Experience with the Expanded Endonasal Approach for Resection of the Odontoid Process in Rheumatoid Disease

2007 ◽  
Vol 21 (5) ◽  
pp. 601-606 ◽  
Author(s):  
Jayakar V. Nayak ◽  
Paul A. Gardner ◽  
Allan D. Vescan ◽  
Ricardo L. Carrau ◽  
Amin B. Kassam ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Odontoid Process ◽  
Infectious Complications ◽  
Upper Cervical Spine ◽  
Transnasal Approach ◽  
Velopharyngeal Incompetence ◽  
Expanded Endonasal Approach ◽  
Upper Cervical ◽  
Transnasal Endoscopic Approach ◽  
Traditional Approaches

Background One of the common indications for removal of the odontoid process includes decompression of the cervicomedullary junction in patients with arthritic degeneration. Resection of the odontoid process can be accomplished using a completely transnasal endoscopic approach. Methods A retrospective review was performed of patients with rheumatoid pannus undergoing transnasal endoscopic resection of the odontoid to assess preoperative characteristics, postoperative complications, and outcomes. Patients were followed for a minimum of 3 months in the postoperative period and/or until death. In addition to the primary procedure, those patients with preoperative cervical instability underwent posterior fusion of the upper cervical spine to the occiput for stabilization during the same hospitalization. Results Nine patients underwent transnasal endoscopic resection of the odontoid process for rheumatoid or degenerative pannus and brainstem compression. Perioperatively, four patients required a tracheostomy; two of whom had significant preoperative pharyngeal dysfunction. Two patients experienced postoperative velopharyngeal incompetence, which was transient. No patients had cerebrospinal fluid leaks, and there were no perioperative infectious complications noted. There was one delayed death in this patient cohort because of a presumed pulmonary embolus. Otherwise, all patients showed an improvement of their preoperative neurological symptoms. Conclusion This early series of patients with rheumatoid pannus shows the feasibility of a fully endoscopic, completely transnasal approach for the resection of the odontoid process. Potential advantages include improved visualization, limited morbidity, decreased pain, and faster recovery than traditional approaches.

The Expanded Endonasal Approach: A Fully Endoscopic Transnasal Approach and Resection of the Odontoid Process

Skull Base ◽  
2005 ◽  
Vol 15 (S 2) ◽  
Author(s):  
Carl Snyderman ◽  
Amin Kassam ◽  
Paul Gardner ◽  
Ricardo Carrau ◽  
Richard Spiro
Keyword(s):  
Odontoid Process ◽  
Endonasal Approach ◽  
Transnasal Approach ◽  
Expanded Endonasal Approach ◽  
Endoscopic Transnasal Approach

scholarly journals Odontoid process fracture in 2 year old child: a rare case report

2017 ◽  
Vol 31 (4) ◽  
pp. 522-525
Author(s):  
Prajapati Hanuman Prasad ◽  
Singh Deepak Kumar ◽  
Singh Rakesh Kumar ◽  
Yadav Kuldeep
Keyword(s):  
Cervical Spine ◽  
Odontoid Process ◽  
The Body ◽  
Upper Cervical Spine ◽  
Age Group ◽  
Spine Injuries ◽  
Rare Case Report ◽  
Upper Cervical ◽  
Cervical Spine Fractures ◽  
Odontoid Process Fracture

Abstract In small childrens spine injuries are rare. In this age group upper cervical spine is commonally affected. Odontoid process fracture involve only a subset of cervical spine fractures. In small childrens, this fracture typically involves the cartilaginousplate that separates the odontoid process from the body of the axis. Odontoid processfracture is rare in children less than 7 years of age.

Microscopic Decompression of the Anterior Upper Cervical Spine: A Case of Odontoid Malunion to the Atlas

Neurosurgery ◽  
1984 ◽  
Vol 14 (5) ◽  
pp. 583-587 ◽  
Author(s):  
Jimmy Miller ◽  
Andrew D. Parent
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Odontoid Process ◽  
Transoral Approach ◽  
Upper Cervical Spine ◽  
Basilar Impression ◽  
Odontoid Fractures ◽  
Surgical Microscope ◽  
The Past ◽  
Upper Cervical

