Anatomical location of the vertebrobasilar junction: computed tomography morphometrics for planning endoscopic transsphenoidal transclival approaches

Background: The aim of this study was to determine the anatomical localisation and morphometry of vertebrobasilar junction (VBJ) by computed tomography (CT) images which may be helpful in planning the correct procedure before surgery such as endoscopic transsphenoidal transclival approach to the retroclival space. Materials and methods: Vertebrobasilar junction level was determined on axial, coronal reformat and sagittal reformat images. Clivus length, the distances of the VBJ to the upper and lower end of the clivus and to the bottom of the sphenoid sinus were measured. In addition, the position and distance of the VBJ relative to the midline were measured. The vertebral artery dominance was determined and the position of VBJ relative to the midline was evaluated. Results: When compared by gender, 1, a, b and c values were significantly longer in males than in females (p < 0.05). The location of the bottom of the sphenoid sinus was higher than the VBJ level in 263 (98.1%) cases, equal to the VBJ level in 1 (0.4%) case, and lower than the VBJ level in 4 (1.5%) cases. There was no statistically significant difference between the distances to the midline when the VBJs with right and left localisation were compared (p > 0.05). A statistically significant relationship was found between vertebral artery predominance and localisation of VBJ relative to the midline (p < 0.001). Conclusions: Careful perusal of CT images and the described VBJ morphometrics can help in accurate procedure planning to avoid basilar artery injury

Endoscopy

Endoscopy is a fast moving field, and new techniques are continuously emerging. In recent decades, endoscopy has evolved and branched out from a diagnostic modality to enhanced video and computer assisting imaging with impressive interventional capabilities. The modern endoscopy has seen advances not only in types of endoscopes available, but also in types of interventions amenable to the endoscopic approach. To date, there are a lot more developments that are being trialed. Modern endoscopic equipment provides physicians with the benefit of many technical advances. Endoscopy is an effective and safe procedure even in special populations including pediatric patients and renal transplant patients. It serves as the tool for diagnosis and therapeutic interventions of many organs including gastrointestinal tract, head and neck, urinary tract and others