Abstract
Introduction Odontoid pathologies constitute a special category because they may lead to instability.
Instability is defined by abnormal spinal alignment under physiologic conditions (loads)
such as standing, walking, bending, or lifting. Since instability poses a risk of
cord damage, surgical interventions may be required for durable long-term stabilization.
This study demonstrates operative technique and results of endoscopic endonasal approach
to the odontoid pathologies.
Methods We conducted a retrospective study involving 18 patients who underwent endoscopic
endonasal odontoidectomy (EEO) due to craniovertebral pathologies. Demographic data,
clinical features of the patients, risk factors, and intraoperative and postoperative
complications were reported in this series.
Results Satisfactory outcomes achieved in 16 patients based on comparing the modified Rankin
scale before and after the surgery (p = 0.0001). The mean duration for EEO was 232.6 ± 18.8 minutes. The mean blood loss
during surgery was 386.67 ± 153.04 mL. The mean duration of hospital stay was 7 days.
All patients were extubated within a few hours after surgery. Despite of successful
anterior decompression in the aforementioned cases, intraoperative cerebrospinal fluid
(CSF) leakage, postoperative meningitis, and pulmonary thromboembolism occurred as
complications. However, two intraoperative CSF leakages were managed by direct dural
repair and fat graft; two patients died due to postoperative meningitis and pulmonary
thromboembolism at 7 and 4 days after the second surgery.
Conclusion In conclusion, EEO can be effectively used for anterior decompression of the odontoid
pathologies, despite the risk of complications.
Keywords
surgical endoscopy - cervical spine - cervical vertebrae - craniovertebral junction
- skull base - complications
