Roadmap to Ventral Craniocervical Junction Through the Endonasal Corridor: Anatomic Evaluation of Inverted U-Shaped Nasopharyngeal Flap Exposure in a Cadaveric Study.
Oper Neurosurg (Hagerstown)
; 23(1): e2-e9, 2022 07 01.
Article
em En
| MEDLINE
| ID: mdl-35486872
ABSTRACT
BACKGROUND:
There is a paucity of data in the literature describing quantitative exposure of the ventral craniocervical junction through the endonasal corridor in a safe manner mindful of locoregional anatomy.OBJECTIVE:
To quantify ventromedial exposure of O-C1 and C1-2 articular structures after turning an inverted U-shaped nasopharyngeal flap (IUNF) and to obtain measurements assessing the distance of flap margins to adjacent neurovascular structures.METHODS:
In 8 cadaveric specimens, an IUNF was fashioned using a superior incision below the level of the pharyngeal tubercule of the clivus and lateral incisions in the approximate region of Rosenmuller fossae bilaterally. Measurements with calipers and/or neuronavigation software included flap dimensions, exposure of O-C1 and C1-2 articular structures, inferior reach of IUNF, and proximity of the internal carotid artery (ICA) and hypoglossal nerve to IUNF margins.RESULTS:
The IUNF facilitated exposure of an average of 9 mm of the medial surfaces of the right/left O-C1 joints without transgression of the carotid arteries or hypoglossal nerves. The C1-2 articulation could not be routinely accessed. The margins of the IUNF were not in close (<5 mm) proximity to the ICA in any of the 8 specimens. In 6 of 8 specimens, the dimensions of the IUNF were in close (<5 mm) horizontal or vertical proximity to the hypoglossal foramina.CONCLUSION:
The IUNF provided safe and reliable access to the medial O-C1 articulation. Given the close proximity of the exocranial hypoglossal foramen, neuronavigation assistance and neuromonitoring with attention to the superolateral IUNF margin are recommended.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Nariz
/
Fossa Craniana Posterior
Limite:
Humans
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article