Odontoidectomy can help decompress ventral compression of the brainstem and upper cervical spinal cord in the presence of bony abnormalities of the CVJ, e.g., an odontoid pannus. We demonstrated an entirely endonasal approach to the CVJ.

We presented our technique for performing an endoscopic endonasal odontoidectomy.

The patient underwent an open posterior cervical spinal fusion to stabilize the CVJ due to destabilization that occurs with odontoidectomy as part of a single procedure or in a staged manner, depending on the surgeon’s preference. Using a two-surgeon, multi-handed technique in collaboration with neurosurgery, the anterior CVJ was safely approached endoscopically through the nasopharynx. A midline incision was created, and the soft tissue was lateralized widely. The C1 arch was removed with a drill exposing the odontoid process and any associated pannus, then resected. Because this approach was entirely extradural, no reconstruction was necessary. The closure was accomplished by placing absorbable packing material in the defect and medializing the nasopharyngeal tissues.

The study concluded that the endoscopic endonasal odontoidectomy offers excellent exposure and less morbidity than traditional transoral approaches. This technique should be considered in appropriately selected patients.

Reference: https://journals.sagepub.com/doi/full/10.1177/1945892418762659