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Evolution from microscopic transoral to endoscopic endonasal odontoidectomy.
Neurosurg Focus. 2014; 37(4):E15.NF

Abstract

OBJECT

The goal of this study was to compare the indications, benefits, and complications between the endoscopic endonasal approach (EEA) and the microscopic transoral approach to perform an odontoidectomy. Transoral approaches have been standard for odontoidectomy procedures; however, the potential benefits of the EEA might be demonstrated to be a more innocuous technique. The authors present their experience with 12 consecutive cases that required odontoidectomy and posterior instrumentation.

METHODS

Twelve consecutive cases of craniovertebral junction instability with or without basilar invagination were diagnosed at the National Institute of Neurology and Neurosurgery in Mexico City, Mexico, between January 2009 and January 2013. The EEA was used for 5 cases in which the odontoid process was above the nasopalatine line, and was compared with 7 cases in which the odontoid process was beneath the nasopalatine line; these were treated using the transoral microscopic approach (TMA). Odontoidectomy was performed after occipital-cervical or cervical posterior augmentation with lateral mass and translaminar screws. One case was previously fused (Oc-C4 fusion). The senior author performed all surgeries. American Spinal Injury Association scores were documented before surgical treatment and after at least 6 months of follow-up.

RESULTS

Neurological improvement after odontoidectomy was similar for both groups. From the transoral group, 2 patients had postoperative dysphonia, 1 patient presented with dysphagia, and 1 patient had intraoperative CSF leakage. The endoscopic procedure required longer surgical time, less time to extubation and oral feeding, a shorter hospital stay, and no complications in this series.

CONCLUSIONS

Endoscopic endonasal odontoidectomy is a feasible, safe, and well-tolerated procedure. In this small series there was no difference in the outcome between the EEA and the TMA; however, fewer complications were documented with the endonasal technique.

Authors+Show Affiliations

Departments of Neurological Surgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez," Mexico City, Mexico.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25270134

Citation

Ponce-Gómez, Juan Antonio, et al. "Evolution From Microscopic Transoral to Endoscopic Endonasal Odontoidectomy." Neurosurgical Focus, vol. 37, no. 4, 2014, pp. E15.
Ponce-Gómez JA, Ortega-Porcayo LA, Soriano-Barón HE, et al. Evolution from microscopic transoral to endoscopic endonasal odontoidectomy. Neurosurg Focus. 2014;37(4):E15.
Ponce-Gómez, J. A., Ortega-Porcayo, L. A., Soriano-Barón, H. E., Sotomayor-González, A., Arriada-Mendicoa, N., Gómez-Amador, J. L., Palma-Díaz, M., & Barges-Coll, J. (2014). Evolution from microscopic transoral to endoscopic endonasal odontoidectomy. Neurosurgical Focus, 37(4), E15. https://doi.org/10.3171/2014.7.FOCUS14301
Ponce-Gómez JA, et al. Evolution From Microscopic Transoral to Endoscopic Endonasal Odontoidectomy. Neurosurg Focus. 2014;37(4):E15. PubMed PMID: 25270134.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evolution from microscopic transoral to endoscopic endonasal odontoidectomy. AU - Ponce-Gómez,Juan Antonio, AU - Ortega-Porcayo,Luis Alberto, AU - Soriano-Barón,Hector Enrique, AU - Sotomayor-González,Arturo, AU - Arriada-Mendicoa,Nicasio, AU - Gómez-Amador,Juan Luis, AU - Palma-Díaz,Marité, AU - Barges-Coll,Juan, PY - 2014/10/2/entrez PY - 2014/10/2/pubmed PY - 2015/6/3/medline KW - AAS = atlantoaxial subluxation KW - ASIA = American Spinal Injury Association KW - BI = basilar invagination KW - CTA = CT angiography KW - CVJ = craniovertebral junction KW - EEA = endoscopic endonasal approach KW - EEO = endoscopic endonasal odontoidectomy KW - TMA = transoral microscopic approach KW - TMO = transoral microscopic odontoidectomy KW - VPI = velopharyngeal insufficiency KW - craniovertebral junction KW - endoscopic endonasal approach KW - odontoidectomy KW - transoral microscopic approach SP - E15 EP - E15 JF - Neurosurgical focus JO - Neurosurg Focus VL - 37 IS - 4 N2 - OBJECT: The goal of this study was to compare the indications, benefits, and complications between the endoscopic endonasal approach (EEA) and the microscopic transoral approach to perform an odontoidectomy. Transoral approaches have been standard for odontoidectomy procedures; however, the potential benefits of the EEA might be demonstrated to be a more innocuous technique. The authors present their experience with 12 consecutive cases that required odontoidectomy and posterior instrumentation. METHODS: Twelve consecutive cases of craniovertebral junction instability with or without basilar invagination were diagnosed at the National Institute of Neurology and Neurosurgery in Mexico City, Mexico, between January 2009 and January 2013. The EEA was used for 5 cases in which the odontoid process was above the nasopalatine line, and was compared with 7 cases in which the odontoid process was beneath the nasopalatine line; these were treated using the transoral microscopic approach (TMA). Odontoidectomy was performed after occipital-cervical or cervical posterior augmentation with lateral mass and translaminar screws. One case was previously fused (Oc-C4 fusion). The senior author performed all surgeries. American Spinal Injury Association scores were documented before surgical treatment and after at least 6 months of follow-up. RESULTS: Neurological improvement after odontoidectomy was similar for both groups. From the transoral group, 2 patients had postoperative dysphonia, 1 patient presented with dysphagia, and 1 patient had intraoperative CSF leakage. The endoscopic procedure required longer surgical time, less time to extubation and oral feeding, a shorter hospital stay, and no complications in this series. CONCLUSIONS: Endoscopic endonasal odontoidectomy is a feasible, safe, and well-tolerated procedure. In this small series there was no difference in the outcome between the EEA and the TMA; however, fewer complications were documented with the endonasal technique. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/25270134/Evolution_from_microscopic_transoral_to_endoscopic_endonasal_odontoidectomy_ L2 - https://thejns.org/doi/10.3171/2014.7.FOCUS14301 DB - PRIME DP - Unbound Medicine ER -