Skip to main content
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1985 Sep;67(5):321–325.

The transoral approach to the base of the brain and upper cervical cord.

H A Crockard
PMCID: PMC2499532  PMID: 3901865

Abstract

The transoral surgical approach allows access to structures from the sphenoid sinus rostrally to the fourth cervical vertebral body caudally. It is particularly useful for lesions at the anterior aspect of the craniocervical junction. Relief of the spinal cord compression in rheumatoid atlantoaxial subluxation can be achieved by this route. Removal of extradural and intradural tumours is possible using microsurgical techniques and watertight dural closure with the aid of fibrin glue.

Full text

PDF
321

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bonney G. L., Laurence M. Malignant destruction of the axis. Two-year survival. Proc R Soc Med. 1969 Jun;62(6):585–586. [PMC free article] [PubMed] [Google Scholar]
  2. Bonney G. Stabilization of the upper cervical spine by the transpharyngeal route. Proc R Soc Med. 1970 Sep;63(9):896–897. [PMC free article] [PubMed] [Google Scholar]
  3. Bydder G. M., Pennock J. M., Steiner R. E., Orr J. S., Bailes D. R., Young I. R. The NMR diagnosis of cerebral tumors. Magn Reson Med. 1984 Mar;1(1):5–29. doi: 10.1002/mrm.1910010105. [DOI] [PubMed] [Google Scholar]
  4. CLOWARD R. B. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958 Nov;15(6):602–617. doi: 10.3171/jns.1958.15.6.0602. [DOI] [PubMed] [Google Scholar]
  5. Christophidis N., Huskisson E. C. Misleading symptoms and signs of cervical spine subluxation in rheumatoid arthritis. Br Med J (Clin Res Ed) 1982 Jul 31;285(6338):364–365. doi: 10.1136/bmj.285.6338.364. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Crockard H. A., Bradford R. Transoral transclival removal of a schwannoma anterior to the craniocervical junction. Case report. J Neurosurg. 1985 Feb;62(2):293–295. doi: 10.3171/jns.1985.62.2.0293. [DOI] [PubMed] [Google Scholar]
  7. DAVIS F. W., Jr, MARKLEY H. E. Rheumatoid arthritis with death from medullary compression. Ann Intern Med. 1951 Aug;35(2):451–454. doi: 10.7326/0003-4819-35-2-451. [DOI] [PubMed] [Google Scholar]
  8. Derome P., Caron J. P., Hurth M. Indications de la voie trans-bucco-pharyngée et malformations de la charnière cranio-vertébrale. Neurochirurgie. 1977 Oct 20;23(4):282–285. [PubMed] [Google Scholar]
  9. Drake C. G. Progress in cerebrovascular disease. Management of cerebral aneurysm. Stroke. 1981 May-Jun;12(3):273–283. doi: 10.1161/01.str.12.3.273. [DOI] [PubMed] [Google Scholar]
  10. Fox J. L., Jerez A. An unusual atlanto-axial dislocation. Case report. J Neurosurg. 1977 Jul;47(1):115–118. doi: 10.3171/jns.1977.47.1.0115. [DOI] [PubMed] [Google Scholar]
  11. Gilsbach J., Eggert H. R. Transoral operations for craniospinal malformations. Neurosurg Rev. 1983;6(4):199–209. doi: 10.1007/BF01743101. [DOI] [PubMed] [Google Scholar]
  12. Greenberg A. D., Scoville W. B., Davey L. M. Transoral decompression of atlanto-axial dislocation due to odontoid hypoplasia. Report of two cases. J Neurosurg. 1968 Mar;28(3):266–269. doi: 10.3171/jns.1968.28.3.0266. [DOI] [PubMed] [Google Scholar]
  13. Hall J. E., Denis F., Murray J. Exposure of the upper cervical spine for spinal decompression by a mandible and tongue-splitting approach. Case report. J Bone Joint Surg Am. 1977 Jan;59(1):121–123. [PubMed] [Google Scholar]
  14. Hardy J., Wigser S. M. Trans-sphenoidal surgery of pituitary fossa tumors with televised radiofluoroscopic control. J Neurosurg. 1965 Dec;23(6):612–619. doi: 10.3171/jns.1965.23.6.0612. [DOI] [PubMed] [Google Scholar]
