Table 3.

A review of some of the larger recent series of transoral approach with complications and outcomes

Author and year	Number of cases	Complications	Outcomes	Levels fused	Remarks	Follow-up
Crockard et al. (1986)[6]	68	Vertebral artery injury-1, cord damage-1 Palatal dehiscence-2 CSF leaks-6	61 (90%) improved, 3 (4%) deteriorated, 1 died	Occipito-C2/C3 fusion	Transoral decompression relieve ventral compression in rheumatoid arthritis	-
Hadley et al. (1989)[7]	53	5.6% wound dehiscence with CSF leak	94% neurological improvement	Occipito-C3 levels	Good result for ventral pathology	2 years
Dickman et al. (1992)[8]	27	None	22 (81%) improved, 5 (19%) stabilized	9 (33%) fusion of C1–C2, 10 (37%) occipitocervical fusion	Transoral decompression relieves decompression and fusion required in >70% patients and 90% of rheumatoid arthritis patients	14 months
Tuite et al. (1996)[9]	27	Neurological deterioration-4 (15%), CSF leak-2, wound infection-3, palatal fistula-2	9 (33%) improved, 4 (15%) worse, 15 (52%) remained same	Occipito-C3/C5/T4 (1 patient)	Transoral surgery in congenital diseases requires less extensive surgery compared to oncological condition but associated with worse neurological outcomes	4.6 years
Jain et al. (1999)[10]	74	Pharyngeal wound sepsis leading to dehiscence (20.3%) and hemorrhage (4%), velopharyngeal insufficiency (8.1%), CSF leak (6.7%) and inadequate decompression (6.7%)	26 (55.3%) showed improvement from their preoperative status while 14 (29.8%) demonstrated stabilization of their neurological deficits. 7 (14.9%) of them deteriorated	C1-2-3	TOD is logical and effective in relieving ventral compression due to craniovertebral junction anomalies; it carries the formidable risks of instability, incomplete decompression, neurological deterioration, CSF leak, infection and palatopharyngeal dysfunction	3–24 months
Menezes (2008)[11]	28	Wound dehiscence 2, velopalatine insufficiency 5, retropharyngeal infection 1	Neurological improvement in all patients	C1, C2, and C2–3 disc pathology	Indicated in irreducible pathology	-
Mouchaty et al. (2009)[12]	53	2 mortality, 8 patients had morbidity – CSF leak, wound dehiscence, meningitis	51 patients had improvement	C1, C2	Indicated in severe BI	4–96 months
Shousha et al. (2014)[13]	139	3.6% wound infection early, late in 1 patient	94% neurological improvement	-	Postoperative infections higher in rheumatic disease group	4.5 years
Elbadrawi and Elkhateeb (2017)[14]	20	CSF leak wound dehiscence	Improvement in VAS and Nurick score	C2	Safe and effective surgical method for the direct decompression of ventral midline extradural compressive disease of the craniovertebral junction	29.4±3.8 months

VAS – Visual analog scale; CSF – Cerebrospinal fluid