title: Endoscopic transnasal odontoidectomy to treat basilar invagination with congenital osseous malformations.
abstract: OBJECTIVE
  Transoral resection of the odontoid has been accepted as a standard procedure to decompress the cervicomedullary junction during the past several decades. The endoscopic transnasal odontoidectomy is emerging as a feasible surgical alternative to conventional microscopic transoral approach. In this article, we describe several operative nuances and pearls from our experience about this approach, which provided successful decompression.
  
  
  METHODS
  From September 2009 to April 2010, three consecutive patients with basilar invagination, of which the etiology was congenital osseous malformations, underwent endoscopic transnasal odontoidectomy. All patients presented with myelopathy. The last two cases also received occipitocervical fixation and bone fusion during the same surgical episode to ensure stability.
  
  
  RESULTS
  All the patients were extubated after recovery from anesthesia and allowed oral food intake the next day. Cerebrospinal fluid rhinorrhea was found in the second case and cured by continuous lumber drainage of cerebrospinal fluid. No infection was noted. The average follow-up time was more than 24 months. Remarkable neurological recovery was observed postoperative in all patients.
  
  
  CONCLUSIONS
  The endoscopic transnasal odontoidectomy is a feasible approach for anterior decompression of pathology at the cervicomedullary junction. The advantages over the standard transoral odontoidectomy include elimination of risk of tongue swelling and teeth damaging, improvement of visualization, alleviation of prolonged intubation, reduction of need for enteral tube feeding and less risk of affecting phonation. The minimally invasive access and faster recovery associated with this technique make it a valid alternative for decompression of the ventral side of the cervicomedullary junction.
authors.affiliation: Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yu
authors.forename: Xuejian
authors.initials: X
authors.lastname: Wang
authors.forename: Xiaobiao
authors.initials: X
authors.lastname: Zhang
authors.forename: Fan
authors.initials: F
authors.lastname: Hu
authors.forename: Ye
authors.initials: Y
authors.lastname: Gu
authors.forename: Tao
authors.initials: T
authors.lastname: Xie
authors.forename: Xiaoxing
authors.initials: X
authors.lastname: Jiang
authors.forename: Chun
authors.initials: C
authors.lastname: Jiang
mesh_terms: D000328:Adult; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000601:surgery*; D010985:Platybasia / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D016896:Treatment Outcome