Endoscopic transnasal transclival odontoidectomy: a new approach to decompression: technical case report.

Jau Ching Wu, Wen Cheng Huang, Henrich Cheng, Muh Lii Liang, Ching Yin Ho, Tai-Tong Wong, Yang Hsin Shih, Yu Shu Yen

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Abstract

OBJECTIVE: Endoscopic transnasal transclival resection of the odontoid process is less invasive than the standard transoral odontoidectomy. In this article, we describe our techniques, which are less invasive but provide successful decompression. CLINICAL PRESENTATION: From September 2004 to April 2007, three consecutive patients with basilar invagination and instability in the craniovertebral junction were enrolled. The causes for the invagination and instability included rheumatoid arthritis in two patients and trauma in one patient, and all patients presented with myelopathy and quadriparesis before intervention. INTERVENTION: All three patients underwent an endoscopic transnasal transclival approach for anterior decompression and resection of the displaced odontoid process and pannus to decompress the underlying medulla. Subsequently, they received occipitocervical fixation by lateral mass screws and bone fusion to ensure stability. Remarkable neurological recovery was observed after surgery in all patients, and no adverse effects were noted. CONCLUSION: Compared with the standard transoral approach, the transnasal transclival endoscopic approach for decompressing basilar invagination is a feasible and effective alternative that avoids common disadvantages like prolonged intubation, excessive tongue retraction, and the need for palatal incision.

Original languageEnglish
JournalNeurosurgery
Volume63
Issue number1 Suppl 1
Publication statusPublished - Jul 1 2008
Externally publishedYes

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ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Wu, J. C., Huang, W. C., Cheng, H., Liang, M. L., Ho, C. Y., Wong, T-T., Shih, Y. H., & Yen, Y. S. (2008). Endoscopic transnasal transclival odontoidectomy: a new approach to decompression: technical case report. Neurosurgery, 63(1 Suppl 1).