Endoscopic Transnasal Odontoidectomy: A Single-Center’s Experience and Approach to Pathology of the Craniocervical Junction

Introduction: The craniovertebral junction is an important anatomical compartment with unique structural and functional relationships that present challenges to surgeons. Historically, transoral microscopic approaches with additional posterior stabilization have been accepted as the standard of care when treating pathology in this area. However, with the advancement of newer technology, endoscopic transnasal clivus and odontoid surgeries are gaining interest as alternative approaches. We reviewed our experience of using endoscopic transnasal odontoidectomy in the treatment of pathology at the craniovertebral junction. Our objective is to further validate the effectiveness of this approach in selected cases and describe several operative nuances and pearls based on experiences at our institution.

Methods: We retrospectively evaluated nine patients (two males and seven females; age range = 28–81 years) who underwent endoscopic transnasal odontoidectomy between 2013 and 2019.

Results: Among the nine patients, seven had basilar invagination with focal neurologic deficits and two had metastatic osseous lesions invading the odontoid. Seven of the patients underwent posterior stabilization with occiput to cervical fusions of varying construct lengths. Mean modified Rankin scale average demonstrated improvement from 3 to 2, respectively. The follow-up period ranged from 3 to 52 months. Our series demonstrated moderately less overall surgical and medical complications as compared with other retrospective studies.

Conclusion: The endoscopic transnasal modality represents an attractive minimally invasive surgical approach to the craniocervical junction. With proper patient selection and continued development of technique and experience, this approach is a safe and effective tool for a surgeon’s armamentarium.