Endoscopic transnasal odontoidectomy to treat basilar invagination with congenital osseous malformations

Yu, Yong; Wang, Xuejian; Zhang, Xiaobiao; Hu, Fan; Gu, Yajia; Xie, Tao; Jiang, Xiaoxing; Jiang, Chun

doi:10.1007/s00586-012-2605-4

Cited by 57 publications

(53 citation statements)

References 30 publications

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“…Yu et al 106 reported on 3 patients who underwent an endoscopic endonasal odontoidectomy for basilar invagination. The authors used a posterior U-shaped nasopharyngeal flap to gain access to the clivus, anterior arch of C-1, and the odontoid process.…”

Section: Effectiveness Of the Approachmentioning

confidence: 99%

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Dlouhy

Dahdaleh

Menezes³

et al. 2015

FOC

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The craniovertebral junction (CVJ), or the craniocervical junction (CCJ) as it is otherwise known, houses the crossroads of the CNS and is composed of the occipital bone that surrounds the foramen magnum, the atlas vertebrae, the axis vertebrae, and their associated ligaments and musculature. The musculoskeletal organization of the CVJ is unique and complex, resulting in a wide range of congenital, developmental, and acquired pathology. The refinements of the transoral approach to the CVJ by the senior author (A.H.M.) in the late 1970s revolutionized the treatment of CVJ pathology. At the same time, a physiological approach to CVJ management was adopted at the University of Iowa Hospitals and Clinics in 1977 based on the stability and motion dynamics of the CVJ and the site of encroachment, incorporating the transoral approach for irreducible ventral CVJ pathology. Since then, approaches and techniques to treat ventral CVJ lesions have evolved. In the last 40 years at University of Iowa Hospitals and Clinics, multiple approaches to the CVJ have evolved and a better understanding of CVJ pathology has been established. In addition, new reduction strategies that have diminished the need to perform ventral decompressive approaches have been developed and implemented. In this era of surgical subspecialization, to properly treat complex CVJ pathology, the CVJ specialist must be trained in skull base transoral and endoscopic endonasal approaches, pediatric and adult CVJ spine surgery, and must understand and be able to treat the complex CSF dynamics present in CVJ pathology to provide the appropriate, optimal, and tailored treatment strategy for each individual patient, both child and adult. This is a comprehensive review of the history and evolution of the transoral approaches, extended transoral approaches, endoscopie assisted transoral approaches, endoscopie endonasal approaches, and CVJ reduction strategies. Incorporating these advancements, the authors update the initial algorithm for the treatment of CVJ abnormalities first published in 1980 by the senior author.

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Section: Effectiveness Of the Approachmentioning

confidence: 99%

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Dlouhy

Dahdaleh

Menezes³

et al. 2015

FOC

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“…1,24 In the past several years, there also have been case reports of ETO published by several authors worldwide. 3,7,11,12,17,18,28,30,31,37,39,40 However, reports on a series of consecutive patients who underwent ETO and long-term follow-up, including data on radiological and clinical outcomes and complications, are still scarce.The present study is, to date, the largest series reported on purely endoscopic transnasal resection of the odontoid process. The aim of this article is to describe the evolution of our surgical techniques for ETO and the outcomes in our series of patients.…”

mentioning

confidence: 99%

Endoscopic transnasal odontoidectomy without resection of nasal turbinates: clinical outcomes of 13 patients

