Download PDF
CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2021; 82(S 01): S16-S18
DOI: 10.1055/s-0040-1715522
Skull Base: Operative Videos

Endoscopic Endonasal Transclival Odontoidectomy for Basilar Invagination: Operative Video and Technical Nuances

James K. Liu
1   Department of Neurological Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, Robert Wood Johnson Barnabas Health, Newark, New Jersey, United States
2   Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, RWJ Barnabas Health, Newark, New Jersey, United States
3   Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, RWJ Barnabas Health, Newark, New Jersey, United States
,
Vincent N. Dodson
1   Department of Neurological Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, Robert Wood Johnson Barnabas Health, Newark, New Jersey, United States
,
Kevin Zhao
1   Department of Neurological Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, Robert Wood Johnson Barnabas Health, Newark, New Jersey, United States
3   Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, RWJ Barnabas Health, Newark, New Jersey, United States
,
Jean Anderson Eloy
1   Department of Neurological Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, Robert Wood Johnson Barnabas Health, Newark, New Jersey, United States
2   Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, RWJ Barnabas Health, Newark, New Jersey, United States
3   Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, RWJ Barnabas Health, Newark, New Jersey, United States
› Author Affiliations
› Further Information
Also available at
 
 PDF Download Permissions and Reprints

Abstract

Basilar invagination is a congenital or acquired craniovertebral junction abnormality where the tip of the odontoid process projects through the foramen magnum which can cause severe symptomatic compression of the brainstem and spinal cord. If left untreated, patients can develop progressive quadriparesis. Traditionally, basilar invagination can be treated with cervical traction and posterior stabilization. However, in irreducible cases, anterior decompression via a transoral or endonasal approach may be necessary. In this operative video, we demonstrate an endoscopic endonasal transclival approach for odontoidectomy to successfully treat a 37-year-old female with severe basilar invagination causing symptomatic compression on the cervicomedullary junction resulting in unsteady gait and motor weakness. The patient had Klippel–Feil syndrome where the C1 arch was assimilated to the foramen magnum and transclival drilling was needed to adequately access the odontoid process for removal. A second-stage posterior occipitocervical stabilization and fusion was performed the following day. Immediate postoperative imaging showed excellent decompression of the cervicomedullary junction. Postoperatively, the patient had significant improvement in gait and motor strength in all extremities, and was ambulating independently without assistance at 1 year after surgery. The endoscopic endonasal transclival odontoidectomy is a useful strategy to treat severe irreducible basilar invagination causing symptomatic neural compression. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video.

The link to the video can be found at: https://youtu.be/HL4K7KqJEJM.


#

Keywords

endoscopic endonasal approach - transclival odontoidectomy - endoscopic skull base surgery - basilar invagination - craniovertebral junction - operative video
Zoom Image
Fig. 1 Top left: Preoperative T2 weighted sagittal MRI demonstrating severe basilar invagination with the odontoid process compressing the cervicomedullary junction and narrowing of the foramen magnum. Bottom left: Preoperative CT sagittal demonstrating the anterior arch of C1 assimilated to the foramen magnum and the C3 and C4 vertebral bodies were fused consistent with Klippel–Feil syndrome. Right: Intraoperative photograph showing endoscopic drilling of the odontoid process using eggshell technique. CT, computed tomography; MRI, magnetic resonance imaging.
Zoom Image
Fig. 2 (A and B) Preoperative T2-weighted sagittal MRI (A) and sagittal CT (B) demonstrating severe basilar invagination with the odontoid process compressing the cervicomedullary junction and narrowing of the foramen magnum. (C and D) Postoperative T2-weighted sagittal MRI (C) and sagittal CT (D) demonstrating excellent decompression of the cervicomedullary junction and occipitocervical instrumented stabilization. CT, computed tomography; MRI, magnetic resonance imaging.

www.thieme.com/skullbasevideos

www.thieme.com/jnlsbvideos


Quality:

#

Conflict of Interest

None declared.

Address for correspondence

James K. Liu, MD
Department of Neurological Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, RWJ Barnabas Health
90 Bergen Street, Suite 8100, Newark, NJ 07103
United States   

Publication History

Received: 25 June 2020

Accepted: 25 June 2020

Article published online:
02 December 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/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

   Permissions and Reprints
Zoom Image
Fig. 1 Top left: Preoperative T2 weighted sagittal MRI demonstrating severe basilar invagination with the odontoid process compressing the cervicomedullary junction and narrowing of the foramen magnum. Bottom left: Preoperative CT sagittal demonstrating the anterior arch of C1 assimilated to the foramen magnum and the C3 and C4 vertebral bodies were fused consistent with Klippel–Feil syndrome. Right: Intraoperative photograph showing endoscopic drilling of the odontoid process using eggshell technique. CT, computed tomography; MRI, magnetic resonance imaging.
Zoom Image
Fig. 2 (A and B) Preoperative T2-weighted sagittal MRI (A) and sagittal CT (B) demonstrating severe basilar invagination with the odontoid process compressing the cervicomedullary junction and narrowing of the foramen magnum. (C and D) Postoperative T2-weighted sagittal MRI (C) and sagittal CT (D) demonstrating excellent decompression of the cervicomedullary junction and occipitocervical instrumented stabilization. CT, computed tomography; MRI, magnetic resonance imaging.