Abstract For the past 20 years, the transoral approach to the upper cervical spine has been utilized for odontoid fractures, the removal of an abnormal odontoid process, decompression of basilar impression, and biopsy or resection of nasopharyngeal or metastatic tumors. The effectiveness and safety of this procedure is well documented. Use of the surgical microscope adds to the efficiency and safety of the procedure. We are reporting a case of fusion of the odontoid base to the anterior arch of the atlas. To our knowledge, this entity has not been described previously. The spinal cord was protected by an initial posterior fusion of C-1, C-2, followed in 10 days by a tracheostomy and the transoral removal of the anterior C-1 arch and the abnormal dens. Because the medical history did not reveal a source of trauma, it is supposed that the patient had malunion of the odontoid process to C-2, with subsequent migration and fusion of the dens to the C-1 arch.

scholarly journals UPPER CERVICAL SPINE INJURIES: DIAGNOSTICS, CLASSIFICATIONS AND TREATMENT PECULIARITIES

2005 ◽  
pp. 025-044
Author(s):  
Edvard Aleksandrovich Ramikh
Keyword(s):  
Cervical Spine ◽  
Odontoid Process ◽  
Upper Cervical Spine ◽  
Treatment Technique ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Upper Cervical ◽  
Methods Of Treatment ◽  
Traumatic Spondylolisthesis ◽  
Selection Of

Comprehensive diagnostics, accepted classifications, and selection of pathogenetic methods of treatment (including surgery) for axis injuries, odontoid process fractures, axis traumatic spondylolisthesis and hangman’s fractures are discussed in the paper. The presented data prove the necessity and possibility of early exhaustive diagnosing to differentiate the type of a craniocervical disorder and to provide a timely choice of pathogenetic treatment technique, especially of a surgical one.

scholarly journals Biomechanics of upper cervical spine and peculiarities of treatment of patients with odontoid process fractures

1996 ◽  
Vol 3 (1) ◽  
pp. 18-21
Author(s):  
V. A. Moiseenko
Keyword(s):  
Cervical Spine ◽  
Conservative Treatment ◽  
Odontoid Process ◽  
Upper Cervical Spine ◽  
Traction Method ◽  
Cervical Muscles ◽  
Halo Traction ◽  
Upper Cervical ◽  
Extension Fracture

In transdental injuries of atlantoaxial region the indications for conservative treatment and authors bipolar Halo-traction method were worked out on the base of spine biomechanical peculiarities (anterior shifting moment and extensor conditionality of the posterior cervical muscles) as well as depending on the mechanism of the development of plane fracture of C2 odontoid process. In flexion fracture of the odontoid process without dislocation as well as in extension fracture with dislocation within the limits of 1/3 of its diameter the successful conservative treatment with plaster thoracocranial bandage was possible. In the rest of cases the authors method of bipolar Halo-traction was indicated. The experience of treatment of 32 patients was used in the work.

scholarly journals DIAGNOSTICS AND TREATMENT FOR UPPER CERVICAL SPINE INJURIES

2005 ◽  
pp. 016-020
Author(s):  
Stepan Timofeyevich Vetrile ◽  
Sergey Vasilyevich Kolesov
Keyword(s):  
Cervical Spine ◽  
Odontoid Process ◽  
Upper Cervical Spine ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Upper Cervical

The experience of diagnostics and treatment of 82 patients with various injuries of the upper cervical spine was analyzed. The most frequent injuries were fractures of C2 odontoid process and arch. The treatment included a wide application of halo apparatus, and, when indicated, a surgical instrumention stabilization of the upper cervical spine.

The Expanded Endonasal Approach: A Fully Endoscopic Transnasal Approach and Resection of the Odontoid Process: Technical Case Report

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. E213-E213 ◽  
Author(s):  
Amin B. Kassam ◽  
Carl Snyderman ◽  
Paul Gardner ◽  
Ricardo Carrau ◽  
Richard Spiro
Keyword(s):  
Odontoid Process ◽  
Endoscopic Approach ◽  
Illustrative Case ◽  
Endonasal Approach ◽  
Transnasal Approach ◽  
Expanded Endonasal Approach ◽  
Clinical Series ◽  
Long Term Follow Up ◽  
History Of ◽  
Potential Benefits

Abstract THE TRANSORAL APPROACH to the odontoid process is considered the “gold standard” for resection of extradural lesions at this location. A completely transnasal endoscopic approach is feasible based on anatomic studies and our experience with the expanded endonasal approach for neoplasms of the cranial base. An illustrative case is presented to demonstrate the technical details of a fully transnasal completely endoscopic approach for the resection of the odontoid process. A 73-year-old woman with a long-standing history of rheumatoid arthritis presented with progressive cervicomedullary compression. Complete resection of the odontoid was achieved with no significant morbidity. This is the first reported case of a completely endoscopic resection of the odontoid using a fully transnasal route. The report demonstrates the feasibility of this approach and larger clinical series with long-term follow-up will be needed to determine the reproducibility and validation of any potential benefits.

