J Neurol Surg B Skull Base 2017; 78(S 01): S1-S156
DOI: 10.1055/s-0037-1600746
Poster Abstracts
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Endo-Nasal Odontoid Resection with Real-Time Intraoperative Image Guided Computed Tomography (CT)

Harminder Singh
1   Stanford University School of Medicine, Stanford, California, United States
,
Sarang Rote
2   Weill Cornell Medical College, New York, New York, United States
,
Ajit Jada
2   Weill Cornell Medical College, New York, New York, United States
,
Evan Bander
2   Weill Cornell Medical College, New York, New York, United States
,
Gustavo J. Almodovar-Mercado
2   Weill Cornell Medical College, New York, New York, United States
,
Roger Hartl
2   Weill Cornell Medical College, New York, New York, United States
,
Vijay K. Anand
2   Weill Cornell Medical College, New York, New York, United States
,
Jeffrey G. Greenfield
2   Weill Cornell Medical College, New York, New York, United States
,
Theodore H. Schwartz
2   Weill Cornell Medical College, New York, New York, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
02 March 2017 (online)

 

Introduction: We present four cases in which we used intraoperative CT scanning to provide real-time image guidance during endonasal odontoid resection. While intraoperative CT has previously been used as a confirmatory test after surgical resection, this is the first time it has been used to provide real-time image guidance during endonasal odontoid resection. The operating room setup, as well as the advantages and pitfalls of this approach are discussed.

Methods: Airo, the mobile intraoperative CT from Brainlab, was used in conjunction with the Curve, also from Brainlab, for cranio-spinal neuronavigation in four patients, who underwent endoscopic endonasal odontoidectomy for basilar invagination.

Results: All patients underwent a successful decompression. In three out of four patients, real-time intraoperative CT image guidance was instrumental in achieving a comprehensive decompression. In all four cases where the right nostril was the predominant working channel, there was a tendency for asymmetric decompression toward the right side, meaning residual bone was seen on the left, which was subsequently removed.

Conclusion: Endoscopic endo-nasal odontoid resection with real-time intraoperative image guided CT is feasible, and provides accurate intraoperative localization of pathology thereby increasing the chance of complete odontoidectomy. For right handed surgeons operating predominantly through the right nostril, special attention should be paid to the contralateral side of the resection, where there is often a tendency for residual pathology.