title: Transoral endoscopic odontoidectomy to decompress the cervicomedullary junction.
abstract: METHODS
  Clinical study.
  
  
  OBJECTIVE
  To investigate the feasibility of the transoral endoscopic odontoidectomy without occipitocervical fusion.
  
  
  BACKGROUND
  Endoscopic transnasal resection of the odontoid process is less invasive than the conventional transoral odontoidectomy. However, the endonasal approach has a much longer working distance compared with the transoral approach to the craniovertebral junction and usually the endonasal approach needs a previous occipitocervical posterior fusion.
  
  
  METHODS
  From July 2007 to June 2010, 5 patients (3 males and 2 females, age range, 25-41 yr) with irreducible cervicomedullary junction compression were subjected to endoscopic transoral odontoidectomy without occipitocervical posterior fixation and bone fusion.
  
  
  RESULTS
  A purely endoscopic transoral odontoidectomy for decompression of the cervicomedullary junction without the occipitocervical fusion was achieved successfully in 5 patients. None of the patients underwent tracheotomy and postoperative gastrostomy tube placement. The patients were started on liquids on the third postoperative day and advanced to a regular diet on the fourth postoperative day. There was no postoperative velopharyngeal insufficiency, cerebrospinal fluid leakage, regional infection, or meningitis. The patients were discharged in 10 to 12 days after the surgery. There were no evidence of instability at the craniovertebral junction at 12 to 47 months of follow-up and remarkable improvement in neurological function was observed in each patient.
  
  
  CONCLUSIONS
  The endoscopic transoral approach may be a more direct route to C1 and the odontoid than the endoscopic endonasal approach. This approach allows complete resection odontoid to decompress the cervicomedullary junction without increasing the risk of complications such as wound infection, meningitis, and velopharyngeal insufficiency. Usually, the occipitocervical posterior fusion and tracheotomy is less necessary in this approach.
authors.affiliation: Skull Base Surgery Center, Capital Medical University Xuanwu Hospital, Beijing, China. zhangqiuhang@yahoo.com.cn
authors.forename: Zhang
authors.initials: Z
authors.lastname: Qiuhang
authors.forename: Kong
authors.initials: K
authors.lastname: Feng
authors.forename: Yan
authors.initials: Y
authors.lastname: Bo
authors.forename: Guo
authors.initials: G
authors.lastname: Hongchuan
authors.forename: Li
authors.initials: L
authors.lastname: Mingchu
authors.forename: Chen
authors.initials: C
authors.lastname: Ge
authors.forename: Ling
authors.initials: L
authors.lastname: Feng
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods*; D004032:Diet; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009809:Odontoid Process / Q000601:surgery*; D011184:Postoperative Period; D011859:Radiography; D015203:Reproducibility of Results; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome