title: Endoscopic transnasal transclival odontoidectomy: a new approach to decompression: technical case report.
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.
  
  
  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.
authors: Neural Regeneration Laboratory, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan, Republic of China.
authors: Jau-Ching
authors: JC
authors: Wu
authors: Wen-Cheng
authors: WC
authors: Huang
authors: Henrich
authors: H
authors: Cheng
authors: Muh-Lii
authors: ML
authors: Liang
authors: Ching-Yin
authors: CY
authors: Ho
authors: Tai-Tong
authors: TT
authors: Wong
authors: Yang-Hsin
authors: YH
authors: Shih
authors: Yu-Shu
authors: YS
authors: Yen
mesh_terms: 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