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


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Wu
Jau-Ching
JC
Neural Regeneration Laboratory, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan, Republic of China.
Huang
Wen-Cheng
WC
Cheng
Henrich
H
Liang
Muh-Lii
ML
Ho
Ching-Yin
CY
Wong
Tai-Tong
TT
Shih
Yang-Hsin
YH
Yen
Yu-Shu
YS
D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000000981:diagnostic imaging / Q000601:surgery*; D044583:Neuroendoscopy / Q000379:methods* / Q000639:trends; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography