Endoscopic transnasal resection of the odontoid: case series and clinical course

Abstract

The transoral route is the gold standard for odontoid resection. Results are satisfying though surgery can be challenging for patients and surgeons due to its invasiveness. A less invasive transnasal approach could provide a sufficient extent of resection with less collateral damage. The technique of transnasal endoscopic odontoid resection is demonstrated by a case series of three patients. A fully endoscopic transnasal odontoid resection was conducted by use of CT-based neuronavigation. A complete odontoid resection succeeded in all patients. Symptoms such as dysarthria, swallowing disturbance, salivary retention, myelopathic gait disturbances, neck pain, and tetraparesis improved in all patients markedly. Transnasal endoscopic odontoid resection is a feasible alternative to the transoral technique. It leaves the oropharynx intact, which could result in lower approach related complications especially in patients with bulbar symptoms.

Evolution from microscopic transoral to endoscopic endonasal odontoidectomy

“…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.…”

“…Hickman et al 12 reported a pediatric endonasal odontoidectomy that required a second intervention, and they explained that the main factor was the lack of accuracy of the navigation system because of the loosening of the head pins in the thin skull attributable to osteogenesis imperfecta. Gempt et al 9 performed a second surgery for a laterally and caudally expanded resection 5 days after the first surgery, due to persistent symptoms and brainstem compression. They agreed with the importance of neuronavigation because there are no clear landmarks for the lateral extent of the resection; however, the lateral exposure is limited by the eustachian tubes initially and by the atlantooccipital articulation deep in the field.…”

“…1,22 In 2005, Kassam et al 14 documented an expanded endoscopic endonasal approach (EEA), which has since been used, modified, and reported by several authors. 9,11,12,[16][17][18]34,36 We present our experience with craniocervical pathological entities that required posterior instrumentation and odontoidectomy. Endoscopic endonasal odontoidectomy (EEO) and transoral microscopic odontoidectomy (TMO) are described, analyzed, and compared.…”

Os Odontoideum: Review Article

“…Recent studies indicate the description of endoscopic endonasal odontoidectomy in a patient with Down syndrome suffering from irreducible IAAD due to OO, as reported by Magrini et al 17 In 2011, Gempt et al performed the same procedure in a 52-year-old female with OO. 137 A relatively safer route, endoscopic odontoidectomy via transcervical corridor, was described by Wolinsky et al 138 This route is similar to that which has been previously described by Smith and Robinson, with the only difference being that the incision is at a higher cervical region. Through the application of these techniques, the offending anterior bony mass, redundant ligaments, granulation, and hypertrophic scar tissues are removed until adequate ventral decompression has been achieved.…”

“…61 In 2011, Gempt et al performed the same procedure in a 52-year-old female with OO. 137 Recent studies indicate the contribution of Yen et al who operated on 13 patients suffering from IAAD via transnasal endoscopic odontoidectomy without resection of nasal turbinate. Two out of these 13 reported cases implicated OO.…”