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Endonasal Endoscopic Odontoidectomy: Operative Nuances.
Suresh K Sankhla1, Anshu Warade, Ghulam M Khan
1Department of Neurosurgery, Gleneagles Hospital. Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India.
Neurology India
|January 9, 2026
Summary
Endonasal endoscopic odontoidectomy (EEA) offers a safe and effective minimally invasive alternative for treating non-reducible atlanto-axial dislocation. This technique provides optimal visualization for complex cranio-vertebral junction decompression.
Area of Science:
- Neurosurgery
- Minimally Invasive Surgery
- Spine Surgery
Background:
- The transoral approach (TOA) is the traditional standard for anterior decompression of the cranio-vertebral junction (CVJ).
- Advancements in endoscopic techniques enable minimally invasive transnasal odontoidectomy.
Purpose of the Study:
- To critically analyze cases of odontoid subluxation treated with endonasal endoscopic odontoidectomy (EEA).
- To evaluate the safety and efficacy of EEA for cranio-vertebral junction pathologies.
Main Methods:
- Seven patients with atlanto-axial dislocation refractory to conservative treatment underwent EEA.
- Patient conditions included basilar invagination, Chiari malformation, odontoid tumors, abscess, and osteomyelitis.
Main Results:
- No EEA patients experienced velopharyngeal insufficiency, respiratory distress, speech issues, or CSF leaks.
- Tracheostomy, gastrostomy, and prolonged ventilation were avoided.
- One patient had transient swallowing difficulties that resolved postoperatively.
Conclusions:
- Endonasal endoscopic odontoidectomy (EEA) is a safe and effective treatment for non-reducible atlanto-axial dislocation.
- The technique facilitates superior visualization with specialized endoscopic instruments.
