Considerations on “Endoscopic endonasal approach to the craniocervical junction: the importance of anterior C1 arch preservation or its reconstruction”

摘要

Dear Editor, i should like to make some comments of the paper of re et al. * . The authors report on 10 patients un- dergoing endoscopic endonasal decompression for differ- ent CCJ pathologies. in 8 patients, the authors were able to preserve the anterior C1 arch, while in 2 cases they recon- structed it with clinical improvement or stabilisation and preservation of spinal stability in all without posterior fixa- tion (mean follow-up of 31 months). Four surgical techni- cal topics deserve particular consideration in this paper. . The assumed superiority of a transnasal approach compared with a transoral approach to the CCJ. . The dural opening and tumour removal in case of C1- C2 neoplastic lesions. . The endoscopic pannus removal and subsequent ante- rior screw fixation by self-tapping screws for a better fracture healing and spinal realignment (only for in- veterate C2 Anderson-D'Alonso type.ii fractures). . The anterior arch of C1 reconstruction a) by placing bone chips compressed between the bone under en- doscopic control and subsequent fixation with three screws and one plate or b) with autologous bone graft and titanium mash (in a non-union anterior atlas frac- ture after conservative treatment that developed C1 lateral masses displacement with cranial settling).