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Endoscopic Endonasal Approach to the Craniovertebral Junction Lesions: A Case Series of 18 Patients
Introduction Odontoid pathologies constitute a special category because they may lead to instability. Instability is defined by abnormal spinal alignment under physiologic conditions (loads) such as standing, walking, bending, or lifting. Since instability poses a risk of cord damage, surgical interventions may be required for durable long-term stabilization. This study demonstrates operative technique and results of endoscopic endonasal approach to the odontoid pathologies.
Methods We conducted a retrospective study involving 18 patients who underwent endoscopic endonasal odontoidectomy (EEO) due to craniovertebral pathologies. Demographic data, clinical features of the patients, risk factors, and intraoperative and postoperative complications were reported in this series.
Results Satisfactory outcomes achieved in 16 patients based on comparing the modified Rankin scale before and after the surgery (p = 0.0001). The mean duration for EEO was 232.6 ± 18.8 minutes. The mean blood loss during surgery was 386.67 ± 153.04 mL. The mean duration of hospital stay was 7 days. All patients were extubated within a few hours after surgery. Despite of successful anterior decompression in the aforementioned cases, intraoperative cerebrospinal fluid (CSF) leakage, postoperative meningitis, and pulmonary thromboembolism occurred as complications. However, two intraoperative CSF leakages were managed by direct dural repair and fat graft; two patients died due to postoperative meningitis and pulmonary thromboembolism at 7 and 4 days after the second surgery.
Conclusion In conclusion, EEO can be effectively used for anterior decompression of the odontoid pathologies, despite the risk of complications.
Keywordssurgical endoscopy - cervical spine - cervical vertebrae - craniovertebral junction - skull base - complications
The Methods section stating that the experimental protocol and informed consent were approved by the Institutional Review Board (IRB identifier: IR.GUMS.REC.1400.507), and that all patients gave informed consent.
All authors contributed in all parts of the study including designing the structure of the study, conducting the search, extracting and analyzing data, interpreting results, and writing the report.
Received: 27 May 2022
Accepted: 04 August 2022
Accepted Manuscript online:
16 August 2022
Article published online:
14 September 2022
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