Yen

Chang

Huang

et al. 2014

SPI

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Object The goal of the study was to report a series of consecutive patients who underwent endoscopic transnasal odontoidectomy (ETO) without resection of nasal turbinates. The techniques for this minimally invasive approach are described in detail. Methods The authors conducted a retrospective review of consecutive patients who underwent ETO for basilar invagination. All the patients had myelopathy caused by compression at the cervicomedullary junction, which required surgical decompression. Preoperative and postoperative data, including those from radiographic and clinical evaluations, were compared. Morbidity and mortality rates for the procedure are also reported in detail. Results Thirteen patients (6 men and 7 women) with a mean age of 52.7 years (range 24–72 years) were enrolled. The basilar invagination etiologies were rheumatoid arthritis (n = 5), trauma (n = 4), os odontoideum (n = 2), ankylosing spondylitis (n = 1), and postinfectious deformity (n = 1). The average follow-up duration was 51.2 months (range 0.3–105 months). One patient died 10 days after the operation as a result of meningitis caused by CSF leakage. Among the other 12 patients, the average postoperative Nurick grade (3.2) was significantly improved over that before the operation (4.1, p = 0.004). The mean (± SD) duration of postoperative intubation was 1.5 ± 2.1 days, and there was no need for perioperative tracheostomy or nasogastric tube feeding. There also was no postoperative velopharyngeal insufficiency. There were 6 (46%) intraoperative and 2 (15%) postoperative CSF leaks in the 13 patients in this series. Conclusions ETO is a viable and effective option for decompression at the ventral cervicomedullary junction. This approach is minimally invasive and causes little velopharyngeal insufficiency. The pitfall of this approach is the difficulty in repairing dural defects and subsequent CSF leakage.

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“…14 Several indications for anterior decompression and odontoidectomy include irreducible basilar invagination, 13,17,22,26,27,34,50,52,53 severe compressive rheumatoid pannus not resolved by posterior stabilization, 14,40,51 os odontoideum, 29,32 and severely retroflexed odontoid processes associated with Chiari malformation Type I.…”

Section: Neurosurg Focus 38 (4):e17 2015mentioning

confidence: 99%

“…

neurosurgical focus

Neurosurg Focus 38 (4):E17, 2015V arious abnormalities of the craniocervical junction can result in ventral compression of the cervicomedullary junction and require anterior decompression, including resection of the C-1 arch and odontoidectomy.14 Several indications for anterior decompression and odontoidectomy include irreducible basilar invagination, 13,17,22,26,27,34,50,52,53 severe compressive rheumatoid pannus not resolved by posterior stabilization, 14,40,51 os odontoideum, 29,32 and severely retroflexed odontoid processes associated with Chiari malformation Type I.

21The transoral approach has been the accepted workhorse and gold standard for anterior decompression of the craniocervical junction for the last several decades. 3,5,[7][8][9][10]17,20,30,[35][36][37]39,47 This approach provides the most direct anterior route to the ventral craniocervical junction.

…”

mentioning

confidence: 99%

Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances

Liu

Patel²,

Goldstein³

et al. 2015

FOC

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The transoral approach is considered the gold-standard surgical route for performing anterior odontoidectomy and ventral decompression of the craniovertebral junction for pathological conditions that result in symptomatic cervicomedullary compression, including basilar invagination, rheumatoid pannus, platybasia with retroflexed odontoid processes, and neoplasms. Extended modifications to increase the operative corridor and exposure include the transmaxillary, extended “open-door” maxillotomy, transpalatal, and transmandibular approaches. With the advent of extended endoscopic endonasal skull base techniques, there has been increased interest in the last decade in the endoscopic endonasal transclival transodontoid approach to the craniovertebral junction. The endonasal route represents an attractive minimally invasive surgical alternative, especially in cases of irreducible basilar invagination in which the pathology is situated well above the palatine line. Angled endoscopes and instrumentation can also be used for lower-lying pathology. By avoiding the oral cavity and subsequently using a transoral retractor, the endonasal route has the advantages of avoiding complications related to tongue swelling, tracheal swelling, prolonged intubation, velopharyngeal insufficiency, dysphagia, and dysphonia. Postoperative recovery is quicker, and hospital stays are shorter. In this report, the authors describe and illustrate their method of purely endoscopic endonasal transclival odonotoidectomy for anterior decompression of the craniovertebral junction and describe various operative pearls and nuances of the technique for avoiding complications.

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Endoscopic transnasal odontoidectomy to treat basilar invagination with congenital osseous malformations

Cited by 57 publications

References 30 publications

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Endoscopic transnasal odontoidectomy without resection of nasal turbinates: clinical outcomes of 13 patients

Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances

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