title: Endoscopic transnasal odontoid resection to decompress the bulbo-medullary junction: a reliable anterior minimally invasive technique without posterior fusion.
abstract: OBJECTIVE
  Anterior decompression of the craniovertebral junction is reserved to patients with irreducible ventral bulbo-medullary lesions and rapidly deteriorating neurological functions. Classically performed through the transoral approach, the exposure of this region can be now achieved by a minimally invasive endonasal endoscopic approach (EEA).
  
  
  METHODS
  Four patients with irreducible, anterior bulbo-medullary compression due to rheumatoid pannus and basilar invagination were enrolled. The imaged-guided EEA was used to resect the odontoid process, trying to preserve the C1 anterior arch.
  
  
  RESULTS
  Neurological improvement and adequate bulbo-medullary decompression were obtained in all patients. In two cases, anterior C1 ring was preserved. These patients did not required a posterior fusion.
  
  
  CONCLUSIONS
  Compared with the standard transoral technique, the EEA provides the same good exposure but with potentially less complications. The preservation of the anterior C1 arch can contribute to avoid cranial settling and posterior fusion with its related risk of subaxial instability.
authors.affiliation: Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy. mauriziogladi@gmail.com
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gladi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Iacoangeli
authors.forename: Nicola
authors.initials: N
authors.lastname: Specchia
authors.forename: Massimo
authors.initials: M
authors.lastname: Re
authors.forename: Mauro
authors.initials: M
authors.lastname: Dobran
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Alvaro
authors.forename: Elisa
authors.initials: E
authors.lastname: Moriconi
authors.forename: Massimo
authors.initials: M
authors.lastname: Scerrati
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009666:Nose; D009777:Occipital Bone / Q000000981:diagnostic imaging / Q000473:pathology; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome