Endoscopic endonasal odontoidectomy: clinical series

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Spinal Surgery

Background:

• Odontoidectomy is a primary treatment for basilar invagination.
• Transoral-transpharyngeal odontoidectomy is the established standard.
• Endoscopic endonasal approach offers an alternative surgical route.

Purpose of the Study:

• To analyze the outcomes of endoscopic endonasal odontoidectomy.
• To evaluate the surgical technique, its advantages, and limitations.
• To compare the endoscopic endonasal approach with traditional methods.

Main Methods:

• Evaluation of consecutive endoscopic endonasal odontoidectomies since 2008.
• Pre- and postoperative neurological assessment (physical exam, ASIA scale, neurophysiology).
• Pre- and postoperative neuroradiological imaging (MRI, CT, radiography).

Main Results:

• The study included 5 cases with progressive tetraparesis, including irreducible atlantoaxial subluxation and basilar invagination.
• No surgical complications were observed; early extubation and oral feeding resumption were common.
• Neurological symptoms improved in 2 cases and stabilized in 3 cases at a mean follow-up of 34.2 months.

Conclusions:

• Endoscopic endonasal odontoidectomy is a safe, effective, and well-tolerated procedure.
• This approach can be advantageous for specific anatomical conditions like micrognathia and macroglossia.
• Different odontoidectomy approaches should be viewed as complementary, not alternatives.