Endoscopic Endonasal Approach to the Craniovertebral Junction Lesions: A Case Series of 18 Patients

Abstract

Introduction: Odontoid pathologies constitute a special category because they may lead to instability. Instability is defined by abnormal spinal alignment under physiologic conditions (loads) such as standing, walking, bending, or lifting. Since instability poses a risk of cord damage, surgical interventions may be required for durable long-term stabilization. This study demonstrates operative technique and results of endoscopic endonasal approach to the odontoid. Methods: We conducted a retrospective study involving 18 patients who underwent endoscopic endonasal odontoidectomy (EEO) due to Craniovertebral pathologies. Demographic data, clinical features of the patients, risk factors, intraoperative and postoperative complications were reported in this series. Results: Satisfactory outcomes achieved in 16 patients based on comparing modified Rankin scale before and after the surgery (P value= 0.0001). The mean duration for EEO was 232.6 ± 18.8 minutes. The mean blood loss during surgery was 386.67 ± 153.04 ml. The mean duration of hospital stay was seven days. All patients were extubated within a few hours after surgery. Against the backdrop of a successful anterior decompression in the aforementioned cases, intraoperative cerebrospinal fluid (CSF) leakage, postoperative meningitis, and pulmonary thromboembolism have emerged as devastating complications. However, two intraoperative CSF leakages were managed by direct dural repair and fat graft; two patients died due to postoperative meningitis and pulmonary thromboembolism 7 and 4 days after the second surgery. Conclusion: In conclusion, EEO can be effectively used for anterior decompression of the odontoid pathologies, despite the risk of complications.

Complications of Endonasal Odontoidectomy in Pediatric versus Adult Populations: A Systematic Review and Meta-Analysis

“…24 Other reported complications included pneumocephalus, hydrocephalus, and new neurologic deficits. 18,19,[25][26][27] Meta-analysis identified that neurologic complications occurred at a significantly higher rate in pediatric patients. One possible reason for this may be due to challenges in CSF leak closure in the clival and upper cervical spine region, which may be more difficult in children when reconstructive options such as the nasoseptal flap yield less surface area coverage, and therefore increasing their potential risk for postoperative CSF leak and meningitis.…”