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Kenji Tanaka, Kazufumi Ito and Toshio Wagai

. 5. Direct application of a sterile transducer on the brain surface (5 megacycle). (3) Transoral Examination Although the above methods gave successful results in diagnosing supratentorial tumors, the results in the infratentorial cases were unsatisfactory. For this reason we used a transoral approach for ultrasonic examination of this area. A specially designed transducer was used with a barium titanate disc 10 mm. in diameter with 2.25 megacycle resonance. The ultrasonic wave is irradiated through the pharyngeal region of the oral cavity under

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George C. Stevenson, Ronald J. Stoney, Roland K. Perkins and John E. Adams

route, 54 an intraoral excision, 11 a transoral approach with resection of the lower jaw and soft palate, 35 a transoral transpalatal approach, 38, 40 and a subtemporal or subparieto-occipital exposure with tentorial splitting. 8, 44, 48, 57 Because these approaches are so often accompanied by meningeal infection 21, 38 and occasionally by serious hemorrhage, 21 an approach through the neck would be more desirable. During recent studies in our laboratory on the cerebral blood flow in the isolated intracranial circulation in monkeys, we needed to ligate the

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S. Mullan, R. Naunton, J. Hekmat-Panah and G. Vailati

patients and in the thoracic lumbar vertebrae of a 6th have been removed through an anterior or antero-lateral approach. In 4 of these cases, the cavity was filled with bone graft which fused with the surrounding bone in 3. We have suggested that the transoral approach may be a useful one in dealing with tumors and congenital abnormalities of the anterior foramen magnum and that selected patients with very slowly growing vertebral tumors may benefit by excision and grafting at the earliest detected stage. References 1. Bucy , P. C. The

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Alvin D. Greenberg, William B. Scoville and Lycurgus M. Davey

T he transoral approach to the upper cervical spine is not a new procedure. In 1930, German 5 demonstrated its feasibility in dogs; Crowe 12 drained several cases of tuberculous spondylitis and retropharyngeal abscesses through the mouth; Scoville 10 reported its use for removal of the odontoid process in basilar impression; Southwick and Robinson 12 and Mosberg and Lippman 7 described the transoral treatment of lesions of the second cervical vertebra; Fang and Ong 3 reported six cases of transoral reduction and fusion of atlanto-axial dislocations

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A. N. Guthkelch and R. G. Williams

mitigate the possibility of postoperative edema of the mouth and pharynx, a complication which did not occur in either of our patients. The transoral approach involves a much less taxing preliminary dissection than the transcervical route advocated by Stevenson and his colleagues. 4 Although the latter avoids the risk of infection associated with working through the pharynx, our limited experience indicates that this complication can be avoided when the transoral route is used, even if the dura has been opened. Acknowledgments We wish to acknowledge the help

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Michael H. Sukoff, Milton M. Kadin and Terrance Moran

✓ A case of rheumatoid cervical myelopathy that responded to posterior decompression and fusion is presented. Progression of the disease ultimately required anterior decompression through a transoral approach.

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Shelley N. Chou and Humberto J. Ortiz-Suarez

on the location of the lesion. We believe there is little doubt that the lesions close to the top of the basilar should be approached subtemporally and those on the vertebral up to the PICA are best reached suboccipitally. The aneurysms situated at or close to the junction of the vertebrals can only be exposed via an anterior approach, either transclivally or transorally. We have not used the transoral approach for fear of contaminating the subarachnoid space. However, the transclival approach is an extremely time-consuming and difficult one. In each of our cases

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John L. Fox and Alvaro Jerez

-mouth anteroposterior view, showing the odontoid process (arrow) . a: odontoid process in front of anterior arch of C-1; b: right superior facet of C-2; c: left superior facet of C-2; d: right inferior facet of C-1; e: left inferior facet of C-1; f: spinous process of C-2; g: mastoid process; h: superior facet of C-3. Operation . On June 18, 1975, the axis and atlas were exposed surgically via an anterior transoral approach. The odontoid previously could be palpated through the open mouth. The axis-atlas relationship was as described above, except that the odontoid appeared to

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Foramen magnum tumors

Analysis of 57 cases of benign extramedullary tumors

Shozo Yasuoka, Haruo Okazaki, Jasper R. Daube and Collin S. MacCarty

suboccipital craniectomy and cervical laminectomy. Although the transoral approach has been successful for some authors, 24 macroscopic total removal was possible in all patients without the employment of the anterior approach, even in the patient with a meningioma situated anterior to the spinal cord. In three patients who were tetraplegic, prophylactic tracheostomy was performed before the removal of the tumor in order to prevent postoperative respiratory distress. Two operative deaths occurred. One patient died of cardiac arrest secondary to malignant hyperthermia

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Akira Yamaura, Hiroyasu Making, Katsumi Isobe, Tsuneo Takashima, Takao Nakamura and Sanzo Takemiya

✓ A technique for closure of a cerebrospinal fluid fistula following a transoral transclival approach to a basilar aneurysm is described. Transposition of a rotation flap of the mucosa of the septum and the floor of the posterior nasal cavity in the choana resulted in complete closure of the thin and fragile nasopharynx without tension at the suture site.