Endonasal Endoscopic Odontoidectomy: Operative Nuances

Microscopic transoral approach (TOA) has been considered as the gold standard for anterior decompression of the cranio-vertebral junction (CVJ). The progress in endonasal endoscopic procedures has made it possible to perform odontoidectomy via a minimally invasive transnasal route.

The aim is to critically analyze our cases of odontoid subluxation and those described in the literature that were treated by the endonasal endoscopic odontoidectomy (EEA).

Seven consecutive patients that failed conservative treatment and other surgical procedures of atlanto-axial dislocation, were managed surgically by endonasal endoscopic odontoidectomy at our institution. There were 4 patients with basilar invagination, Chiari malformation, and atlanto-axial dislocation, and one patient each with a tumor of the odontoid process, retropharyngeal abscess, and osteomyelitis.

None of our patients developed velopharyngeal insufficiency, respiratory distress, speech disturbances, or CSF leak after surgery. Transoral odontoidectomy, tracheostomy, gastrostomy, or prolonged ventilation was not required in any patients. One patient developed transient swallowing difficulty postoperatively which improved after a few weeks.

The endonasal endoscopic odontoidectomy is a safe and effective procedure for patients with non-reducible atlanto-axial dislocation. The technique allows optimal viewing when using angulated instruments and angled endoscopes.