Posterior Transdural Approach for Odontoidectomy in a Child: Case Report

Abstract

INTRODUCTION The transoral transpharyngeal approach is the standard approach to resect the odontoid process and decompress the cervicomedullary spinal cord. There are some significant risks associated with this approach, however, including infection, CSF leak, prolonged intubation or tracheostomy, need for nasogastric tube feeding, extended hospitalization, and possible effects of phonation. Recently, a posterior transdural approach was used to resect retro-odontoid cysts in 3 adult patients. We sought to use a similar approach to perform a posterior transdural odontoidectomy METHODS We present the case of a 12-yr-old girl with Down syndrome and significant spinal cord compression from basilar invagination and a retro-flexed odontoid process. We performed a posterior transdural odontoidectomy prior to occiptocervical fusion. RESULTS At 12-mo follow-up, we report satisfactory clinical and radiographic outcomes with this approach. CONCLUSION In carefully selected patients, a posterior odonoidectomy is a viable approach that can safely provide adequate ventral decompression of the spinal cord.

Transdural Approach for Resection of Craniovertebral Junction Cysts: Case Series

“…18 Reported complications include posterior pharyngeal wall breakdown, need for prolonged intubation or tracheosotomy, tongue edema, phonation problems, and occult CSF leak. 7,19…”

“…18 Reported complications include posterior pharyngeal wall breakdown, need for prolonged intubation or tracheosotomy, tongue edema, phonation problems, and occult CSF leak. 7,19 More recently, the far-lateral approach has been described to address retro-odontoid cysts. Manhas et al described the case of a 74-year-old woman with recurrent myelopathy who demonstrated radiographic regression of the retro-odontoid cyst.…”

Commentary: Transcondylar Odontoid Resection and Stabilization for Craniovertebral Degenerative Compression: 2-Dimensional Operative Video

“…It would also likely avoid the need for brainstem auditory evoked response monitoring and allows for bilateral surgical fixation via the same incision during the same procedure. 10,12 Overall, a periodontoid pannus caused by craniocervical spondylosis remains one of the more difficult degenerative spinal lesions to treat. They can cause various neurological deficits and have the potential to create significant disability for the patient.…”

“…2,6,9 In the subset of patients in whom compression is not reduced after traction alone, alternative decompressive approaches must be performed. [10][11][12] The authors provide a detailed video describing the preoperative evaluation and surgical management of a patient with a nonneoplastic periodontoid pannus secondary to craniocervical instability and spondylotic changes. 13 Given that the anterior compression in this patient was irreducible, resection of the lesion was felt to be necessary.…”

Letter to the Editor. Posterior transdural approach for cervical stenosis caused by retroflexion of anterior elements in a child with Pfeiffer syndrome

“…TO THE EDITOR: We greatly enjoyed reading the article by Archer et al 1 (Archer J, Thatikunta M, Jea A. Posterior transdural approach for odontoidectomy in a child: case report. J Neurosurg Pediatr.…”