Purely endoscopic endonasal surgery of the craniovertebral junction: A systematic review. Issue 8 (5th May 2015)

• Record Type: Journal Article
• Authors: Fang, Christina H.; Friedman, Remy; Schild, Sam D.; Goldstein, Ira M.; Baredes, Soly; Liu, James K.; Eloy, Jean Anderson
• Is Part Of: International forum of allergy & rhinology. Volume 5:Issue 8(2015:Aug.)
• Page Start: 754
• Page End: 760
• Publication Date: 2015-05-05
• Subjects: 617.51005
• DOI: 10.1002/alr.21537
• Languages: English
• ISSNs: 2042-6976

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="alr21537-sec-0010" sec-type="section"> <title>Background</title> <p>Endoscopic endonasal surgery (EES) is a relatively novel approach to the craniovertebral junction (CVJ). The purpose of this analysis is to determine the surgical outcomes of patients who undergo purely EES of the CVJ.</p> </sec> <sec id="alr21537-sec-0020" sec-type="section"> <title>Methods</title> <p>A search for articles related to EES of the CVJ was performed using the MEDLINE/PubMed database. A bibliographic search was done for additional articles. Demographics, presenting symptoms, imaging findings, complications, follow‐up, and patient outcomes were analyzed.</p> </sec> <sec id="alr21537-sec-0030" sec-type="section"> <title>Results</title> <p>Eighty‐five patients from 30 articles were included. The mean patient age was 47.9 ± 24.8 years (range, 3 to 96 years), with 44.7% being male. The most common presenting symptom was myelopathy (n = 64, 75.3%). The most common indications for surgery were brainstem compression secondary to basilar invagination (n = 41, 48.2%) and odontoid pannus (n = 20, 23.5%). Odontoidectomy was performed in 97.6% of cases. Intraoperative complications occurred in 16 patients (18.8%) and postoperative complications occurred in 18 patients (21.2%). Six patients developed postoperative respiratory failure necessitating a tracheostomy. Neurologic improvement was seen in 89.4% of patients at a mean follow‐up of 22.2 months.</p> </sec> <sec id="alr21537-sec-0040" sec-type="section"> <title>Conclusion</title> <p>Our analysis found that EES of the CVJ results in a high rate of neurologic improvement with acceptable complication rates. Given its minimally invasive nature and high success rate, this approach appears to be a reasonable alternative to the traditional transoral approach in select cases. This study represents the largest pooled sample size of EES of the CVJ to date. Increasing use of the endoscopic endonasal approach will allow for further studies with greater statistical power.</p> </sec> </abstract>