Institutional members access full text with Ovid®

ENDOSCOPIC TRANSNASAL TRANSCLIVAL ODONTOIDECTOMY: A NEW APPROACH TO DECOMPRESSION: TECHNICAL CASE REPORT

Wu, Jau-Ching M.D.; Cheng, Henrich M.D., Ph.D.; Huang, Wen-Cheng M.D.; Liang, Muh-Lii M.D.; Wong, Tai-Tong M.D.; Shih, Yang-Hsin M.D.; Yen, Yu-Shu M.D.; Ho, Ching-Yin M.D., Ph.D.

doi: 10.1227/01.NEU.0000313115.51071.D5
SPINE: Technical Case Report

OBJECTIVE: Endoscopic transnasal transclival resection of the odontoid process is less invasive than the standard transoral odontoidectomy. In this article, we describe our techniques, which are less invasive but provide successful decompression.

CLINICAL PRESENTATION: From September 2004 to April 2007, three consecutive patients with basilar invagination and instability in the craniovertebral junction were enrolled. The causes for the invagination and instability included rheumatoid arthritis in two patients and trauma in one patient, and all patients presented with myelopathy and quadriparesis before intervention.

INTERVENTION: All three patients underwent an endoscopic transnasal transclival approach for anterior decompression and resection of the displaced odontoid process and pannus to decompress the underlying medulla. Subsequently, they received occipitocervical fixation by lateral mass screws and bone fusion to ensure stability. Remarkable neurological recovery was observed after surgery in all patients, and no adverse effects were noted.

CONCLUSION: Compared with the standard transoral approach, the transnasal transclival endoscopic approach for decompressing basilar invagination is a feasible and effective alternative that avoids common disadvantages like prolonged intubation, excessive tongue retraction, and the need for palatal incision.

Neural Regeneration Laboratory, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, and School of Medicine and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, Republic of China (Wu) (Cheng)

Neural Regeneration Laboratory, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China (Huang)

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China (Liang) (Wong) (Shih)

Department of Otolaryngology, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China (Ho)

Reprint requests: Yu-Shu Yen, M.D., Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, 17F, No. 201, Shih-Pai Road, Sec. 2, Peitou, Taipei 11217, Taiwan, Republic of China. Email: ysyen@vghtpe.gov.tw

Received, August 4, 2007.

Accepted, December 26, 2007.

Copyright © by the Congress of Neurological Surgeons