{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:22:21Z","timestamp":1787764941710,"version":"build-2784847793"},"reference-count":53,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>Context:<\/jats:title>\n                    <jats:p>Anterior craniocervical junction lesions have always been a challenge for neurosurgeons. Presenting with lower cranial nerve dysfunction and symptoms of brainstem compression, decompression is often required. While posterior approaches offer indirect ventral brainstem decompression, direct decompression via odontoidectomy is necessary when they fail. The transoral and endoscopic endonasal approaches have been explored but come with their own limitations and risks. A novel retropharyngeal approach to the cervical spine has shown promising results with reduced complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>This study aims to explore the feasibility and potential advantages of the anterior retropharyngeal approach for accessing the odontoid process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Surgical Technique:<\/jats:title>\n                    <jats:p>To investigate the anatomical aspects of the anterior retropharyngeal approach, a paramedian skin incision was performed below the submandibular gland on two cadaveric specimens. The subcutaneous tissue followed by the platysma is dissected, and the superficial fascial layer is opened. The plane between the vascular sheath laterally and the pharyngeal structures medially is entered below the branching point of the facial vein and internal jugular vein. After reaching the prevertebral plane, further dissection cranially is done in a blunt fashion below the superior pharyngeal nerve and artery. Various anatomical aspects were highlighted during this approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The anterior, submandibular retropharyngeal approach to the cervical spine was performed successfully on two cadavers highlighting relevant anatomical structures, including the carotid artery and the glossopharyngeal, hypoglossal, and vagus nerves. This approach offered wide exposure, avoidance of oropharyngeal contamination, and potential benefit in repairing cerebrospinal fluid fistulas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>For accessing the craniocervical junction, the anterior retropharyngeal approach is a viable technique that offers many advantages. However, when employing this approach, surgeons must have adequate anatomical knowledge and technical proficiency to ensure better outcomes. Further studies are needed to enhance our anatomical variations understanding and reduce intraoperative risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jcvjs.jcvjs_112_23","type":"journal-article","created":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T00:00:12Z","timestamp":1701216012000},"page":"393-398","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Transcervical, retropharyngeal odontoidectomy \u2013 Anatomical considerations"],"prefix":"10.4103","volume":"14","author":[{"given":"Salim M.","family":"Yakdan","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob K.","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajit A.","family":"Krishnaney","sequence":"additional","affiliation":[{"name":"Center for Spine Health, Cleveland Clinic, Neurologic Institute, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E.","family":"Mroz","sequence":"additional","affiliation":[{"name":"Center for Spine Health, Cleveland Clinic, Neurologic Institute, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Spiessberger","sequence":"additional","affiliation":[{"name":"Center for Spine Health, Cleveland Clinic, Neurologic Institute, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,11,29]]},"reference":[{"key":"R1-20240904","doi-asserted-by":"crossref","first-page":"923","DOI":"10.3171\/2016.11.JNS16637","article-title":"Endoscopic endonasal resection of the odontoid process: Clinical outcomes in 34 adults","volume":"128","author":"Zwagerman","year":"2018","journal-title":"J Neurosurg"},{"key":"R2-20240904","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1227\/00006123-197809000-00012","article-title":"Transoral exposure of the atlantoaxial region","volume":"3","author":"Apuzzo","year":"1978","journal-title":"Neurosurgery"},{"key":"R3-20240904","doi-asserted-by":"crossref","first-page":"132","DOI":"10.25259\/SNI_237_2022","article-title":"Anterior transcervical release with posterior atlantoaxial fixation for neglected malunited type II odontoid fractures","volume":"13","author":"Rehman","year":"2022","journal-title":"Surg Neurol Int"},{"key":"R4-20240904","first-page":"158","article-title":"Radiographic and anatomic basis of endoscopic anterior craniocervical decompression: A comparison of endonasal, transoral, and transcervical approaches","volume":"65","author":"Baird","year":"2009","journal-title":"Neurosurgery"},{"key":"R5-20240904","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1080\/02688699550041304","article-title":"Transoral surgery: Some lessons learned","volume":"9","author":"Crockard","year":"1995","journal-title":"Br J Neurosurg"},{"key":"R6-20240904","doi-asserted-by":"crossref","first-page":"E239","DOI":"10.1097\/01.BRS.0000065489.02720.D8","article-title":"Pyogenic osteomyelitis of the odontoid process: Single stage decompression and fusion","volume":"28","author":"Suchomel","year":"2003","journal-title":"Spine (Phila Pa 1976)"},{"key":"R7-20240904","doi-asserted-by":"crossref","first-page":"895","DOI":"10.3171\/jns.1988.69.6.0895","article-title":"Transoral-transpharyngeal approach to the anterior craniocervical junction. 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