Endoscopic Endonasal Odontoidectomy in the Hybrid Operating Room

The endoscopic endonasal approach for the craniovertebral junction (CVJ), instead of the microscopic transoral approach, has been widely adopted and accepted, especially in resection of the odontoid process for basilar invagination. However, there is concern regarding insufficient resection of odontoid and surgical complications, including vessel injuries, because this is a historically immature procedure. Here, we report a surgical case of endoscopic endonasal odontoidectomy (EEO) in the hybrid operating room (hOR) for improvement of its safety and reliability.

A 70-year-old man presented with a 2-month history of myelopathic gait disturbance and swallowing disturbance. Neuroimaging analysis indicated medulla oblongata compression associated with basilar invagination. The patient underwent EEO in the hOR after posterior instrumented fixation. With the hOR, the extent of bone resection and anatomic orientation were confirmed intraoperatively. Postoperative course was uneventful, and symptoms were improved after surgery.

The application of the hOR may make the EEO safe and precise for anterior decompression of the CVJ. To our knowledge, this is the first case report describing clinical experience of EEO in the hOR.