Abstract：
Surgical approaches directed toward craniovertebral junction (CVJ) can be addressed to the ventral, dorsal, and lateral aspects through a variety of 360° surgical corridors Herein, we report features, advantages, and limits of the updated technical support in CVJ surgery in clinical setting and dissection laboratories enriched by our preliminary surgical results of the simultaneous application of O-arm intraoperative neuronavigation and imaging system along with the 3D-4K EX in TOA for the treatment of CVJ pathologies.In the past 4 years, eight patients harboring CVJ compressive pathologies underwent one-step combined anterior neurosurgical decompression and posterior instrumentation and fusion technique with the aid of exoscope and O-arm. In our equipped Cranio-Vertebral Junction Laboratory, we use fresh cadavers (and injected \"head and neck\" specimens) whose policy, protocols, and logistics have already been elucidated in previous works. Five fresh-frozen adult specimens were dissected adopting an FLA. In these specimens, a TOA was also performed, as well as a neuronavigation-assisted comparison between transoral and transnasal explorable distances.A complete decompression along with stable instrumentation and fusion of the CVJ was accomplished in all the cases at the maximum follow-up (mean: 25.3 months). In two cases, the O-arm navigation allowed the identification of residual compression that was not clearly visible using the microscope alone. In four cases, it was not possible to navigate C1 lateral masses and C2 isthmi due to the angled projection unfitting with the neuronavigation optical system, so misleading the surgeon and strongly suggesting changing surgical strategy intraoperatively. In another case (case 4), it was possible to navigate and perform both C1 lateral masses and C2 isthmi screwing, but the screw placement was suboptimal at the immediate postoperative radiological assessment. In this case, the hardware displacement occurred 2 months later requiring reoperation.
摘要：
针对颅骨交界处（CVJ）的手术方法可以针对腹侧，背侧,以及通过各种360°手术走廊的横向方面，我们报告功能，优势,同时应用O型臂术中神经导航和成像系统以及TOA中的3D-4KEX治疗CVJ病变的初步手术结果丰富了CVJ手术在临床环境和解剖实验室中更新的技术支持的局限性。在过去的4年里,八名患有CVJ压迫性病变的患者在外镜和O形臂的帮助下进行了一步联合的前神经外科减压术和后路器械和融合技术。在我们配备的颅骨连接实验室，我们使用新鲜的尸体（并注射“头颈部”标本），其政策，协议,和物流已经在以前的工作中得到了阐明。采用FLA解剖了五个新鲜冷冻的成年标本。在这些标本中,还进行了TOA，以及经口和经鼻可探查距离之间的神经导航辅助比较。在最大随访时间（平均25.3个月）中，所有病例均完成了完全减压，稳定的仪器和CVJ融合。在两种情况下，O形臂导航允许识别仅使用显微镜无法清晰可见的残余压迫.在四个案例中，由于角度投影不适合神经导航光学系统，因此无法导航C1侧块和C2峡部，因此误导外科医生，并强烈建议术中改变手术策略。在另一种情况下（情况4），可以导航并执行C1侧块和C2地缝螺纹连接，但在术后即刻的放射学评估中,螺钉的放置并不理想.在这种情况下,硬件移位发生在2个月后，需要重新操作。
