title: Comparison of Anesthetic Management and Outcomes in Patients Having Either Transnasal or Transoral Endoscopic Odontoid Process Surgery.
abstract: BACKGROUND
  Endoscopic neurosurgical procedures involving the upper cervical vertebrae are challenging due to a narrow operating field and close proximity to vital anatomical structures. Historically, transoropharyngeal (transoral) endoscopy has been the preferred approach. More recently, however, an endoscopic transnasal approach was developed as an alternative method in hopes to reduce postoperative dysphagia, a common complication following transoral neurosurgery.
  
  
  METHODS
  Twenty-two endoscopic neurosurgical cases involving the odontoid or C1 vertebra were reviewed between January 1, 2005 and December 31, 2015 (17 and 5 through transoral and transnasal approaches, respectively). Patient demographics, anesthetic technique, intraoperative course, and postoperative outcomes such as were recorded.
  
  
  RESULTS
  Patients who underwent transnasal odontoidectomy had a shorter length of stay and lower rates of tracheostomy compared with those having similar surgery via the transoral route. In those having transoral surgery, no patient presented to the operating room with a preexisting tracheostomy. In 16 of 17 patients within the transoral group, a tracheostomy was performed. In those having transnasal surgery, 2 of 5 patients had a preexisting tracheostomy. In the remaining 3 of 5 patients, orotracheal intubation was performed and patients were extubated after the procedure.
  
  
  CONCLUSIONS
  The transnasal odontoid resection technique may become a more popular surgical approach without increasing rates of complications compared with those having transoral surgery. Ultimately, a larger, study is needed to further clarify these relationships.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Sexton
authors.forename: Arnoley S
authors.initials: AS
authors.lastname: Abcejo
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Pasternak
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods*; D002574:Cervical Vertebrae / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000601:surgery*; D009296:Nasal Cavity / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D009809:Odontoid Process / Q000601:surgery*; D014139:Tracheostomy / Q000706:statistics & numerical data; D016896:Treatment Outcome