Abstract
Introduction: The transoral approach was first described by Kanavel in 1917 to treat injuries of the craniospinal junction. In 2002, Frempong-Boaudu reported 7 adults who underwent endoscopically assisted transoral surgery, this was the first report that endoscope was used in an assisted manner for transoral surgery. In 2005, Kassam published the first report of an EEA being used to perform an odontoidectomy. Method: A descriptive, retrospective and linear study was carried out in 16 patients who underwent surgery using the microsurgical and endoscopic transoral and Extended Endoscopic Endonasal approach in the period from January 2004 to May 2021. Results: The average age of the patients was 45 years and there was a predominance of the male sex (10) with the female one (6). The tumoral pathology (9), 6 cases with histological diagnosis of clivus cordroma and 1 patient with chondrosarcoma, two cases with Meningioma and cholesterol granuloma of clival localization, achieving gross total resection in 2 of them and in the rest subtotal resection, all improved neurological symptoms. Complications, partial dehiscence of the velopalatine surgical wound 1 case, 1 lesion of the left vertebral artery and 1 case decompensated Diabetes Mellitus and hemoneumothorax during stay in the ICU, which death 7 days after surgery and 1 CSF fistula. Conclusions: Both, the transoral and endonasal endoscopic approaches have their precise indications in each particular case, having their indications well defined. To achieve this, we must have neuroimaging studies and be able to correctly define the selection of the surgical approach.
Highlights
The transoral approach was first described by Kanavel in 1917 to treat injuries of the craniospinal junction, later in 1957 Southwick and Robinson describe the case of a giant osteoma removed through a transoral route
The patients attended during this period presented degenerative or tumor lesions of the craniospinal region, all patients underwent a transoral approach, both standard and endoscopic, as well as endoscopic endonasal approach extended to the clivus or odontoid process
Radiotherapy was indicated in cases with subtotal resection after surgery
Summary
The transoral approach was first described by Kanavel in 1917 to treat injuries of the craniospinal junction. Fang and Ong in 1962 established the transoral route as a surgical technique by publishing its use in 6 cases with injuries to the upper cervical vertebrae; in their casuistry, three of the cases were traumatic, due to dislocation or fracture dislocation in the Atlanto-axial joint, in two cases it was due to recurrent dislocations of unknown causes and one case of tuberculous infection in the two upper vertebrae, of these one died of Sepsis and the others evolved satisfactorily [1] Following these events, criticism of transoral surgery continued because of limited exposure, poor lighting, and inadequate instrumentation. Each approach has its advantages and disadvantages, it has limitations in its exposure, surgeons must be familiar with various anteromedial approaches and their modifications, to select the best approach in each case [11,12,13,14,15,16]
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