Massimiliano Visocchi - Böcker

Skull-base surgery is a minimally invasive endoscopic procedure, which involves the surgeon inserting instruments through the natural openings in the skull—the nose or mouth—or by making a small hole just above the eyebrow. This type of surgery requires a team of specialists, which may include ENT (ear, nose, and throat), maxillofacial and neurosurgeons, as well as radiologists. The craniovertebral junction (CVJ) has a unique anatomical bone and neurovascular structure, which not only separates the subaxial cervical spine but also provides a special cranial flexion, extension and axial rotation pattern. As such, a sound knowledge of the basic principles of spine instrumentation and the region’s kinematics are essential when it comes to strategic preoperative planning. Skull-base, craniovertebral junction, spine demolitive and reconstructive surgery, neuromodulation, bioengineering and transplantation are recent tools used to improve reconstruction, restoration and rehabilitation – three key words central to the core aim of the Neurorehabilitation and Reconstruction Committee of the WFNS, which is to promte mechanical morphological and functional restoration.

Skull-base surgery is a minimally invasive endoscopic procedure, which involves the surgeon inserting instruments through the natural openings in the skull—the nose or mouth—or by making a small hole just above the eyebrow. This type of surgery requires a team of specialists, which may include ENT (ear, nose, and throat), maxillofacial and neurosurgeons, as well as radiologists. The craniovertebral junction (CVJ) has a unique anatomical bone and neurovascular structure, which not only separates the subaxial cervical spine but also provides a special cranial flexion, extension and axial rotation pattern. As such, a sound knowledge of the basic principles of spine instrumentation and the region’s kinematics are essential when it comes to strategic preoperative planning. Skull-base, craniovertebral junction, spine demolitive and reconstructive surgery, neuromodulation, bioengineering and transplantation are recent tools used to improve reconstruction, restoration and rehabilitation – three key words central to the core aim of the Neurorehabilitation and Reconstruction Committee of the WFNS, which is to promte mechanical morphological and functional restoration.

These proceeding cover new trends presented at the IV Congress of the International Society of Reconstructive Neurosurgery (ISRN), 2015. ISRN is an “open” multidisciplinary society that deals with advances in spine and peripheral-nerve reconstructive surgery, central nervous system revascularization (surgical, radio interventional), neuromodulation, bioengineering and transplantation, which are the latest tools used to promote reconstruction, restoration and rehabilitation.

This issue of Acta Neurochirururgica presents the latest surgical and experimental approaches to the craniovertebral junction (CVJ). It discusses anterior midline (transoral transnasal), posterior (CVJ craniectomy laminectomy, laminotomy, instrumentation and fusion), posterolateral (far lateral) and anterolateral (extreme lateral) approaches using state-of-the-art supporting tools. It especially highlights open surgery, microsurgical techniques, neuronavigation, the O-arm system, intraoperative MR, neuromonitoring and endoscopy. Endoscopy represents a useful complement to the standard microsurgical approach to the anterior CVJ: it can be used transnasally, transorally and transcervically; and it provides information for better decompression without the need for soft palate splitting, hard palate resection, or extended maxillotomy. While neuronavigation allows improved orientation in the surgical field, intraoperative fluoroscopy helps to recognize residual compression. Under normal anatomic conditions, there are virtually no surgical limitations to endoscopically assisted CVJ and this issue provides valuable information for the new generation of surgeons involved in this complex and challenging field of neurosurgery.