How to cite this article Randhya R, Sundar S, Kowsky D, Velmurugan N, Arul B. Unusual Location of a Second Mesiobuccal Canal in the Maxillary First Molar managed with the Aid of Cone-beam Computed Tomography. J Oper Dent Endod 2016;1(1):35-38.

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