  15. Hayakawa T., Kamikawa K., Ohnishi T., Yoshimine T. Prevention of postoperative complications after a transoral transclival approach to basilar aneurysms. Technical note. J Neurosurg. 1981 May;54(5):699–703. doi: 10.3171/jns.1981.54.5.0699. [DOI] [PubMed] [Google Scholar]
  16. Hitchcock E., Cowie R. Transoral-transclival clipping of a midline vertebral artery aneurysm. J Neurol Neurosurg Psychiatry. 1983 May;46(5):446–448. doi: 10.1136/jnnp.46.5.446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Locksley H. B. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg. 1966 Aug;25(2):219–239. doi: 10.3171/jns.1966.25.2.0219. [DOI] [PubMed] [Google Scholar]
  18. MCCORMICK W. F., NOFZINGER J. D. SACCULAR INTRACRANIAL ANEURYSMS: AN AUTOPSY STUDY. J Neurosurg. 1965 Feb;22:155–159. doi: 10.3171/jns.1965.22.2.0155. [DOI] [PubMed] [Google Scholar]
  19. Marks J. S., Sharp J. Rheumatoid cervical myelopathy. Q J Med. 1981 Summer;50(199):307–319. [PubMed] [Google Scholar]
  20. Meijers K. A., Cats A., Kremer H. P., Luyendijk W., Onvlee G. J., Thomeer R. T. Cervical myelopathy in rheumatoid arthritis. Clin Exp Rheumatol. 1984 Jul-Sep;2(3):239–245. [PubMed] [Google Scholar]
  21. Meijers K. A., van Beusekom G. T., Luyendijk W., Duijfjes F. Dislocation of the cervical spine with cord compression in rheumatoid arthritis. J Bone Joint Surg Br. 1974 Nov;56-B(4):668–680. doi: 10.1302/0301-620X.56B4.668. [DOI] [PubMed] [Google Scholar]
  22. Mullan S., Naunton R., Hekmat-Panah J., Vailati G. The use of an anterior approach to ventrally placed tumors in the foramen magnum and vertebral column. J Neurosurg. 1966 Feb;24(2):536–543. doi: 10.3171/jns.1966.24.2.0536. [DOI] [PubMed] [Google Scholar]
  23. Newman P., Sweetnam R. Occipito-cervical fusion. An operative technique and its indications. J Bone Joint Surg Br. 1969 Aug;51(3):423–431. [PubMed] [Google Scholar]
  24. Pásztor E., Vajda J., Piffkó P., Horváth M., Gádor I. Transoral surgery for craniocervical space-occupying processes. J Neurosurg. 1984 Feb;60(2):276–281. doi: 10.3171/jns.1984.60.2.0276. [DOI] [PubMed] [Google Scholar]
  25. SCOVILLE W. B., SHERMAN I. J. Platybasia, report of 10 cases with comments on familial tendency, a special diagnostic sign, and the end results of operation. Ann Surg. 1951 Apr;133(4):496–502. doi: 10.1097/00000658-195104000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Sano K., Jinbo M., Saito I. [Vertebro-basilar aneurysms, with special reference to the transpharyngeal approach to basilar artery aneurysm]. No To Shinkei. 1966 Dec;18(12):1197–1203. [PubMed] [Google Scholar]
  27. Spetzler R. F., Selman W. R., Nash C. L., Jr, Brown R. H. Transoral microsurgical odontoid resection and spinal cord monitoring. Spine (Phila Pa 1976) 1979 Nov-Dec;4(6):506–510. doi: 10.1097/00007632-197911000-00009. [DOI] [PubMed] [Google Scholar]
  28. Thompson H. Transpharyngeal fusion of the upper cervical spine. Proc R Soc Med. 1970 Sep;63(9):893–896. [PMC free article] [PubMed] [Google Scholar]
  29. Troupp H. The natural history of aneurysms of the basilar bifurcation. Acta Neurol Scand. 1971;47(3):350–356. doi: 10.1111/j.1600-0404.1971.tb07489.x. [DOI] [PubMed] [Google Scholar]
  30. Wilson C. B., Dempsey L. C. Transsphenoidal microsurgical removal of 250 pituitary adenomas. J Neurosurg. 1978 Jan;48(1):13–22. doi: 10.3171/jns.1978.48.1.0013. [DOI] [PubMed] [Google Scholar]
  31. Windle-Taylor P. C. Cervical chordoma: report of a case and the technique of transoral removal. Br J Surg. 1977 Jun;64(6):438–441. doi: 10.1002/bjs.1800640618. [DOI] [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES