Endoscopic image-guided odontoidectomy for decompression of basilar invagination via a standard anterior cervical approach. Technical note

Jean Paul Wolinsky*, Daniel M. Sciubba, Ian Suk, Ziya L. Gokaslan

*Corresponding author for this work

Research output: Contribution to journalArticle

99 Scopus citations

Abstract

Symptomatic irreducible basilar invagination has traditionally been approached through a transoral-transpharyngeal route with resection of the anterior portion of C-1 and the odontoid. Modification of this exposure with either a Le Fort osteotomy or a transmandibular osteotomy and circumglossal approach has increased the access to pathological conditions in this region. These traditional routes all require traversing the oral cavity and accepting the associated potential complications. The authors have developed a novel surgical approach, an endoscopic transcervical odontoidectomy, which allows access for resection of the odontoid and for brainstem and spinal cord decompression without traversing the oral cavity. In this paper they describe the technique and its advantages and present three cases in which patients underwent the endoscopic transcervical odontoidectomy for basilar invagination. Three consecutive patients (age range 42-74 years) who had irreducible basilar invagination underwent the endoscopic transcervical odontoidectomy. All were symptomatic and had neck pain and myelopathy. All were evaluated preoperatively and postoperatively with computed tomography and magnetic resonance imaging. In all cases the procedure resulted in complete decompression. There were no serious complications. No patient required prolonged intubation, tracheostomy, or enteral tube feeding. One patient had an intraoperative cerebrospinal fluid leak, which had no postoperative sequelae. The authors present an alternative surgical approach for treating ventral compression of the brainstem and spinal cord. The technique is safe and effective for decompression and provides a surgical route that can be added to the armamentarium of treatments for pathological conditions in this region.

Original languageEnglish (US)
Pages (from-to)184-191
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume6
Issue number2
DOIs
StatePublished - Feb 1 2007

Keywords

  • Basilar invagination
  • Endoscopy
  • Myelopathy
  • Odontoidectomy
  • Transoral approach

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

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