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2016, Volume 7, Number 3, Page(s) 153-162
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The Endoscopic Endonasal Approach for Craniovertebral Junction Pathology
Alex M Witek1, Troy D Woodard1,2, Raj Sindwani1,2, Varun R Kshettry1, Pablo F Recinos1,2
1Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
2Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
Keywords: Craniovertebral junction, craniovertebral junction pathology, endoscopic endonasal approach

The craniovertebral junction (CVJ) can be affected by a variety of disease processes, which at times may cause irreducible ventral compression that is best addressed by an anterior approach. Over the past decade, the endoscopic endonasal approach (EEA) has emerged as a viable alternative to the established microscopic transoral approach. Published experience using the EEA for CVJ pathology has grown steadily, and a number of anatomic studies have helped to further refine the technique and define its indications and limitations. In this article we provide a description of the surgical technique and present an illustrative case. The indications, complications, and neurologic outcomes of the EEA are discussed, and a comparison is made between the EEA and alternative anterior approaches. Potential complications with the EEA include airway problems, velopharyngeal insufficiency, dysphagia, cerebrospinal fluid leak, and infection.

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