Endoscopic endonasal resection of the odontoid peg—case report and literature review

Abstract

There are several techniques enabling access to the anterior cranio-cervical junction, including more recently the endonasal approach [1–29]. Cadaveric studies using advanced robotic technology in the form of the da Vinci® Surgical System may provide potential approaches for the resection of the odontoid peg in patients with odontoid peg region pathology [30]. The first clinical case of a transnasal approach to the odontoid peg was described in by Kassam et al. in 2005 [16]. An increasing number of reports describing both benefits and successful outcomes of this technique have been published from several international skull base centres [16–29]. Utilising the mouth/nose avoids cosmetic facial issues particularly scaring. Lee et al. [23] reported on the benefits of both these approaches and concluded that the transnasal approach negated the use of a tracheostomy would not lead to velopharyngeal insufficiency (VPI), and it should not result in tongue oedema. To date, transnasal surgery has not been reported to give rise to long-term VPI as has been described for the transoral route. However, it must be borne in mind that the transnasal approach is a new technique and more complications may become apparent as the technique becomes more widely employed. We describe a case of an endoscopic transnasal resection of an odontoid peg in a child with cervico-medullary junction (CMJ) compression resulting in severe high cervical myelopathy and bulbar dysfunction.