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Endoscopic Endonasal Approach to the Odontoid Pathologies.
World Neurosurg. 2016 May; 89:394-403.WN

Abstract

BACKGROUND

Surgical anterior decompression represents the treatment of choice for symptomatic irreducible ventral craniovertebral junction (CVJ) compression. With the refinement of the endoscopic techniques, the endonasal route has been proposed as alternative to the classic transoral approach to CVJ. Some reports assess the effectiveness and safety of endoscopic endonasal approaches to CVJ pathologies.

MATERIALS AND METHODS

From July 2011 to February 2014, 12 patients with symptomatic nonreducible ventral spinal cord compression underwent purely 3-dimensional endoscopic endonasal odontoidectomy in our department. The surgical technique is described.

RESULTS

A good brainstem-medullary decompression was achieved in all patients. In 10 of 12 patients the endotracheal tube was removed just after the procedure with good recovery of the respiratory function. We report no cases of velopharyngeal insufficiency. In 5 of 12 patients the preservation of C1 anterior was achieved, without the need for posterior cervical fixation.

DISCUSSION AND CONCLUSIONS

Endoscopic endonasal odontoidectomy has proven to be safe and effective in selected patients. Soft and hard palate preservation dramatically reduces the risk of postoperative velopharyngeal insufficiency. Moreover, the endonasal endoscopic approach provides a direct access to the dens. Three-dimensional high-definition endoscope, laser, and ultrasound bony curettes revealed to be useful tools for this approach that, however, remains a demanding one.

Authors+Show Affiliations

Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy. Electronic address: paolopacca84@gmail.com.Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.1st ENT Division, Department of Surgical Sciences, University of Torino, Genova, Italy.Division of Neurosurgery, Department of Neurosciences, University of Torino, Cherasco, Italy.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

26868425

Citation

Zenga, Francesco, et al. "Endoscopic Endonasal Approach to the Odontoid Pathologies." World Neurosurgery, vol. 89, 2016, pp. 394-403.
Zenga F, Pacca P, Tardivo V, et al. Endoscopic Endonasal Approach to the Odontoid Pathologies. World Neurosurg. 2016;89:394-403.
Zenga, F., Pacca, P., Tardivo, V., Pennacchietti, V., Garbossa, D., Pecorari, G., & Ducati, A. (2016). Endoscopic Endonasal Approach to the Odontoid Pathologies. World Neurosurgery, 89, 394-403. https://doi.org/10.1016/j.wneu.2016.02.011
Zenga F, et al. Endoscopic Endonasal Approach to the Odontoid Pathologies. World Neurosurg. 2016;89:394-403. PubMed PMID: 26868425.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic Endonasal Approach to the Odontoid Pathologies. AU - Zenga,Francesco, AU - Pacca,Paolo, AU - Tardivo,Valentina, AU - Pennacchietti,Valentina, AU - Garbossa,Diego, AU - Pecorari,Giancarlo, AU - Ducati,Alessandro, Y1 - 2016/02/09/ PY - 2015/11/09/received PY - 2016/02/01/revised PY - 2016/02/02/accepted PY - 2016/2/13/entrez PY - 2016/2/13/pubmed PY - 2017/5/24/medline KW - CVJ stability KW - Endonasal approach KW - Endoscopic KW - Odontoidectomy SP - 394 EP - 403 JF - World neurosurgery JO - World Neurosurg VL - 89 N2 - BACKGROUND: Surgical anterior decompression represents the treatment of choice for symptomatic irreducible ventral craniovertebral junction (CVJ) compression. With the refinement of the endoscopic techniques, the endonasal route has been proposed as alternative to the classic transoral approach to CVJ. Some reports assess the effectiveness and safety of endoscopic endonasal approaches to CVJ pathologies. MATERIALS AND METHODS: From July 2011 to February 2014, 12 patients with symptomatic nonreducible ventral spinal cord compression underwent purely 3-dimensional endoscopic endonasal odontoidectomy in our department. The surgical technique is described. RESULTS: A good brainstem-medullary decompression was achieved in all patients. In 10 of 12 patients the endotracheal tube was removed just after the procedure with good recovery of the respiratory function. We report no cases of velopharyngeal insufficiency. In 5 of 12 patients the preservation of C1 anterior was achieved, without the need for posterior cervical fixation. DISCUSSION AND CONCLUSIONS: Endoscopic endonasal odontoidectomy has proven to be safe and effective in selected patients. Soft and hard palate preservation dramatically reduces the risk of postoperative velopharyngeal insufficiency. Moreover, the endonasal endoscopic approach provides a direct access to the dens. Three-dimensional high-definition endoscope, laser, and ultrasound bony curettes revealed to be useful tools for this approach that, however, remains a demanding one. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/26868425/Endoscopic_Endonasal_Approach_to_the_Odontoid_Pathologies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(16)00222-9 DB - PRIME DP - Unbound Medicine ER -