title: Endoscopic endonasal odontoidectomy: clinical series.
abstract: METHODS
  This study evaluates a series of consecutive endoscopic endonasal odontoidectomies performed since 2008 in our center.
  
  
  OBJECTIVE
  The aim of the study was to analyze the outcome and the surgical technique to enlighten advantages and limitations of this procedure.
  
  
  BACKGROUND
  Odontoidectomy represents the treatment of choice in selected cases of basilar invagination. Transoral-transpharyngeal odontoidectomy is the "gold standard" and more experienced technique. Recently, the endoscopic endonasal approach has been proposed as an alternative route.
  
  
  METHODS
  All patients underwent a pre- and postoperative evaluation of neurological status using physical neurological examination, assessment of American Spinal Injury Association impairment scale score, and neurophysiological investigations. Pre- and postoperative neuroradiological examinations consisted of magnetic resonance imaging, computed tomography, and radiography in flexion and extension. Surgical complications, time of orotracheal extubation and of resumption of oral feeding after surgery were considered, basing on medical records.
  
  
  RESULTS
  The series is composed of 5 cases. All cases presented a progressive tetraparesis despite a posterior occipitocervical arthrodesis. Two patients presented with irreducible atlantoaxial subluxation in Down syndrome, whereas the others presented with an atlanto-occipital malformation with platybasia and basilar invagination. No complications were observed. In all except one case, orotracheal intubation was removed immediately at the end of surgery. Oral feeding was resumed 1 day after surgery in all but one case that initially required an orogastric tube. At follow-up (mean: 34.2 mo; range: 3-57 mo), neurological symptoms have been shown to improve in 2 cases and stabilization, arresting the neurological worsening, in 3 cases.
  
  
  CONCLUSIONS
  Endoscopic endonasal odontoidectomy resulted in a safe, effective, and well-tolerated procedure. From our experience, we conclude that the different approaches for odontoidectomy should be considered to be complementary rather than alternative: the endonasal endoscopic can be advantageous in selected cases presenting some anatomical conditions related (micrognathia and macroglossia) to the oral cavity and to high position of the odontoid.
authors: *Center of Pituitary Tumors and Skull Base Endoscopic Surgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy †ENT Department, Azienda USL, Bologna, Italy.
authors: Diego
authors: D
authors: Mazzatenta
authors: Matteo
authors: M
authors: Zoli
authors: Carmelo
authors: C
authors: Mascari
authors: Ernesto
authors: E
authors: Pasquini
authors: Giorgio
authors: G
authors: Frank
mesh_terms: D000328:Adult; D002648:Child; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000601:surgery*; D010985:Platybasia / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome