Endoscopic endonasal odontoidectomy with anterior C1 arch preservation in elderly patients affected by rheumatoid arthritis

Iacoangeli, Maurizio; Gladi, Maurizio; Alvaro, Lorenzo; Rienzo, Alessandro Dı; Specchia, Nicola; Scerrati, Massimo

doi:10.1016/j.spinee.2013.01.043

Cited by 53 publications

(44 citation statements)

References 30 publications

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“…11,12,17,18,26,30,31 There also have been reports about using ETO in pediatric and elderly patients. 12,19,28 Unlike the technique used in these other published cases, which uniformly involved a U-shaped mucosal flap, we used a linear vertical mucosal incision in the nasopharynx. By following the midline, this vertical linear incision theoretically reduced the risks of compromising the opening of the eustachian tubes or vidian nerves.…”

Section: Discussionmentioning

confidence: 99%

“…1,24 In the past several years, there also have been case reports of ETO published by several authors worldwide. 3,7,11,12,17,18,28,30,31,37,39,40 However, reports on a series of consecutive patients who underwent ETO and long-term follow-up, including data on radiological and clinical outcomes and complications, are still scarce.The present study is, to date, the largest series reported on purely endoscopic transnasal resection of the odontoid process. The aim of this article is to describe the evolution of our surgical techniques for ETO and the outcomes in our series of patients.…”

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confidence: 99%

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Endoscopic transnasal odontoidectomy without resection of nasal turbinates: clinical outcomes of 13 patients

Yen

Chang

Huang

et al. 2014

SPI

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Object The goal of the study was to report a series of consecutive patients who underwent endoscopic transnasal odontoidectomy (ETO) without resection of nasal turbinates. The techniques for this minimally invasive approach are described in detail. Methods The authors conducted a retrospective review of consecutive patients who underwent ETO for basilar invagination. All the patients had myelopathy caused by compression at the cervicomedullary junction, which required surgical decompression. Preoperative and postoperative data, including those from radiographic and clinical evaluations, were compared. Morbidity and mortality rates for the procedure are also reported in detail. Results Thirteen patients (6 men and 7 women) with a mean age of 52.7 years (range 24–72 years) were enrolled. The basilar invagination etiologies were rheumatoid arthritis (n = 5), trauma (n = 4), os odontoideum (n = 2), ankylosing spondylitis (n = 1), and postinfectious deformity (n = 1). The average follow-up duration was 51.2 months (range 0.3–105 months). One patient died 10 days after the operation as a result of meningitis caused by CSF leakage. Among the other 12 patients, the average postoperative Nurick grade (3.2) was significantly improved over that before the operation (4.1, p = 0.004). The mean (± SD) duration of postoperative intubation was 1.5 ± 2.1 days, and there was no need for perioperative tracheostomy or nasogastric tube feeding. There also was no postoperative velopharyngeal insufficiency. There were 6 (46%) intraoperative and 2 (15%) postoperative CSF leaks in the 13 patients in this series. Conclusions ETO is a viable and effective option for decompression at the ventral cervicomedullary junction. This approach is minimally invasive and causes little velopharyngeal insufficiency. The pitfall of this approach is the difficulty in repairing dural defects and subsequent CSF leakage.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Endoscopic transnasal odontoidectomy without resection of nasal turbinates: clinical outcomes of 13 patients

Yen

Chang

Huang

et al. 2014

SPI

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“…25,47,55 Although these extended approaches can lead to significant enhancement of the surgical exposure, they also significantly increase surgical complexity and the depth of the operative corridor, rates of morbidities such as infections from bacterial oral flora, velopharyngeal insufficiency, hypernasal speech, nasal regurgitation, soft palate dehiscence, tongue edema, and necrosis, and the potential need for tracheotomy and nasogastric feeding tube, resulting in a longer hospital recovery time. 10,37,41,45 In the last decade, some minimally invasive endoscopic approaches, such as the EEA, 7,8,11,18,19,[21][22][23][24]26,27,29,30,[33][34][35]40,44,51 the ETA, 16,17 a combined EEA/ETA with or without the assistance of robotics, 12,13,31,32,50,54 and a transcervical approach, 53 have been adopted to address CVJ pathology. The growing number of publications in the last decade shows that the EEA can be an excellent minimal-access alternative to traditional transoral surgery and offers certain anatomical advantages.…”

Section: Discussionmentioning

confidence: 99%

“…All these publications highlight the benefits of endoscopic endonasal odontoidectomy as a safe, effective, and welltolerated technique. 7,8,11,18,19,[21][22][23][24]26,27,29,30,[33][34][35]40,44,51 The main advantages of the EEA over the traditional microscopic approaches are the location of the incision (in the nasopharynx rather than the oropharynx) and the wider, closer, and brighter view provided by the endoscope.…”

