Evolution from microscopic transoral to endoscopic endonasal odontoidectomy

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Spinal Surgery

Background:

• Odontoidectomy is a standard procedure for craniovertebral junction instability.
• Transoral microscopic approach (TMA) has been the traditional method.
• Endoscopic endonasal approach (EEA) presents a potentially less invasive alternative.

Purpose of the Study:

• To compare indications, benefits, and complications of EEA versus TMA for odontoidectomy.
• To evaluate the safety and efficacy of EEA in treating craniovertebral junction instability.

Main Methods:

• Retrospective analysis of 12 consecutive cases of craniovertebral junction instability.
• Comparison between 5 cases treated with EEA and 7 cases treated with TMA.
• Odontoidectomy performed after posterior instrumentation; neurological status assessed using American Spinal Injury Association scores.

Main Results:

• Neurological improvement was comparable between EEA and TMA groups.
• EEA group experienced no complications, while TMA group had dysphonia, dysphagia, and CSF leakage.
• EEA required longer surgical time but resulted in faster extubation, oral feeding, and shorter hospital stay.

Conclusions:

• Endoscopic endonasal odontoidectomy is a feasible, safe, and well-tolerated procedure.
• EEA demonstrated a lower complication rate compared to TMA in this series.
• Both approaches yielded similar neurological outcomes for odontoidectomy.