Endoscopic-Assisted Microsurgical Techniques at the Craniovertebral Junction: A Systematic Review with Illustrative Cases

Background: Endoscopic-assisted microsurgery (EAM) techniques are employed to improve visualization of the surgical field while minimizing brain retraction and trauma to neurovascular structures. The purpose of this study was to present illustrative cases of endoscopic-assisted microsurgical techniques at the CVJ.

Methods: Illustrative cases from the senior author's clinical series are presented to highlight indications and the utility of EAM at the CVJ.

Results: The utility of the endoscope has been demonstrated in the transoral, transcervical, lateral, far lateral and posterolateral approaches in the literature. EAM can be used in the transoral approach to increase surgical exposure of the clivus and minimize the need to split the soft palate. In the transoral and lateral transatlantal, EAM may allow for more complete decompression of the neural elements. Finally, in the far lateral and posterolateral approaches, EAM can improve visualization down narrow or deep surgical corridors to help identify critical neurovascular structures and it can minimize the need for extensive bony exposures. The endoscope can be used to look around bony, vascular, or neoplastic lesions to visualize the surgical space behind these structures. Finally, it can be used to assess for tumor remnants after microsurgical resection.

Conclusion: EAM techniques can improve illumination and visualization of the surgical field at the CVJ. In addition, the EAM techniques can help to minimize the need for brain retraction or extensive exposures. Utilizing both the endoscope and microscope allows the surgeon to benefit from the advantages from each modality.