Video-assisted microsurgical transoral approach to the craniovertebral junction: personal experience in childhood

This paper outlines the perspectives of transoral craniosurgery for anterior craniovertebral junction (CVJ) compressive abnormalities in the specific subset of paediatric patients. In particular we analyzed the opportunity for endoscopic video-assisted approach to the CVJ along with neuronavigation for anterior decompression by the transoral approach in paediatric patients. Among 30 patients ranging 6-78 years undergoing CVJ decompressive procedures, we operated transorally 3 paediatric patients (ranging 11-15 years) by using open access, microsurgical technique, neuronavigation, and endoscopy. The microscope was the main stone of the transoral procedure; a complete CVJ decompression was accomplished in all the cases by using the 30-degree endoscope that allowed to identify residual compression not clearly visible by using the microscope alone. The use of an angled-lens endoscope can significantly improve the exposure of the clivus without splitting the soft palate. Endoscopically assisted transoral surgery represents an emerging alternative to the standard microsurgical approach to the anterior CVJ. Used in conjunction with traditional microsurgery and intraoperative fluoroscopy, endoscopy provides information for a better decompression with a reduced need for extensive soft-palate splitting, no need for hard-palate resection, or extended maxillotomy. Transoral video-assisted microsurgical approach should be considered the gold standard especially in the paediatric patient.