Resection of the Odontoid Process through the Expanded Endonasal Approach: Clinical Experience from 14 Patients

Background: Indications for removal of the odontoid process include decompression of the brainstem in patients with rheumatoid degeneration and access to tumors or vascular lesions at the foramen magnum. Resection of the odontoid can be accomplished using a completely transnasal endoscopic approach.

Methods: We performed a retrospective review of the first series of patients at our institution (n = 14) undergoing transnasal endoscopic resection of the odontoid, and reviewed preoperative symptoms and postoperative outcomes with a minimum follow-up of 3 months.

Results: Fourteen patients underwent transnasal endoscopic resection of the odontoid for rheumatoid disease with brainstem compression or resection of tumors involving the dens. All patients demonstrated improvement in symptoms of myelopathy. There was a low incidence of postoperative complications: 36% of patients required a tracheostomy; 14% experienced transient velopharyngeal insufficiency; 29% had CSF leaks that were successfully repaired; and 7% developed meningitis that was successfully treated. There were 3 patients (21%) who expired from various causes not thought to be attributable to the transnasal approach described herein.

Conclusions: This series demonstrates the feasibility and promising outcomes of a fully endoscopic approach for resection of the odontoid process. Potential advantages and limitations of this innovative approach will be discussed.