Microscopic Posterior Transdural Resection of Cervical Retro-Odontoid Pseudotumors

Retro-odontoid pseudotumors are noninflammatory masses formed posterior to the odontoid process. Because of their anatomy, the optimal surgical approach for resecting pseudotumors is controversial. Conventionally, 3 approaches are used: the anterior transoral approach, the lateral approach, and the posterior extradural approach; however, each approach has its limitations. The posterior extradural approach is the most common; however, it remains challenging due to severe epidural veins. Although regression of pseudotumors after fusion surgery has been reported, direct decompression and a pathologic diagnosis are ideal when the pseudotumor is large. We therefore developed a new microscopic surgical technique; transdural resection. After C1 laminectomy, the dorsal and ventral dura was incised while preserving the arachnoid. Removal of the pseudotumor was performed and both of the dura were repaired. The patient's clinical symptoms subsequently improved and the pathologic findings showed degenerative fibrocartilaginous tissue. In addition, no neurological deterioration, central spinal fluid leakage, or arachnoiditis was observed. Currently, the usefulness of the transdural approach has been reported for cervical and thoracic disk herniation. According to our results, the transdural approach is recommended for resection of retro-odontoid pseudotumors because it enables direct decompression of the spinal cord and a pathologic diagnosis.