Endoscopic endonasal odontoidectomy: a long-term follow-up results for a cohort of 21 patients

Abstract

Background Endoscopic endonasal odontoidectomy (EEO) has been described as a potential approach for craniovertebral junction (CVJ) disease which could cause anterior bulbomedullary compression and encroaching. Due to the atlantoaxial junction’s uniqueness and complex biomechanics, treating CVJ pathologies uncovers the challenge of preventing C1–C2 instability. A large series of patients treated with endonasal odontoidectomy is reported, analyzing the feasibility and necessity of whether or not to perform posterior stabilization. Furthermore, the focus is on the long-term follow-up, especially those whom only underwent partial C1 arch preservation without posterior fixation. Methods This study is a retrospective analysis of patients with ventral spinal cord compression for non-reducible CVJ malformation, consecutively treated with EEO from July 2011 to March 2019. Postoperative dynamic X-ray and CT scans were obtained in each case in order to document CVJ decompression as well as to exclude instability. The anterior atlas‐dens interval, posterior atlas‐dens interval and C1–C2 total lateral overhang were measured as a morphological criteria to determine upper cervical spine stability. Results Twenty-one patients (11:10 F:M) with a mean age of 60.6 years old at the time of surgery (range 34–84 years) encountered the inclusion criteria. For all 21 patients, a successful decompression was achieved at the first surgery. In 11 patients, the partial C1 arch integrity did not require a posterior cervical instrumentation on the bases of postoperative and constant follow-up radiological examination. In 13 cases, an improvement of motor function was recorded at the time of discharge. Only one patient had further motor function improvement at follow-up. Among the patients that did not show any significant motor change at discharge, 4 patients showed an improvement at the last follow-up. Conclusions The outcomes, even in C1 arch preservation without posterior fixation, are promising, and it could be said that the endonasal route potentially represents a valid option to treat lesions above the nasopalatine line.

3D-printed guides for cervical pedicle screw placement in primary spine tumor: Case report and technical description

“…The procedure was performed by using total intravenous anesthesia to allow intraoperative neuromonitoring (IONM). Once reached the lower clivus and the CVJ by using expanded endoscopic endonasal approach—as already reported in previous papers by the senior author ( 16 – 19 )—a huge mass was encountered into the rhinopharynx, and there was no chance to harvest the usually reverse U -shape flap. Therefore, a right naso-septal flap (NSF) was harvested with a laser.…”

Novelties for increased safety in cranio-vertebral surgery: a review

“…In the last few years, this paradigm shift has also been clearly demonstrated in the management of CVJ pathologies [ 17 , 24 , 57 , 74 ]. In 2022, Perrer et al reported on their surgical series of 21 patients who underwent endoscopic endonasal odontoidectomy with favorable clinical courses at long-term follow-up, even in those cases with C1 arch preservation without posterior fixation [ 53 ], in line with the preliminary findings by Mazzatenta et al [ 46 ].…”

“…The ongoing advancement in endoscopic skull base surgery has been transplanted to CVJ surgery to address anterior pathologies through a direct approach exploiting a close-up view of the relevant anatomy [ 16 , 21 , 53 , 69 ]. In the past, microscopic transoral approaches proved to be effective treatments of oncologic, traumatic, and degenerative diseases of the CVJ.…”

“…Increased safety at CVJ level has been obtained thanks to the implementation of endoscopic techniques for the abovementioned indications. Anterior open techniques to CVJ, e.g., transoral and transmaxillary, had been associated with an increased complication rate that is now extremely lowered by use of less invasive endoscopic guidance [ 17 , 24 , 53 , 57 ].…”

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

“…2 Another frequently reported complication in adults was pneumonia, which may be related to aspiration. 4,9,[16][17][18][19][20] In the pediatric population, there were several cases of reintubation due to aspiration. 12,21 There was one case of prolonged postoperative intubation for 3 days in an 11-year-old male with Down syndrome.…”