Expanded endoscopic transnasal odontoidectomy and posterior stabilization: a combined approach.

Abstract

Lesions of the craniovertebral junction are difficult to access, which is due to the anatomical features and high concentration of vital structures in the area. The transoral access has been most used for anterior approach to treat craniovertebral junction pathology. This method has consistently shown a high complication rate and difficulties in-patient rehabilitation. In this study we analyzed the benefits of surgical treatment of the craniovertebral junction area pathology with the transnasal approach. Four patients with C2 odontoid process invagination and brain stem compression were treated with the transnasal endoscopic resection of the pathological process combined with simultaneous occipital-cervical stabilization (OCS). Surgical procedure, anatomical findings, complications, and rehabilitation period were assessed. Transnasal treatment of C2 odontoid process lesions was applied successfully in all four cases. A modified extended transnasal approach was used. This approach is characterized by an increased operating time (238 minutes), lower complication rate, safer access (less traumatization of oropharyngeal tissue), better patient rehabilitation (no need for tracheostomy or feeding tube), better recovery and higher patient satisfaction (quick regression of the symptomatic patients). The extended transnasal access to the craniovertebral junction is a safer, more comfortable technique, which facilitates more radical treatment of lesions in this area. For brain stem compression due to C2 odontoid process invagination, a combination of transnasal resection and OCS shows excellent preliminary results. This method should be favorable over the transoral approach in certain cases, as it provides a better direct access to lesion of the craniovertebral junction and allows for more complex combined procedures.