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Submandibular approach for single-stage craniovertebral junction ventral decompression and stabilization: a preliminary cadaveric study of technical feasibility
EANS Academy. Stumpo V. 09/26/19; 275929; EP02131
Mr. Vittorio Stumpo
Mr. Vittorio Stumpo

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Abstract
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Background: The craniovertebral junction (CVJ) may be affected by several diseases. It is anatomically complex, involving osteo-ligamentous, vascular and nervous structures, which makes surgeries challenging. When there is evidence of ventral compression, an anterior approach is preferable, but a subsequent atlanto-axial fixation is often required. Trans-mucosal approaches are associated with high rates of infections, which could result increased when instrumentation devices are placed through these ways. Alternatively, retropharyngeal (RF) extramucosal approaches offer a good opportunity for instrumentation/fixation, even though decompression may be challenging.
Objective: To investigate the feasibility of a single stage, anterior extramucosal approach to the CVJ for simultaneous decompression and stabilization.
Methods: The present is a preliminary cadaveric feasibility study on two injected heads. Submandibular (SM) approach variation with a short 'boomerang' incision, microsurgical decompression of the ventral CVJ and a new hybrid construct for atlanto-axial stabilization have been investigated. The surgical approach, the decompression and the instrumentation technique have been described. In addition, intra-procedural images and x-rays, and post-procedural CT scan results were collected. Surgical exposure, working corridors, and decompression grade were measured.
Results: SM approach provides a wide exposure of ventral CVJ, and the possibility for instrumentation and decompression. Mechanical investigations of this new hybrid system and in-vivo studies are needed to confirm our results.
Conclusion: A single stage, anterior extramucosal approach for decompression and stabilization of CVJ may result in shorter surgical duration and less related comorbidities.
Background: The craniovertebral junction (CVJ) may be affected by several diseases. It is anatomically complex, involving osteo-ligamentous, vascular and nervous structures, which makes surgeries challenging. When there is evidence of ventral compression, an anterior approach is preferable, but a subsequent atlanto-axial fixation is often required. Trans-mucosal approaches are associated with high rates of infections, which could result increased when instrumentation devices are placed through these ways. Alternatively, retropharyngeal (RF) extramucosal approaches offer a good opportunity for instrumentation/fixation, even though decompression may be challenging.
Objective: To investigate the feasibility of a single stage, anterior extramucosal approach to the CVJ for simultaneous decompression and stabilization.
Methods: The present is a preliminary cadaveric feasibility study on two injected heads. Submandibular (SM) approach variation with a short 'boomerang' incision, microsurgical decompression of the ventral CVJ and a new hybrid construct for atlanto-axial stabilization have been investigated. The surgical approach, the decompression and the instrumentation technique have been described. In addition, intra-procedural images and x-rays, and post-procedural CT scan results were collected. Surgical exposure, working corridors, and decompression grade were measured.
Results: SM approach provides a wide exposure of ventral CVJ, and the possibility for instrumentation and decompression. Mechanical investigations of this new hybrid system and in-vivo studies are needed to confirm our results.
Conclusion: A single stage, anterior extramucosal approach for decompression and stabilization of CVJ may result in shorter surgical duration and less related comorbidities.
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