title: Advantages and limitations of endoscopic endonasal odontoidectomy. A series of nine cases.
abstract: BACKGROUND
  Transoral odontoidectomy is the treatment of choice in cases of anterior bulbo-medullary compression. The development of endoscopic procedures has made it possible to perform odontoidectomy via a minimally invasive endoscopic endonasal approach. We discuss the feasibility, advantages, and limitations of this surgical approach.
  
  
  METHODS
  We report a two-center retrospective series of patients who underwent endoscopic endonasal odontoidectomy between September 2011 and February 2013. Preoperative characteristics, intraoperative data, clinical course, and postoperative complications were studied. The patients were followed for a minimum of 6 months. Cervico-occipital posterior fusion was performed during the same hospital stay in cases of preoperative instability.
  
  
  RESULTS
  Nine patients underwent decompressive odontoidectomy, for rheumatoid pannus in five cases and basilar impression in four cases. All had progressive neurological symptoms. Seven patients also underwent posterior fusion. In six patients, the C1 anterior arch was preserved. Decompression was achieved satisfactorily in all nine cases. The patients were able to resume oral feeding the day after the intervention. No patient required tracheostomy. We observed no dural fistulae or infectious complications. One patient died 2 months after the intervention of a pulmonary embolism. All patients improved in terms of their preoperative neurological status.
  
  
  CONCLUSIONS
  This short series shows the feasibility of the endoscopic endonasal approach for resection of the dens. This approach allows optimal viewing when using angulated instrumentation and seems to result in low morbidity. In some cases, this approach makes it possible to preserve the C1 anterior arch, thus limiting the risk of cranial settling.
  IV retrospective study.
authors.affiliation: Service de neurochirurgie, hôpital maison Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France. Electronic address: duntzejulien@hotmail.fr.
authors.forename: J
authors.initials: J
authors.lastname: Duntze
authors.affiliation: Service de neurochirurgie, hôpital maison Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Eap
authors.affiliation: Service de neurochirurgie, hôpital maison Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Kleiber
authors.affiliation: Service de neurochirurgie, hôpital maison Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Théret
authors.affiliation: Service de neurochirurgie, hôpital de La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex, France.
authors.forename: H
authors.initials: H
authors.lastname: Dufour
authors.affiliation: Service de neurochirurgie, hôpital de La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Fuentes
authors.affiliation: Service de neurochirurgie, hôpital maison Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: C-F
authors.initials: CF
authors.lastname: Litré
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications*; D019299:Decompression, Surgical / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009666:Nose; D009809:Odontoid Process / Q000601:surgery*; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
keywords: C1 arch preservation; Endoscopic endonasal approach; Morbidity; Odontoidectomy; Rheumatoid arthritis