Image-guided transoral surgery in childhood

The study aims to report a preliminary experience of image guidance during transoral surgery in a paediatric population. In paediatric practice, the small size of the oropharynx and the distortion of the craniocervical junction anatomy (whether congenital or acquired) are both factors that may compromise the transoral approach. Prior immobilisation of the craniocervical axis by virtue of posterior fixation or external halo body orthosis permits the use of intra-operative image guidance to navigate this region. Neuronavigation was used during transoral surgery in six paediatric cases. Preliminary immobilisation of the craniocervical junction was ensured in all patients. Volumetric imaging was then obtained prior to the transoral procedure which was then carried out using neuronavigation assistance (Stealth Station Medtronic). Early post-operative imaging was obtained in each case to assess the extent of the surgical resection. Neuronavigation was found to correlate well with the intra-operative findings and, in all cases, the surgical objective, decompression of the neuraxis, was achieved. Post-operative imaging reflected the operating surgeon's perception regarding the extent of the decompression. In one case, there was a transient neurological deterioration; there was no mortality and no instances of wound-related complications or cerebrospinal fluid leakage. Intraoperative neuronavigation during transoral surgery is feasible in the paediatric population. In this unusual patient population, the technique appears to be of value in negotiating complex anatomy and achieving a safe and predictable decompression.