Anotomical Study Of Endoscopic Endonasal Approach To Cranio Cervical Junction Region

Background and PurposeCraniocervical ventral areas usually refers to the slope of1/3, the anteriormargin of the foramen magnum,and atlantoaxial ventral region, since, due tothecomplex anatomy of the cranio cervical junction region, craniocervical junction hasbeen recognized as the operation area, a big reason is the high incidence ofcomplication and trauma incision operation in this area with traditional operation. Inrecent years, along with the anatomy and technique progress of skull base under themicroscope, Department of neurosurgery has improved rapidly, the cranio cervicaljunction region become a hot regional neurosurgeons constantly studies. But now thecraniocervical ventral region disease, due to its anatomical location is deep, alsorelates to a number of important blood vessel and nerve, anatomy reduction afteroperation, complications and other factors, the craniocervical junction diseasescaused in the course of treatment the mortality and mutilation rate is still higher thanthat of other neurological diseases.Nerve endoscopy and continuous application, represents the Department ofneurosurgery operation equipment constantly updated, also brought the reformoperation concept for neurosurgeon, the technique using endoscope produced byillumination and imaging, such as: human nasal cavity, pharynx, sphenoid sinus,ethmoidal sinus, maxillary sinus and other natural holes or gaps operation, reduce thepostoperative complications and pain. In the last10years, with the continuous improvement of endoscopic techniques,there have been many domestic and foreign neurosurgeon to endoscopic transoral andnasopharyngeal into the path of craniocervical ventral lesion treatment was discussed,but in this field for the first operation indication, operation to operation area and thesurrounding the important blood vessels and nerve protection, postoperative cranialbase defect repair, the management of cerebrospinal fluid leakage problems have notperfect solution. Therefore, this study through the anatomy of the cranio cervicaljunction of nasopharynx and bony structures and the regional endoscopic, find thesign fixed the approach process, at the same time, the simulated operation oncadaveric heads, for further clinical work to lay the foundation for the developmentof.MethodsThis study is divided into two parts, the first observation of endoscopic nasal tothe craniocervical junctionbony specimens of cadaveric head, signs, fixed, easyidentification to find out, at the same time around to sign important vessels, nerves,muscles, joints and detailed observation, description, measurement, and datarecording. The second part simulation operation on cadaveric head specimens,endoscopic removal of bone, dura and slope exposure subdural structure, explorationand measurement of grinding bone area, and try to grind the odontoid process, andunderstand the removal effect on the stability of occipitocervical joint of odontoidprocess, for the later clinical work to lay the foundation.Result1in36cases of skulls,5sets of atlanto axial cone specimens and6cadaverheads, established the mark operation approach in the process, fixed, legibilitystructure of middle turbinate, posterior, anterior wall of the sphenoidal sinus,pharyngeal, pharyngeal tubercle, anterior margin of the foramen magnum, odontoidprocess the atlas, vertebral anterior tubercle.2pre operation along the mark point gradually into the mirror, the operationapproach can successfully reach the lower slope and craniocervical junction, and asmooth grinding down the slope and resection of odontoid process, can incise thedura mater, expose subdural blood vessels and nerves, brainstem structures, without removal of the soft palate and palate, less postoperative complications.ConclusionIn this study, the landmark points and important structure of the middle linedistance, to establish the safety range operation, simulate operation by endoscopic,further confirmed the safety, effectiveness and feasibility of the operation approach,endoscope has a vision and a broader definition than microscopy, endoscopicoperation approach is in many ways a transoral approach more secure.