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Endoscopic Endonasal Approach to the Odontoid Pathologies
Francesco Zenga1, Paolo Pacca1, Valentina Tardivo1
1Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.
World Neurosurgery
|February 13, 2016
Summary
Endoscopic endonasal odontoidectomy safely and effectively decompresses the brainstem in patients with ventral craniovertebral junction compression. This minimally invasive approach preserves palate function and offers direct access to the dens.
Area of Science:
- Neurosurgery
- Minimally Invasive Surgery
- Endoscopic Techniques
Background:
- Surgical anterior decompression is standard for irreducible ventral craniovertebral junction (CVJ) compression.
- The endonasal endoscopic route is an emerging alternative to the transoral approach for CVJ pathologies.
Observation:
- Twelve patients with symptomatic nonreducible ventral spinal cord compression underwent 3D endoscopic endonasal odontoidectomy.
- Surgical technique involved preservation of soft and hard palate.
Findings:
- Complete brainstem-medullary decompression was achieved in all patients.
- Ten of 12 patients had successful extubation post-procedure with preserved respiratory function.
- No cases of velopharyngeal insufficiency were reported; 5 patients had C1 anterior preservation without posterior fixation.
Implications:
- Endoscopic endonasal odontoidectomy is a safe and effective option for selected CVJ compression cases.
- Palate preservation minimizes risk of velopharyngeal insufficiency.
- 3D endoscopes and specialized tools enhance surgical precision for this demanding approach.
