Endoscopic Endonasal Approach to the Odontoid Pathologies

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• 作者：Francesco Zenga¹ ; Paolo Pacca¹ ; ^{paolopacca84@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Valentina Tardivo¹ ; Valentina Pennacchietti¹ ; Diego Garbossa¹ ; Giancarlo Pecorari² ; Alessandro Ducati¹
• 关键词：CVJ stability ; Endonasal approach ; Endoscopic ; Odontoidectomy
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：89
• 期：Complete
• 页码：394-403
• 全文大小：4273 K

文摘

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.