Lesson learned in endoscopic endonasal dens resection for C1-C2 spinal cord decompression

Eur Spine J. 2024 Feb;33(2):438-443. doi: 10.1007/s00586-023-08001-y. Epub 2023 Nov 7.

Abstract

Purpose: Endoscopic endonasal approach (EEA) is the safest and most effective technique for odontoidectomy. Nevertheless, this kind of approach is yet not largely widespread. The aim of this study is to share with the scientific community some tips and tricks with our ten-year-old learned experience in endoscopic endonasal odontoidectomy (EEO), which remains a challenging surgical approach.

Material and methods: Our case series consists of twenty-one (10 males, 11 females; age range of 34-84 years) retrospectively analyzed patients with ventral spinal cord compression for non-reducible CVJ malformation, treated with EEA from July 2011 to March 2019.

Results: The results have recently been reported in a previous paper. The only intraoperative complication observed was intraoperative cerebrospinal fluid (CSF) leak (9.5%), without any sign of post-operative CSF leak.

Conclusions: Considering our experience, EEO represents a valid and safe technique to decompress neural cervical structures. Despite its technical complexity, mainly due to the use of endoscope and the challenging surgical area, with this study we encourage the use of EEO displaying our experience-based surgical tips and tricks.

Keywords: C1–C2 instability; Craniovertebral junction; Endoscopic endonasal approach; Odontoidectomy; Spinal cord decompression.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cerebrospinal Fluid Leak / etiology
  • Cerebrospinal Fluid Leak / surgery
  • Child
  • Decompression, Surgical*
  • Endoscopy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Spinal Cord