TRANSORAL-TRANSPHARYNGEAL APPROACH TO THE CRANIOCERVICAL JUNCTION

The transoral-transpharyngeal approach is a reliable and technically s ound method for gaining anterior extradural exposure to the craniocerv ical junction. We report 23 patients undergoing this approach for path ology lying between the inferior clivus and third cervical vertebra, P athology included 6 patients with congenital malformations of the odon toid process, 4 patients with basilar invagination caused by rheumatoi d arthritis, 2 patients with atlantoaxial subluxation caused by Down's syndrome, and 1 each with Chiari l malformation, pseudogout of C1/C2, ossification of the posterior longitudinal ligament, and chronic dens dislocation caused by trauma. Malignant tumors included 4 chordomas, 2 giant cell tumors of C1-C3, and 1 chondrosarcoma. Orotracheal intuba tion without tracheotomy was used in 22 patients. Sixteen of these 22 patients were extubated either immediately or within 24 hours, Six com plications occurred in 5 patients and included a palatal dehiscence in 2, delayed oropharyngeal hemorrhage, prolonged endotracheal intubatio n because of severe tongue edema, and I case each of meningitis and as piration pneumonia responsive to intravenous antibiotics. No deaths, l ocal infections, or postoperative cerebrospinal fluid leaks occurred. Neurologic symptoms of cord compression improved or stabilized in all patients. The transoral-transpharyngeal approach is an effective means for extradural decompression of the anterior craniocervical junction and for exposure of selected tumors at this site.