Endoscopic endonasal resection of the odontoid peg—case report and literature review

Beech, Thomas; McDermott, Ann-Louise; Kay, Andrew D.; Ahmed, Shahzada

doi:10.1007/s00381-012-1791-z

Cited by 14 publications

(9 citation statements)

References 30 publications

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“…EES has been successfully used for odontoidectomy in children, thereby avoiding the morbid transoral corridor. 15,16 Studies specific to pediatric craniopharyngioma have shown good outcomes 17,18 and may suggest EES is the preferred approach for this pathology, despite its anatomically heterogeneous presentations. 19…”

Section: Treatmentmentioning

confidence: 99%

Endoscopic Endonasal Repair of Congenital Defects of the Anterior Skull Base: Developmental Considerations and Surgical Outcomes

Gump

2015

J Neurol Surg B

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Techniques of endoscopic endonasal surgery, initially developed primarily for intracranial neoplasms, have been adapted to treat a wide variety of pathologies previously addressed with open craniotomy including congenital and acquired defects of the anterior skull base. Congenital defects can lead to herniation of leptomeninges containing cerebrospinal fluid alone or with brain tissue. Specific types of encephalocele can be defined on the basis of the associated abnormal bony anatomy. Endoscopic endonasal surgery represents a relatively recent development in the treatment of these entities. Technical considerations include relatively younger age range of the patient population, dimensions of preexisting bony defect, volume of herniated meninges and brain tissue, and distorted anatomy from abnormal development of the affected craniofacial skeleton. Recent highly detailed anatomical studies have quantitatively verified the utility of endoscopic endonasal surgery in the pediatric population. Particular attention has been directed toward adequacy of nasoseptal flap reconstruction in pediatric patients. Several reports have described patients with encephalocele of the anterior cranial fossa successfully treated with endoscopic surgery. The literature on endoscopic repair of congenital encephalocele is reviewed. Outcomes have generally been reported as favorable, although long-term follow-up and systematic studies have not been pursued.

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Section: Treatmentmentioning

confidence: 99%

Endoscopic Endonasal Repair of Congenital Defects of the Anterior Skull Base: Developmental Considerations and Surgical Outcomes

Gump

2015

J Neurol Surg B

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“…Serious complications documented in previous case reports and clinical series 3,[9][10][11][12]14,16,17,25,26,30,31,34 are infrequent. However, maintaining the integrity of the dura mater is crucial.…”

Section: Discussionmentioning

confidence: 81%

“…Previous studies 3,[9][10][11][12]14,16,17,22,25,26,30,31,34 have demonstrated the effectiveness and feasibility of an odontoidectomy performed using an EEA and suggest the possibility of less invasiveness than with the oral or cervical approaches. In our small series there is no evidence of different neurological functional outcomes between the techniques.…”

Section: Discussionmentioning

confidence: 99%

“…15 The EEA provides a shorter route to the surgical field 2 and the closeup view allows better drilling precision, which in our opinion prevents dural tears. In previous reports only 3 cases of velopharyngeal insufficiency (VPI) 3,25 have been detailed, which resolved during the follow-up, and there was 1 death attributed to pulmonary embolism 2 weeks after surgery. 25 In our series, we did not document VPI and there were no deaths.…”

Section: Discussionmentioning

confidence: 99%

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Evolution from microscopic transoral to endoscopic endonasal odontoidectomy

Ponce-Gómez

Ortega-Porcayo

Soriano-Baron

et al. 2014

FOC

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Object The goal of this study was to compare the indications, benefits, and complications between the endoscopic endonasal approach (EEA) and the microscopic transoral approach to perform an odontoidectomy. Transoral approaches have been standard for odontoidectomy procedures; however, the potential benefits of the EEA might be demonstrated to be a more innocuous technique. The authors present their experience with 12 consecutive cases that required odontoidectomy and posterior instrumentation. Methods Twelve consecutive cases of craniovertebral junction instability with or without basilar invagination were diagnosed at the National Institute of Neurology and Neurosurgery in Mexico City, Mexico, between January 2009 and January 2013. The EEA was used for 5 cases in which the odontoid process was above the nasopalatine line, and was compared with 7 cases in which the odontoid process was beneath the nasopalatine line; these were treated using the transoral microscopic approach (TMA). Odontoidectomy was performed after occipital-cervical or cervical posterior augmentation with lateral mass and translaminar screws. One case was previously fused (Oc–C4 fusion). The senior author performed all surgeries. American Spinal Injury Association scores were documented before surgical treatment and after at least 6 months of follow-up. Results Neurological improvement after odontoidectomy was similar for both groups. From the transoral group, 2 patients had postoperative dysphonia, 1 patient presented with dysphagia, and 1 patient had intraoperative CSF leakage. The endoscopic procedure required longer surgical time, less time to extubation and oral feeding, a shorter hospital stay, and no complications in this series. Conclusions Endoscopic endonasal odontoidectomy is a feasible, safe, and well-tolerated procedure. In this small series there was no difference in the outcome between the EEA and the TMA; however, fewer complications were documented with the endonasal technique.

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“…There were eight intraoperative cerebrospinal fluid (CSF) leaks (11.3%) that were all successfully treated with fibrin glue, fat graft, and mucosal flap repair. Beech et al 30 and Choudhri et al 31 each reported a case of velopharyngeal incompetency (2.8%) that resolved within 6 months of surgery. A further two cases of epistaxis, one case of persistent neuropathic pain, and one case of postoperative myocardial infarction were reported.…”

Section: Literature Reviewmentioning

confidence: 99%

Endoscopic Endonasal Approaches to the Craniovertebral Junction: A Systematic Review of the Literature

2015

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Background We reviewed the current literature pertaining to extended endoscopic endonasal approaches to the craniovertebral junction. Methods A systematic literature review was utilized to identify published surgical cases of endoscopic endonasal approaches to the craniovertebral junction. Full-text manuscripts were examined for various measures of surgical indications, patient characteristics, operative technique, and surgical outcomes. Results We identified 71 cases involving endoscopic endonasal approaches for surgical management of a variety of pathologies located within the craniovertebral junction. Patient ages ranged from 3 to 87 years, with 40 females and 31 males. Five patients required tracheostomy, two were reintubated, and all others experienced an average intubation duration of 0.54 days following surgery. Fifty-eight patients (81.7%) underwent an additional posterior decompression or fusion either before or after the endonasal procedure. A complete resection of the pathologic lesion was reported in 57 cases (83.8%), another five were successful biopsies, and four resulted in partial resection. The follow-up time ranged from 0.5 to 57 months. Conclusion Although the transoral approach has been the standard for anterior surgical management for the past several decades, our systematic review illustrates that the extended endoscopic endonasal approach is a safe and effective alternative for most pathologies affecting the craniovertebral junction.

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Endoscopic endonasal resection of the odontoid peg—case report and literature review

Cited by 14 publications

References 30 publications

Endoscopic Endonasal Repair of Congenital Defects of the Anterior Skull Base: Developmental Considerations and Surgical Outcomes

Endoscopic Endonasal Repair of Congenital Defects of the Anterior Skull Base: Developmental Considerations and Surgical Outcomes

Evolution from microscopic transoral to endoscopic endonasal odontoidectomy

Endoscopic Endonasal Approaches to the Craniovertebral Junction: A Systematic Review of the Literature

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