Videoassisted anterior surgical approaches to the craniocervical junction: rationale and clinical results.

PURPOSE: In this narrative review, we aim to give an update on the anatomic fundamentals of endoscopic assisted surgery to the craniocervical junction (transnasal, transoral and transcervical), and to report on the available clinical results. METHODS: A non-systematic review and reporting on the anatomical and clinical results of endoscopic assisted approaches to the craniocervical junction (CVJ) is performed. RESULTS: Pure endonasal and cervical endoscopic approaches still have some disadvantages, including the learning curve and the lack of 3-dimensional perception of the surgical field. Endoscopically assisted transoral surgery with 30° endoscopes represents an emerging alternative to standard microsurgical techniques for transoral approaches to the anterior CVJ. Used in conjunction with traditional microsurgery and intraoperative fluoroscopy, it provides a safe and improved method for anterior decompression with or without a reduced need for extensive soft palate splitting, hard palate resection, or extended maxillotomy. CONCLUSIONS: Transoral (microsurgical or video-assisted) approach with sparing of the soft palate still remains the gold standard compared to the "pure" transnasal and transcervical approaches due to the wider working channel provided by the former technique. Transnasal endoscopic approach alone appears to be superior when the CVJ lesion exceeds the upper limit of the inferior third of the clivus. Combined transnasal and transoral procedures can be tailored according to the specific pathological and radiological findings.

Fractura del ahorcado: antecedentes históricos / Hangmen's fracture: historical background

La fractura del ahorcado es la lesión traumática del arco neural del axis. El entendimiento de esta afección comenzó a desarrollarse a principios de este siglo, aunque el proceder del ahorcamiento judicial se utilizaba desde cientos de años con anterioridad. Este trabajo se propone revisar los antecedentes históricos hasta el momento actual en el conocimiento de dicha afección, su presentación natural, el diagnóstico imagenológico y las alternativas del tratamiento(AU)

Hangmans fracture is the traumatic injury of the neural arch of the axis. This affection started to be understood at the beginning of the last century, though the procedure of the judicial hanging had been used hundreds of years before. The objective of this paper is to review the historical antecedents of the knowledge of this affection, its natural presentation, the imaging diagnosis and the treatment alternatives up to now(AU)

Lesiones traumáticas del raquis cervical superior / Traumatic injuries of the upper cervical rachis

Se efectúa un análisis acerca de las lesiones del raquis cervical superior. Se estudiaron 30 pacientes atendidos en el Servicio de Neurocirugía del Hospital Universitario "General Calixto García", que constituyen el universo de casos que acudió con este tipo de lesión, en el período comprendido entre septiembre de 1996 y septiembre de 1999. Se describen características sociodemográficas, clínicas e imagenológicas de los pacientes. El síntoma dominante por excelencia fue el dolor occipito-cervical, y en la mayoría de los enfermos quedó intacto el funcionamiento neurológico. Se discuten los resultados y se ofrecen recomendaciones con vistas a contribuir a una utilización más eficiente de los recursos imagenológicos en el diagnóstico y tratamiento de estas afecciones(AU)

An analysis is made about the injuries of the upper cervical rachis. The 30 patients with this type of injury that received attention at the Neurosurgery Service of "General Calixto García" Teaching Hospital from September, 1996, to September, 1999, were included in the study. Sociodemographic, clinical and imgaing features of the patients are described. The predominant symptom was occipitocervical pain and in most of the patients the neurological functioning was intact. The results were discussed and recommendations were made to contribute to a more efficient use of the imaging resources in the diagnosis and treatment of these affections(AU)

Malformación de odontoides descompensada por trauma cervical: reporte de 1 caso / Malformation of the odontoid decompensated by cervical trauma: report of a case

Entre las malformaciones congénitas de la unión craneoespinal se describen las provocadas por anomalías de la apófisis odontoides del axis, las cuales pueden ser causantes de manifestaciones neurológicas por compresión de la unión bulbomedular. Se presenta en este artículo un caso de compresión bulbomedular anterior provocado por una apófisis odontoides exuberante de origen congénito, que se torna sintomática como consecuencia de un trauma. Se hace una revisión de la técnica quirúrgica utilizada y de la literatura médica pertinente(AU)

Among the congenital malformations of the craniospinal junction, those produced by anomalies of the odontoid apophysis of the axis, which may cause neurological manifestations as a result of compression of the bulbomedullary junction, are described. A case of anterior bulbomedullary compression provoked by an exhuberant congenital odontoid apophysis that becomes symptomatic because of a trauma is presented in this paper. A review of the surgical technique used as well as of the relevant medical literature is made(AU)

Dislocaciones occipito-atloideas: revisión de la literatura y presentación de 7 casos / Atlanto-occipital dislocations: literature review and report of 7 cases

Esta lesión poco común, se presenta con gran frecuencia como muerte súbita, por lo que su diagnóstico muchas veces se realiza posmortem. Gracias al desarrollo de las técnicas de resucitación y reanimación en los centros especializados en politrauma, han sobrevivido algunos pacientes con dislocación occipito-atloidea, tema de este trabajo. Se presentan 7 casos atendidos en el Servicio de Neurocirugía del Hospital Universitario General Calixto García(AU)

This uncommon injury is frequently presented as sudden death. That`s why its diagnosis is many times made after death. Thanks to the development of resuscitation and reanimation techniques in the centers specialized in polytrauma, some patients with atlanto-occipital dislocation have survived, and this is the topic we deal with in this paper. 7 cases that received attention at the Neurosurgery Service of General Calixto García Teaching Hospital are presented here(AU)