Feasibility of Using Intraoperative Magnetic Resonacing Imaging for Endoscopic Transcervical Odontoidectomy

Introduction: Endoscopic transcervical odontoidectomy is a treatment option for pathology at the cranio-cervical junction. The use of intraoperative MRI (iMRI) has not been reported in conjunction with this approach and its role in this procedure has not been defined.

Methods: An endoscopic transcervical odontoidectomy using the iMRI was performed as a second stage in a patient who had previously undergone a posterior occiput-C4 fusion. The ability to obtain adequate imaging and additional logistical steps for performing this procedure in the iMRI room were noted.

Results: An intraoperative, preprocedure MRI was obtained to register the neuronavigation and to serve as a baseline study. Despite the presence of posterior hardware, the MRI quality was of sufficient quality to be fused with the preoperative CT for neuronavigation. The extent of resection was assessed intraoperatively by obtaining a postprocedure MRI, which confirmed adequate decompression. Total procedure time was 4 hours and 30 minutes. Additional time was required for a pre-MRI additional safety count and for obtaining the MRI. There were no MRI-related complications.

Conclusion: Utilization of iMRI is technically feasible for endoscopic transcervical odontoidectomy. Additional time is required for a pre-MRI safety count and for obtaining the scan. Whether the additional steps, time, and expense required justify the use of iMRI for this procedure remains to be determined.

Fig. 1 Screenshot of neuronavigation utilizing intraoperative, preprocedure MRI that was fused with a preoperative CT.

Fig. 2 Intraoperative, postprocedure axial (left) and sagittal (right) T2-weighted MRI demonstrated adequate odontoid resection and decompression.