• Daniele Armocida, Brunetto Giacoma Maria Floriana GMF Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy., Luca Proietti, Mauro Palmieri, Alessandro Pesce, Antonio Santoro, Giorgio Balsamo, Giovanni Di Nardo, and Alessandro Frati.
• Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy. Electronic address: danielearmocida@yahoo.it.
• World Neurosurg. 2020 Sep 1; 141: 219-225.

BackgroundPharyngoesophageal injury during anterior cervical spine surgery is a rare and potentially life-threatening complication; generally it is the result of intraoperative manipulation or hardware erosion and sometimes may be due to weakness of the pharyngoesophageal wall from pre-existing pathologic conditions, such as diabetes, gastritis, or obesity.Case DescriptionWe describe the management strategies in patients with an early postoperative hypopharyngeal perforation that occurred after anterior cervical spine surgery without failure of instrumentation, and we present a case treated endoscopically at our institution.ConclusionsAppropriate treatment for pharyngoesophageal perforations is controversial and not investigated in detail. There is a lack of prospective studies comparing initial conservative versus surgical approaches to treatment. In addition, endoscopic management is growing as a therapeutic option, but no consensus concerning the indications for an endoscopic approach in the treatment of pharyngoesophageal injury in anterior cervical spine surgery is currently reached. A common theme proposed in the literature is that early recognition and aggressive investigation and treatment are essential to ensure a good outcome. A customized interdisciplinary surgical approach is essential for successful treatment. Use of the transoral endoscopic approach is a useful noninvasive method to treat this rare but potentially devastating complication.Copyright © 2020 Elsevier Inc. All rights reserved.

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