Atlas dislocation after transverse ligament injury is one of the most rare types of
trauma to the upper cervical level. If magnetic resonance imaging of the craniovertebral
junction reveals the Kassam line passing through the cervix of the odontoid process,
a transnasal approach can be used for surgical treatment. Here, we present a case
in which an endoscopic endonasal approach was used to treat chronic traumatic transligamentous
atlas dislocation. A 26-year-old male underwent two-stage surgical treatment; during
the first stage, posterior decompression and fixation were performed under halo immobilization.
In the second stage, a transnasal endoscopic approach to the odontoid process was
used. A transnasal approach permitted complete decompression of the medulla oblongata
and facilitated early extubation of the patient without any postoperative complications
such as respiratory or pharyngopalatine deficiency. The patient was discharged in
good condition 9 days after the surgery.
Key-words:
Craniovertebral endoscopy - endonasal resection - Kassam line - odontoid resection
- transligamentous atlas dislocations
