Pure Endoscopic Endonasal Odontoidectomy for Basilar Impression

Abstract

Introduction: Odontoidectomy is often required to treat basilar impression with compression of the brainstem or cervical spinal cord. The transoral resection is the approach most often used. However, it is related with significant morbidity. Recently, there is a growing interest in the expanded endoscopic endonasal corridor to approach the craniocervical junction. Study Design: We present our four initial cases of pure endoscopic endonasal odontoidectomy for the treatment of basilar impression. Results: Three women and one man were treated between 47 and 70 years old. All patients presented with long-lasting history of severe gait ataxia and less frequently, neck pain, tinnitus, dysphagia, and tongue fibrillation. The procedure was divided in two operative settings (same operative time). First, it was performed the endoscopic endonasal approach, grafting of nasoseptal flap (Hadad-Bassagasteguy type), dissection of the clival region, removal of the anterior arch of C1 and the dens of C2. Afterward the patient was turned and an occipital-cervical fixation (occiput to lateral masses of C2-C3-C4) was performed. In all patients there was a substantial improvement in gait ataxia (3-year follow-up). No major morbidity or mortality was reported. Conclusion: The endoscopic approach is safe and effective to treat ventral brainstem compression due to basilar impression in comparison with the classic transoral approach.