Clinical Outcomes of Endoscopic Endonasal Odontoid Resection: A Single Center Experience

Introduction: The advent of endoscopic endonasal skull base techniques has enabled safe and effective access to the anterior craniocervical junction which offers several advantages over the traditional transoral approach. Recent literature comparing the endonasal and transoral approach showed that the endonasal approach reduces the length of hospital stay, ventilation time, and the incidence of postoperative tracheostomy, allows earlier extubation and postoperative feeding. Some risks that exist with the transnasal approach, including cerebrospinal fluid (CSF) leakage, cervical instability, and vascular injury, can be effectively managed through the endonasal approach. The objective of this study is to review the intra- and postoperative complications associated with endoscopic endonasal odontoid resection.

Methods: This study is a retrospective chart review of all adult patients who underwent an endoscopic endonasal odontoid resection at a single tertiary care center between January 2011 and May 2019. Demographic, clinical, surgery, and pathology data were collected. Patients’ intra- and postoperative complications were analyzed.

Results: Seventeen patients who underwent endoscopic endonasal odontoid resection were included in the study. The median age at admission was 67 years (range, 33–84 years) and 61% of the patients were female. The median follow up duration was 9 months (range, 4–47 months). Indications for surgery included basilar invagination (8/17, 47%), rheumatoid arthritis (3/17, 18%), congenital osseous malformation (2/17, 12%), odontoid fracture (1/17, 6%), and compression of cervicomedullary area (3/17, 18%). Presenting symptoms included difficulty with fine hand movements (10/17, 59%), myelopathy (9/17, 53%), lower cranial nerve symptoms (3/17, 18%), difficulty walking (8/17, 47%), and sensory symptoms (5/17, 29%). Four patients (4/17, 24%) had a syrinx on MRI. In terms of intraoperative complications, one patient (1/17, 6%) required a blood transfusion, one patient (1/17, 6%) had vertebral artery injury which had to be coiled with no neurological deficits, and three patients (3/17, 18%) had intraoperative CSF leaks with no postoperative leak. Posterior fusion was performed in 16 patients (16/17, 94%). The median length of hospital stay was 13 days (range, 2–76 days). Three patients (3/17, 18%) developed postoperative infection which required debridement in the operating room. Four patients (4/17, 23%) developed transient postoperative dysphagia. One patient (1/17, 6%) had postoperative epistaxis and one patient (1/17, 6%) had postoperative lower cranial nerve symptoms.

Conclusion: Although the transoral approach has been the traditional route for anterior decompression of the craniocervical junction, endoscopic endonasal odontoid resection may be considered a safe and effective procedure for treating various odontoid pathologies.

No conflict of interest has been declared by the author(s).