title: Endoscopic Endonasal Approach to the Odontoid Pathologies.
abstract: BACKGROUND
  Surgical anterior decompression represents the treatment of choice for symptomatic irreducible ventral craniovertebral junction (CVJ) compression. With the refinement of the endoscopic techniques, the endonasal route has been proposed as alternative to the classic transoral approach to CVJ. Some reports assess the effectiveness and safety of endoscopic endonasal approaches to CVJ pathologies.
  
  
  METHODS
  From July 2011 to February 2014, 12 patients with symptomatic nonreducible ventral spinal cord compression underwent purely 3-dimensional endoscopic endonasal odontoidectomy in our department. The surgical technique is described.
  
  
  RESULTS
  A good brainstem-medullary decompression was achieved in all patients. In 10 of 12 patients the endotracheal tube was removed just after the procedure with good recovery of the respiratory function. We report no cases of velopharyngeal insufficiency. In 5 of 12 patients the preservation of C1 anterior was achieved, without the need for posterior cervical fixation.
  
  
  CONCLUSIONS
  Endoscopic endonasal odontoidectomy has proven to be safe and effective in selected patients. Soft and hard palate preservation dramatically reduces the risk of postoperative velopharyngeal insufficiency. Moreover, the endonasal endoscopic approach provides a direct access to the dens. Three-dimensional high-definition endoscope, laser, and ultrasound bony curettes revealed to be useful tools for this approach that, however, remains a demanding one.
authors: Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.
authors: Francesco
authors: F
authors: Zenga
authors: Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy. Electronic address: paolopacca84@gmail.com.
authors: Paolo
authors: P
authors: Pacca
authors: Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.
authors: Valentina
authors: V
authors: Tardivo
authors: Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.
authors: Valentina
authors: V
authors: Pennacchietti
authors: Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.
authors: Diego
authors: D
authors: Garbossa
authors: 1st ENT Division, Department of Surgical Sciences, University of Torino, Genova, Italy.
authors: Giancarlo
authors: G
authors: Pecorari
authors: Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.
authors: Alessandro
authors: A
authors: Ducati
mesh_terms: D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: CVJ stability; Endonasal approach; Endoscopic; Odontoidectomy