Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic transnasal odontoid resection to decompress the bulbo-medullary junction: a reliable anterior minimally invasive technique without posterior fusion

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Anterior decompression of the craniovertebral junction is reserved to patients with irreducible ventral bulbo-medullary lesions and rapidly deteriorating neurological functions. Classically performed through the transoral approach, the exposure of this region can be now achieved by a minimally invasive endonasal endoscopic approach (EEA).

Methods

Four patients with irreducible, anterior bulbo-medullary compression due to rheumatoid pannus and basilar invagination were enrolled. The imaged-guided EEA was used to resect the odontoid process, trying to preserve the C1 anterior arch.

Results

Neurological improvement and adequate bulbo-medullary decompression were obtained in all patients. In two cases, anterior C1 ring was preserved. These patients did not required a posterior fusion.

Conclusions

Compared with the standard transoral technique, the EEA provides the same good exposure but with potentially less complications. The preservation of the anterior C1 arch can contribute to avoid cranial settling and posterior fusion with its related risk of subaxial instability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Crockard HA (1985) The transoral approach to the base of the brain and upper cervical cord. Ann R Coll Surg Engl 67:321–325

    PubMed  CAS  Google Scholar 

  2. Blazier CJ, Hadley MN, Spetzler RF (1986) The transoral surgical approach to craniovertebral pathology. J Neurosci Nurs 18:57–62

    Article  PubMed  CAS  Google Scholar 

  3. Baird CJ, Conway JE, Sciubba DM, Prevedello DM, Quiñones-Hinojosa A, Kassam AB (2009) Radiographic and anatomic basis of endoscopic anterior craniocervical decompression: a comparison of endonasal, transoral, and transcervical approaches. Neurosurgery 65(6 Suppl):158–163

    PubMed  Google Scholar 

  4. Alfieri A, Jho HD, Tschabitscher M (2002) Endoscopic endonasal approach to the ventral cranio-cervical junction: anatomical study. Acta Neurochir (Wien) 144:219–225

    Article  CAS  Google Scholar 

  5. Cavallo LM, Messina A, Cappabianca P, Esposito F, de Divitiis E, Gardner P, Tschabitscher M (2005) Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus 19:E2

    PubMed  Google Scholar 

  6. Naderi S, Crawford NR, Melton MS, Sonntag VK, Dickman CA (1999) Biomechanical analysis of cranial settling after transoral odontoidectomy. Neurosurg Focus 6(6):E7

    Article  PubMed  CAS  Google Scholar 

  7. Steinmetz MP, Mroz TE, Benzel EC (2010) Craniovertebral junction: biomechanical considerations. Neurosurgery 66(3 Suppl):7–12

    Article  PubMed  Google Scholar 

  8. Ito H, Neo M, Sakamoto T, Fujibayashi S, Yoshitomi H, Nakamura T (2009) Subaxial subluxation after atlantoaxial transarticular screw fixation in rheumatoid patients. Eur Spine J 18:869–876

    Article  PubMed  Google Scholar 

  9. Ranawat CS, O’Leary P, Pellicci P, Tsairis P, Marchisello P, Dorr L (1979) Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg Am 61:1003–1010

    PubMed  CAS  Google Scholar 

  10. Revanappa KK, Rajshekhar V (2011) Comparison of Nurick grading system and modified Japanese Orthopaedic Association scoring system in evaluation of patients with cervical spondylotic myelopathy. Eur Spine J 20:1545–1551

    Article  PubMed  Google Scholar 

  11. Kassam AB, Snyderman C, Gardner P, Carrau R, Spiro R (2005) The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery 57(1 Suppl):E213

    Article  PubMed  Google Scholar 

  12. Wu JC, Huang WC, Cheng H, Liang ML, Ho CY, Wong TT, Shih YH, Yen YS (2008) Endoscopic transnasal transclival odontoidectomy: a new approach to decompression: technical case report. Neurosurgery 63(1 Suppl 1):ONSE92–ONSE94

    Google Scholar 

  13. Visocchi M, Doglietto F, Della Pepa GM, Esposito G, La Rocca G, Di Rocco C, Maira G, Fernandez E (2011) Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies. Eur Spine J 20:1518–1525

