Transoral vs transnasal approach for craniovertebral junction pathologies: Light and shadows

CO-ORGANIZED EVENT:2^nd International Conference on Spine and Spinal Disorders & 6^th International Conference on Neurology and Neuromuscular Diseases

July 24-26, 2017 Rome, Italy

Massimiliano Visocchi

Institute of Neurosurgery Catholic University of Rome, Italy

Keynote: J Spine

Abstract :

Background: Several pathologies affecting the craniovertebral junction (CVJ) can be approached by means of a microsurgical transoral approach (TOA) or with an endoscopic endonasal approach (EEA), potentially able to overcome some complications sometimes associated to the former approach. Herein, starting from the updated literature experience and adding our surgical experience, we critically analyze these procedures, trying to demonstrate that TOA still deserve a consideration and that, in some cases, it can be even considered superior to EEA. Methods: Our experience deals with 25 anterior procedures in 24 paediatric and adult patients (18 TOA and 7 EEA). The TOA group (13 male and 5 female, median age 33,1) encompasses 3 tumors, 3 Reumathoid arthritis, 1 condilus tertius, 3 Basilar invaginations, 4 Impressio basilaris, 1 developmental anomaly of C0-C1, 1 Os odontoideum, 1 post-traumatic C1-C2 compression, 1 C2 fracture. EEA Group (3 male and 4 female; median age 39,7 year-old) comprises 4 tumors, 2 Impressio basilaris and 1 Impressio basilaris with platybasia. Results: All the patients of TOA group but one were discharged after posterior procedures within two weeks and improved or remained unchanged after surgery and during the follow-up. No mayor complications occurred in TOA group. In EEA group two patients died for CSF infection, for disease progression and for heart attack. Conclusions: Our and other available data suggest that no clear superiority of EEA over endoscopic TOA can be assessed so far; on the other hand, EEA can produce complications similar to TOA in CVJ surgery.

Biography :

Massimiliano Visocchi is Associate Professor in Neurosurgery at the Catholic University of Rome Italy and Visiting Professor at the Shanghai University (China) since 2012. Director of the Special Course and the Second degree level Master in Surgery of CranioVertebral Junction at the Catholic University of Rome Italy. Founder of the Research Center in Surgery of CranioVertebral Junction Catholic University of Rome Italy. President Elect of the International Societies of Reconstructive Neurosurgery (ISRN), Member of the Board of the Neuroehabilitation Committe of the World Federation of Neurosurgical Societies (WFNS), Member of the Board of the Italian Society of Neurosurgery (SINCh), former President of 2 National Scientific Societies (SINSEC: Società Italiana di Neurosonologia ed Emodinamica Cerebrale- Gruppo di Studio di Emodinamica Cerebrale della Società Italiana di Neurochirurgia).

Email: mvisocchi@hotmail.com