Skip to main content
  • Endonasal endoscopic approach vs Trans oral odontoidectomy. 12 consecutive cases operated at a major neurological center in Mexico City.

    Final Number:

    Juan Barges-Coll MD, MSc; Alberto Ortega- Porcayo MD; Hector Enrique Soriano-Baron MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Historically C1-C2 juntion, dens process and the CVJ have been usually approached through different routes including: transoral – transpharyngeal , transmandibular – retropharyngeal and anterior cervical approaches. This has change over the last years with the development of the expanded endoscopic endonasal approaches. We present our experience with 12 consecutive cases of C1-C2 instability that required 360 dregree surgery. 5 cases a endonasal endoscopic odontoidectomy was done and compare them with seven regular transoral (TO) cases

    Methods: 12 consecutive cases were documented and diagnosticated with CVJ instability with or without basilar invagination (BI) in Mexico City from 2009 to January 2013. Five cases onset with more than 5mm BI (AVG 11mm) were operated through an endonasal endoscopic approach for the odontoidectomy using a 18cm x 4mm Karl Storz rigid endoscope attached to a High definition camera. Seven cases with non reducible C1-C2 luxation and BI were operated through a traditional TO approach. All cases were fused using a posterior construct with laterall masses screws in the same procedure, just after the odontoidectomy was performed. One case was previously fused (Occiput – C4 fusion). All cases were operated by one neurosurgeon

    Results: In the TO group two pacients presented postoperative disphonia, one disphagia and one CFS leak, non complication were reported on the endoscopic group. Endoscopic approach requieres a larger surgical time (AVG 238 min Vs transoral 141min), but with fewer postop days of hospital stay (AVG 2.8 days Vs 6.5 days). Technically endoasal ensocopic approch to the odontoid process is more demanding and more time consuming.

    Conclusions: Endonasal endoscopic odontoidectomy is a safe and well tolerated procedure. No complications were documented in these five cases, and should be considered if BI is present. Further studies are needed.

    Patient Care: Expanded endonasal approach continues to develop, patients can beneift form this procedure since it is best tolerated.

    Learning Objectives: We present our experience with 12 consecutive cases of C1-C2 instability that required 360 dregree surgery. 5 cases a endonasal endoscopic odontoidectomy was done and compare them with seven regular transoral (TO) cases