    Article  PubMed  Google Scholar 

  14. Grob D, Würsch R, Grauer W, Sturzenegger J, Dvorak J (1997) Atlanto-axial fusion and retrodental pannus in rheumatoid arthritis. Spine (Philadelphia, PA, 1976) 22:1580–1583

    Article  CAS  Google Scholar 

  15. Zygmunt S, Säveland H, Brattström H, Ljunggren B, Larsson EM, Wollheim F (1988) Reduction of rheumatoid periodontoid pannus following posterior occipito-cervical fusion visualised by magnetic resonance imaging. Br J Neurosurg 2:315–320

    Article  PubMed  CAS  Google Scholar 

  16. Mummaneni PV, Haid RW (2005) Transoral odontoidectomy. Neurosurgery 56:1045–1050

    Article  PubMed  Google Scholar 

  17. Wolinsky JP, Sciubba DM, Suk I, Gokaslan ZL (2007) Endoscopic image-guided odontoidectomy for decompression of basilar invagination via a standard anterior cervical approach. Technical note. J Neurosurg Spine 6:184–191

    Article  PubMed  Google Scholar 

  18. Hankinson TC, Grunstein E, Gardner P, Spinks TJ, Anderson RC (2010) Transnasal odontoid resection followed by posterior decompression and occipitocervical fusion in children with Chiari malformation Type I and ventral brainstem compression. J Neurosurg Pediatr 5:549–553

    Article  PubMed  Google Scholar 

  19. Gempt J, Lehmberg J, Meyer B, Stoffel M (2010) Endoscopic transnasal resection of the odontoid in a patient with severe brainstem compression. Acta Neurochir (Wien) 152:559–560

    Article  Google Scholar 

  20. Gempt J, Lehmberg J, Grams AE, Berends L, Meyer B, Stoffel M (2011) Endoscopic transnasal resection of the odontoid: case series and clinical course. Eur Spine J 20:661–666

    Article  PubMed  Google Scholar 

  21. Leng LZ, Anand VK, Hartl R, Schwartz TH (2009) Endonasal endoscopic resection of an os odontoideum to decompress the cervicomedullary junction: a minimal access surgical technique. Spine (Philadelphia, PA, 1976) 34:E139–E143

    Article  Google Scholar 

  22. Cornelius JF, Kania R, Bostelmann R, Herman P, George B (2011) Transnasal endoscopic odontoidectomy after occipito-cervical fusion during the same operative setting—technical note. Neurosurg Rev 34:115–121

    Article  PubMed  Google Scholar 

  23. Lee A, Sommer D, Reddy K, Murty N, Gunnarsson T (2010) Endoscopic transnasal approach to the craniocervical junction. Skull Base 20:199–205

    Article  PubMed  Google Scholar 

  24. Magrini S, Pasquini E, Mazzatenta D, Mascari C, Galassi E, Frank G (2008) Endoscopic endonasal odontoidectomy in a patient affected by Down syndrome: technical case report. Neurosurgery 63:E373–E374

    Article  PubMed  Google Scholar 

  25. Panjabi MM (1992) The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord 5:383–389

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy

    Maurizio Gladi, Maurizio Iacoangeli, Mauro Dobran, Lorenzo Alvaro, Elisa Moriconi & Massimo Scerrati

  2. Department of Orthopaedic Surgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy

    Nicola Specchia

  3. Department of ENT Surgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy

    Massimo Re

  4. Clinica di Neurochirurgia, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Via Conca #71, 60020, Torrette di Ancona, Italy

    Maurizio Iacoangeli

Authors
  1. Maurizio Gladi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maurizio Iacoangeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicola Specchia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Massimo Re
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mauro Dobran
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lorenzo Alvaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elisa Moriconi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Massimo Scerrati
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maurizio Iacoangeli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gladi, M., Iacoangeli, M., Specchia, N. et al. Endoscopic transnasal odontoid resection to decompress the bulbo-medullary junction: a reliable anterior minimally invasive technique without posterior fusion. Eur Spine J 21 (Suppl 1), 55–60 (2012). https://doi.org/10.1007/s00586-012-2220-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2220-4

Keywords

Search

Navigation