Section: Discussionmentioning

confidence: 99%

The rhinopalatine line as a reliable predictor of the inferior extent of endonasal odontoidectomies

Corte

Aldana

Ferroli

et al. 2015

FOC

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OBJECT The endoscopic endonasal approach (EEA) provides a minimally invasive corridor through which the cervicomedullary junction can be decompressed with reduced morbidity rates compared to those with the classic transoral approaches. The limit of the EEA is its inferior extent, and preoperative estimation of its reach is vital for determining its suitability. The aim of this study was to evaluate the actual inferior limit of the EEA in a surgical series of patients and develop an accurate and reliable predictor that can be used in planning endonasal odontoidectomies. METHODS The actual inferior extent of surgery was determined in a series of 6 patients with adequate preoperative and postoperative imaging who underwent endoscopie endonasal odontoidectomy. The medians of the differences between several previously described predictive lines, namely the nasopalatine line (NPL) and nasoaxial line (NAxL), were compared with the actual surgical limit and the hard-palate line by using nonparametric statistics. A novel line, called the rhinopalatine line (RPL), was established and corresponded best with the actual limit of the surgery. RESULTS There were 4 adult and 2 pediatric patients included in this study. The NPL overestimated the inferior extent of the surgery by an average (± SD) of 21.9 ± 8.1 mm (range 14.7-32.5 mm). The NAxL and RPL overestimated the inferior limit of surgery by averages of 6.9 ± 3.8 mm (range 3.7-13.3 mm) and 1.7 ± 3.7 mm (range −2.8 to 8.3 mm), respectively. The medians of the differences between the NPL and NAxL and the actual surgery were statistically different (both p = 0.0313). In contrast, there was no statistically significant difference between the RPL and the inferior limit of surgery (p = 0.4375). CONCLUSIONS The RPL predicted the inferior limit of the EEA to the craniovertebral junction more accurately than previously described lines. The use of the RPL may help surgeons in choosing suitable candidates for the EEA and in selecting those for whom surgery through the oropharynx or the facial bones is the better approach.

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“…6,14,18,43 The endoscopic endonasal approach for odontoidectomy has been investigated in cadaveric studies and in several clinical studies. 2,4,6,14,18,23,24,28,32,33,38,[40][41][42][43][44][45][46]48 Although several variations in technique exist in the literature, the aims of this report are to describe our method of the purely endoscopic endonasal transclival transodontoid approach for anterior decompression of the craniovertebral junction and to describe various operative pearls and nuances of the technique.…”

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confidence: 99%

Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances

Liu

Patel²,

Goldstein³

et al. 2015

FOC

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The transoral approach is considered the gold-standard surgical route for performing anterior odontoidectomy and ventral decompression of the craniovertebral junction for pathological conditions that result in symptomatic cervicomedullary compression, including basilar invagination, rheumatoid pannus, platybasia with retroflexed odontoid processes, and neoplasms. Extended modifications to increase the operative corridor and exposure include the transmaxillary, extended “open-door” maxillotomy, transpalatal, and transmandibular approaches. With the advent of extended endoscopic endonasal skull base techniques, there has been increased interest in the last decade in the endoscopic endonasal transclival transodontoid approach to the craniovertebral junction. The endonasal route represents an attractive minimally invasive surgical alternative, especially in cases of irreducible basilar invagination in which the pathology is situated well above the palatine line. Angled endoscopes and instrumentation can also be used for lower-lying pathology. By avoiding the oral cavity and subsequently using a transoral retractor, the endonasal route has the advantages of avoiding complications related to tongue swelling, tracheal swelling, prolonged intubation, velopharyngeal insufficiency, dysphagia, and dysphonia. Postoperative recovery is quicker, and hospital stays are shorter. In this report, the authors describe and illustrate their method of purely endoscopic endonasal transclival odonotoidectomy for anterior decompression of the craniovertebral junction and describe various operative pearls and nuances of the technique for avoiding complications.

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Endoscopic endonasal odontoidectomy with anterior C1 arch preservation in elderly patients affected by rheumatoid arthritis

Cited by 53 publications

References 30 publications

Endoscopic transnasal odontoidectomy without resection of nasal turbinates: clinical outcomes of 13 patients

Endoscopic transnasal odontoidectomy without resection of nasal turbinates: clinical outcomes of 13 patients

The rhinopalatine line as a reliable predictor of the inferior extent of endonasal odontoidectomies

Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances

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