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European Spine Journal
Published in: European Spine Journal 5/2013

01-05-2013 | Original Article

Endoscopic transnasal odontoidectomy to treat basilar invagination with congenital osseous malformations

Authors: Yong Yu, Xuejian Wang, Xiaobiao Zhang, Fan Hu, Ye Gu, Tao Xie, Xiaoxing Jiang, Chun Jiang

Published in: European Spine Journal | Issue 5/2013

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Abstract

Purpose

Transoral resection of the odontoid has been accepted as a standard procedure to decompress the cervicomedullary junction during the past several decades. The endoscopic transnasal odontoidectomy is emerging as a feasible surgical alternative to conventional microscopic transoral approach. In this article, we describe several operative nuances and pearls from our experience about this approach, which provided successful decompression.

Methods

From September 2009 to April 2010, three consecutive patients with basilar invagination, of which the etiology was congenital osseous malformations, underwent endoscopic transnasal odontoidectomy. All patients presented with myelopathy. The last two cases also received occipitocervical fixation and bone fusion during the same surgical episode to ensure stability.

Results

All the patients were extubated after recovery from anesthesia and allowed oral food intake the next day. Cerebrospinal fluid rhinorrhea was found in the second case and cured by continuous lumber drainage of cerebrospinal fluid. No infection was noted. The average follow-up time was more than 24 months. Remarkable neurological recovery was observed postoperative in all patients.

Conclusion

The endoscopic transnasal odontoidectomy is a feasible approach for anterior decompression of pathology at the cervicomedullary junction. The advantages over the standard transoral odontoidectomy include elimination of risk of tongue swelling and teeth damaging, improvement of visualization, alleviation of prolonged intubation, reduction of need for enteral tube feeding and less risk of affecting phonation. The minimally invasive access and faster recovery associated with this technique make it a valid alternative for decompression of the ventral side of the cervicomedullary junction.
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Metadata
Title
Endoscopic transnasal odontoidectomy to treat basilar invagination with congenital osseous malformations
Authors
Yong Yu
Xuejian Wang
Xiaobiao Zhang
Fan Hu
Ye Gu
Tao Xie
Xiaoxing Jiang
Chun Jiang
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue 5/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-012-2605-4

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Author's Reply

Answer to the Letter to the Editor of A. Gardner concerning “Loss of apical vertebral derotation in adolescent idiopathic scoliosis: 2-year follow-up using multi-planar reconstruction computed tomography” (by G. Cui, K. Watanabe, Y. Nishiwaki, N. Hosogane, T. Tsuji, K. Ishii, M. Nakamura, Y. Toyama, K. Chiba, M. Matsumoto; Eur Spine J (2012) Jun;21(6):1111–20. doi:10.1007/s00586-012-2633-0)