    References: 1. Abuzayed B, Tanriover N, Gazioglu N, Ozlen F, Eraslan BS, Akar Z: Extended endoscopic endonasal approach to the anterior cranio-vertebral junction: anatomic study. Turkish neurosurgery 19:249-255, 2009. 2. al-Mefty O, Borba LA, Aoki N, Angtuaco E, Pait TG: The transcondylar approach to extradural nonneoplastic lesions of the craniovertebral junction. Journal of neurosurgery 84:1-6, 1996. 3. Al-Mefty O, Kadri PA, Hasan DM, Isolan GR, Pravdenkova S: Anterior clivectomy: surgical technique and clinical applications. Journal of neurosurgery 109:783-793, 2008. 4. Altas E, Gursan N, Ucuncu H: Transoral approach to a huge neurofibroma of the parapharyngeal space: a case report. Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat 17:58-62, 2007. 5. Arbit E, Patterson RH, Jr.: Combined transoral and median labiomandibular glossotomy approach to the upper cervical spine. Neurosurgery 8:672-674, 1981. 6. Ayoub B: The far lateral approach for intra-dural anteriorly situated tumours at the craniovertebral junction. Turkish neurosurgery 21:494-498, 2011. 7. Barges-Coll J, Fernandez-Miranda JC, Prevedello DM, Gardner P, Morera V, Madhok R, Carrau RL, Snyderman CH, Rhoton AL, Jr., Kassam AB: Avoiding injury to the abducens nerve during expanded endonasal endoscopic surgery: anatomic and clinical case studies. Neurosurgery 67:144-154; discussion 154, 2010. 8. Blazier CJ, Hadley MN, Spetzler RF: The transoral surgical approach to craniovertebral pathology. The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses 18:57-62, 1986. 9. Cabanillas R, Rodrigo JP, Llorente JL, Suarez C: Oncologic outcomes of transoral laser surgery of supraglottic carcinoma compared with a transcervical approach. Head & neck 30:750-755, 2008. 10. Cavallo LM, Cappabianca P, Messina A, Esposito F, Stella L, de Divitiis E, Tschabitscher M: The extended endoscopic endonasal approach to the clivus and cranio-vertebral junction: anatomical study. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 23:665-671, 2007. 11. Chau AM, Lazzaro A, Mobbs RJ, Teo C: Combined endoscopic endonasal and posterior cervical approach to a clival chordoma. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 17:1463-1465, 2010. 12. Che Mohamed SK, Abd Aziz A: Calcification of the Alar Ligament Mimics Fracture of the Craniovertebral Junction (CVJ): An Incidental Finding from Computerised Tomography of the Cervical Spine Following Trauma. The Malaysian journal of medical sciences : MJMS 16:69-72, 2009. 13. Chen YF, Liu HM: Imaging of craniovertebral junction. Neuroimaging clinics of North America 19:483-510, 2009. 14. Daniel RT, Muzumdar A, Ingalhalikar A, Moldavsky M, Khalil S: Biomechanical stability of a posterior-alone fixation technique after craniovertebral junction realignment. World neurosurgery 77:357-361, 2012. 15. de Divitiis O, Conti A, Angileri FF, Cardali S, La Torre D, Tschabitscher M: Endoscopic transoral-transclival approach to the brainstem and surrounding cisternal space: anatomic study. Neurosurgery 54:125-130; discussion 130, 2004. 16. Debernardi A, D'Aliberti G, Talamonti G, Villa F, Piparo M, Collice M: The craniovertebral junction area and the role of the ligaments and membranes. Neurosurgery 68:291-301, 2011. 17. Fernandez-Miranda JC, Morera VA, Snyderman CH, Gardner P: Endoscopic EndonasalTransclival Approach to the Jugular Tubercle. Neurosurgery, 2011. 18. Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH: Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. Neurosurgery 67:ons150-158; discussion ons158, 2010. 19. Garcia-Navarro V, Lancman G, Guerrero-Maldonado A, Anand VK, Schwartz TH: Use of a side-cutting aspiration device for resection of tumors during endoscopic endonasal approaches. Neurosurgical focus 30:E13, 2011. 20. Hakuba A, Nishimura S: [A mandible and tongue-splitting approach for an anterior decompression at C1/2 level for irreducible atlanto-axial dislocation due to multiple congenital anomalies of the cranio-vertebral junction (author's transl)]. No shinkei geka Neurological surgery 8:23-30, 1980. 21. Jho HD, Ha HG: Endoscopic endonasal skull base surgery: Part 3--The clivus and posterior fossa. Minimally invasive neurosurgery : MIN 47:16-23, 2004. 22. Jung SH, Jung S, Moon KS, Park HW, Kang SS: Tailored surgical approaches for benign craniovertebral junction tumors. Journal of Korean Neurosurgical Society 48:139-144, 2010. 23. Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R: Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurgical focus 19:E6, 2005. 24. Magrini S, Pasquini E, Mazzatenta D, Mascari C, Galassi E, Frank G: Endoscopic endonasal odontoidectomy in a patient affected by Down syndrome: technical case report. Neurosurgery 63:E373-374; discussion E374, 2008. 25. Martin MD, Bruner HJ, Maiman DJ: Anatomic and biomechanical considerations of the craniovertebral junction. Neurosurgery 66:2-6, 2010. 26. Menezes AH: Surgical approaches: postoperative care and complications "transoral-transpalatopharyngeal approach to the craniocervical junction". Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 24:1187-1193, 2008. 27. Menezes AH: Craniovertebral junction abnormalities with hindbrain herniation and syringomyelia: regression of syringomyelia after removal of ventral craniovertebral junction compression. Journal of neurosurgery 116:301-309, 2012. 28. Messina A, Bruno MC, Decq P, Coste A, Cavallo LM, de Divittis E, Cappabianca P, Tschabitscher M: Pure endoscopic endonasal odontoidectomy: anatomical study. Neurosurgical review 30:189-194; discussion 194, 2007. 29. Morera VA, Fernandez-Miranda JC, Prevedello DM, Madhok R, Barges-Coll J, Gardner P, Carrau R, Snyderman CH, Rhoton AL, Jr., Kassam AB: "Far-medial" expanded endonasal approach to the inferior third of the clivus: the transcondylar and transjugular tubercle approaches. Neurosurgery 66:211-219; discussion 219-220, 2010. 30. Refai D, Shin JH, Iannotti C, Benzel EC: Dorsal approaches to intradural extramedullary tumors of the craniovertebral junction. Journal of craniovertebral junction and spine 1:49-54, 2010. 31. Schwartz TH, Fraser JF, Brown S, Tabaee A, Kacker A, Anand VK: Endoscopic cranial base surgery: classification of operative approaches. Neurosurgery 62:991-1002; discussion 1002-1005, 2008. 32. Sen C, Shrivastava R, Anwar S, Triana A: Lateral transcondylar approach for tumors at the anterior aspect of the craniovertebral junction. Neurosurgery 66:104-112, 2010. 33. Shin H, Barrenechea IJ, Lesser J, Sen C, Perin NI: Occipitocervical fusion after resection of craniovertebral junction tumors. Journal of neurosurgery Spine 4:137-144, 2006. 34. Steinmetz MP, Mroz TE, Benzel EC: Craniovertebral junction: biomechanical considerations. Neurosurgery 66:7-12, 2010. 35. Stippler M, Gardner PA, Snyderman CH, Carrau RL, Prevedello DM, Kassam AB: Endoscopic endonasal approach for clival chordomas. Neurosurgery 64:268-277; discussion 277-268, 2009. 36. Taniguchi M, Kohmura E: Endoscopic endonasal removal of laterally extended clival chordoma using side-viewing scopes. Acta neurochirurgica 154:627-632, 2012. 37. Welch WC, Kassam A: Endoscopically assisted transoral-transpharyngeal approach to the craniovertebral junction. Neurosurgery 52:1511-1512, 2003.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy