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CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2021; 82(S 01): S12-S13
DOI: 10.1055/s-0040-1714408
Skull Base: Operative Videos

Endoscopic Endonasal Odontoidectomy with Nasopharyngeal Flap Reconstruction

Nyall R. London Jr.
1   Department of Otolaryngology—Head and Neck Surgery, The Ohio State University, Columbus, Ohio, United States
,
Ahmed Mohyeldin
2   Department of Neurosurgery, The Ohio State University, Columbus, Ohio, United States
,
Ricardo L. Carrau
1   Department of Otolaryngology—Head and Neck Surgery, The Ohio State University, Columbus, Ohio, United States
,
Daniel M. Prevedello
2   Department of Neurosurgery, The Ohio State University, Columbus, Ohio, United States
› Author Affiliations
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Abstract

Objective This study aimed to demonstrate the nuances in preoperative management, surgical technique, and reconstruction for an endoscopic endonasal odontoidectomy.

Design Assembly of an operative video demonstrating technique for endoscopic endonasal odontoidectomy.

Setting this study is a comprehensive skull base team at a tertiary care center.

Participant The patient is a 53-year-old male, with basilar invagination and myelopathy, who underwent cervical fusion, 6 years back, without ventral decompression at an outside hospital. He presented to our clinic with persistent myelopathy and generalized weakness, thus an endoscopic endonasal odontoidectomy for brainstem decompression was recommended.

Main Outcome Measures Preoperative computed tomography (CT) angiography and intraoperative CT navigation demonstrated normal carotid artery anatomic localization. An inverted U-shaped mucosal flap was reflected inferiorly and preserved. The C1 arch was identified and resected with a high speed drill. The resultant diseased soft tissue arising from retropulsion of the odontoid process was then removed and the odontoid process identified. This bone was removed centrally until a thin cap remained. After removal of the cap, the underlying ligamentous tissue was removed until dural pulsations were appreciated and brainstem decompression achieved. Hemostasis was attained and the mucosal flap mobilized into position.

Results Postoperative CT imaging demonstrated resolution of basilar invagination and brainstem decompression ([Fig. 1]). The patient improved both in arm dexterity and ambulation after surgery and the reconstruction demonstrated appropriate healing on nasal endoscopy 2 months postoperatively.

Conclusions This operative video demonstrates nuances in endoscopic endonasal odontoidectomy. This case also demonstrates that ventral decompression after long-term cervical fusion can improve myelopathy and that fusion in the setting of bony ventral compression, rather than rheumatoid panus, may not reduce over time with fusion only.

The link to the video can be found at: https://youtu.be/370FFuBA89Y.


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Keywords

basilar invagination - endoscopic odontoidectomy - odontoidectomy
Zoom Image
Fig. 1 (A) Preoperative sagittal CT imaging demonstrates retropulsion of the odontoid process and basilar invagination. (B) Postoperative sagittal CT demonstrates removal of the anterior C1 arch and odontoid process resulting in brainstem decompression. CT, computed tomography.

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Conflict of Interest

R.L.C. is a consultant for Medtronic. D.M.P. is a consultant for Medtronic, Codman, and Stryker. D.M.P. has received honorarium from Leica Microsystems and has a royalty agreement with KLS-Martin. N.R.L. is a consultant for Cooltech Inc.

Address for correspondence

Daniel M. Prevedello, MD
Department of Neurological Surgery, Wexner Medical Center at The Ohio State University
N-1049 Doan Hall, 410 West 10th Avenue, Columbus OH 43210
United States   

Publication History

Received: 18 January 2019

Accepted: 08 March 2020

Article published online:
23 November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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Zoom Image
Fig. 1 (A) Preoperative sagittal CT imaging demonstrates retropulsion of the odontoid process and basilar invagination. (B) Postoperative sagittal CT demonstrates removal of the anterior C1 arch and odontoid process resulting in brainstem decompression. CT, computed tomography.