scholarly journals Outcome of 132 Operations in 97 Patients With Chordomas of the Craniocervical Junction and Upper Cervical Spine

Neurosurgery ◽  
2010 ◽  
Vol 66 (1) ◽  
pp. 59-65 ◽  
Author(s):  
David Choi ◽  
Robert Melcher ◽  
Jürgen Harms ◽  
Alan Crockard
Keyword(s):  
Cervical Spine ◽  
De Novo ◽  
Major Complication ◽  
Craniocervical Junction ◽  
Cerebrospinal Fluid Leakage ◽  
Upper Cervical Spine ◽  
Fisher Exact Test ◽  
Complication Rates ◽  
Velopharyngeal Incompetence ◽  
Upper Cervical

Abstract OBJECTIVE To study the outcomes of surgery for chordomas of the craniocervical junction and upper cervical spine as well as complication rates, survival, and associated adverse factors. METHODS Retrospective review of patients (1982–2007) at 2 European centers who underwent transoral, transfacial, transmandibular, and anterior cervical approaches for excision of chordomas of the craniocervical junction and cervical spine. The χ2 test and Fisher exact test were used to determine significant adverse factors (P < .05), and log-rank survival analysis was used to compare outcome in different groups. RESULTS One hundred thirty-two operations were performed in 97 patients. The most common operations were transoral surgeries and maxillotomies. After surgery, neck pain was the same or better in 98.1% of patients. Of the 18.6% of patients who presented with myelopathy, 27.8% improved, 44.4% remained unchanged, and 27.8% deteriorated. Major complication rates were velopharyngeal incompetence, 3.1%; vertebral artery stroke, 1%; wound infection, 3.1%; dysphagia, 3.1%; failure of fixation, 2.1%; sepsis, 3.1%; meningitis, 3.1%; and cerebrospinal fluid leakage, 6.2%. Five- and 10-year overall survivals were 55% and 36%, respectively. Patients who presented to our units for revision surgery, after prior attempts at resection elsewhere, were associated with a worse survival than patients who underwent de novo surgery. CONCLUSION We present, to our knowledge, the largest published series of chordomas at the craniocervical junction. Complication rates for these major operations can be minimized at specialist centers, with careful patient selection and counseling. As complete or as radical an operation as possible should be performed at first presentation; the best chance for the patient is the first chance.

scholarly journals Atlantoaxial Subluxation after Pyogenic Spondylitis around the Odontoid Process

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Atsushi Hasegawa ◽  
Mitsuru Yagi ◽  
Masakazu Takemitsu ◽  
Masafumi Machida ◽  
Takashi Asazuma ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Conservative Treatment ◽  
Odontoid Process ◽  
Magnetic Resonance Images ◽  
Atlantoaxial Subluxation ◽  
Upper Cervical Spine ◽  
Protein Levels ◽  
Pyogenic Spondylitis ◽  
Intravenous Antibiotics ◽  
Upper Cervical

Study Design. A case report and review of the literature.Objective. The aim of this study was to describe the conservative management of pyogenic spondylitis around the odontoid process.Summary of Background Data. Atlantoaxial subluxation after pyogenic spondylitis is rare. The therapeutic approach to infection of the upper cervical spine is controversial.Methods. Medical chart and radiological images of a 76-year-old male patient were retrospectively reviewed. Radiography revealed atlantoaxial subluxation, and an abscess was seen around the odontoid process on magnetic resonance images. Intravenous antibiotics and a halo vest were used to treat the patient. We then observed the patient’s conservative treatment course.Results. C-reactive protein levels returned to normal 4 weeks after administration of the intravenous antibiotics. The patient’s muscle weakness also completely recovered 8 weeks after administration of the intravenous antibiotics. Because the patient was able to walk without any support, surgical treatment was not necessary.Conclusions. Pyogenic spondylitis of the upper cervical spine is a rare manifestation. Surgical or conservative treatment must be selected carefully based on the patient’s symptoms. If early diagnosis and treatment can be provided to the patients, conservative treatment can be achieved.

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