Endoscopic Endonasal Decompression of the Hypoglossal Canal

Objective: Stenosis of the hypoglossal canal and compression of the hypoglossal nerve can be caused by several pathologies, including neoplastic, degenerative, infectious, and rheumatologic. Herein we describe a case of hypoglossal canal stenosis and hemitongue atrophy in a patient with a subluxation of the occiput on C1.

Case Report: A 71 year-old male presented with progressive right hemi-tongue atrophy and fasciculations. Electromyography confirmed ongoing right hypoglossal nerve denervation and a thorough workup excluded other etiologies. Imaging was concerning for a subluxation at the O-C1 joint and severe stenosis of the right hypoglossal canal. Dynamic, flexion extension imaging showed no instability. After discussing treatment options with the patient as well as associated risks and benefits he elected to undergo the recommended endoscopic endonasal transcondylar approach for decompression of the hypoglossal canal. The patient was positioned in a neutral position and a rhinopharyngeal flap was elevated for exposure of the craniocervical junction. The inferior clivus and medial portion of the jugular tubercle was drilled followed by partial removal of the anterior arch of C1. The subluxation was evident intraoperatively with the head kept in the neutral position. After the condyle was cored at the level of the supracondylar groove, the hypoglossal nerve was identified with stimulation and was decompressed 180 to 270 degrees along its entire intracanalicular course. Care was taken to avoid removal of the articulating surface of the condyle with the C1 lateral mass to prevent postoperative craniocervical instability and the need for fusion. After decompression a small fat graft was placed in the cavity and a rhinopharyngeal flap was elevated. His course was complicated by sinusitis, and possible fat infection which resolved with a course of antibiotics. The patient's hypoglossal nerve function improved significantly, along with his associated dysphagia, and dysarthria, and he had no clinical or radiographic evidence of instability at 5 months follow-up.

Conclusion: Compression of the hypoglossal nerve within the hypoglossal canal secondary to degenerative craniocervical processes is rare entity, but the endonasal transcondylar approach is a feasible and effective solution to decompression while sparring the need for craniocervical fixation in select cases.

 

MissingLinkText

Die Autoren geben an, dass kein Interessenkonflikt besteht.

Publikationsverlauf

Artikel online veröffentlicht:
15. Februar 2022