Da Vinci Robot-Assisted Transoral Odontoidectomy for Basilar InvaginationLee J.Y.K.a · Lega B.a · Bhowmick D.a · Newman J.G.b · O’Malley, Jr. B.W.b · Weinstein G.S.a, b · Grady M.S.a · Welch W.C.a
Departments of aNeurosurgery and bOtolaryngology, University of Pennsylvania, Philadelphia, Pa., USA
John Y.K. Lee, MD
Department of Neurosurgery, 3 Silverstein
3400 Spruce Street
Philadelphia, PA 19104 (USA)
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The transoral approach is an effective way to decompress the craniocervical junction due to basilar invagination. This approach has been described and refined, but significant limitations and technical challenges remain. Specifically, should the transoral route be used for intradural pathology, such as a meningioma, or should an inadvertent durotomy occur during extradural dissection, achieving a watertight closure of the dura in such a deep and narrow working channel is limited with the current microscopic and endoscopic techniques. Even closure of the posterior pharyngeal mucosa can be challenging, and problems with wound dehiscence encountered in some case series may be attributable to this difficulty. These problems, and the corollary aversion to the procedure felt by many neurosurgeons, led our group to investigate an alternative approach.
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