A new technique: endoscopic transmass odontoidotomy

Area of Science:

• Neurosurgery
• Spinal Surgery
• Endoscopic Techniques

Background:

• Basilar invagination (BI) is a craniovertebral junction anomaly requiring surgical intervention.
• Traditional odontoid resection methods carry significant risks and limitations.
• There is a need for alternative, less invasive surgical approaches for BI.

Purpose of the Study:

• To describe a novel endoscopic posterolateral odontoidotomy technique for managing basilar invagination.
• To evaluate the feasibility and outcomes of this minimally invasive approach.
• To present a case study of BI treated with endoscopic posterolateral odontoidotomy.

Main Methods:

• A 16-year-old male with basilar invagination underwent posterior occipito-cervical fusion.
• Due to symptom exacerbation, a subsequent endoscopic posterolateral transmass approach was used for odontoid resection.
• Partial odontoidectomy was performed, retaining the tip due to anatomical constraints.

Main Results:

• Post-operative imaging confirmed the odontoid tip migrated to the C2 base.
• A subarachnoid space was successfully created, decompressing the brainstem.
• One-year follow-up demonstrated sustained decompression and symptom improvement.

Conclusions:

• Endoscopic posterolateral transmass odontoidotomy is a feasible technique for partial or total odontoid resection.
• This approach offers a viable alternative to traditional methods, potentially avoiding additional surgical approaches and complications.
• The technique should be considered for patients requiring odontoidectomy.