Endoscopic image-guided odontoidectomy for decompression of basilar invagination via a standard anterior cervical approach

✓Symptomatic irreducible basilar invagination has traditionally been approached through a transoral–transpharyngeal route with resection of the anterior portion of C-1 and the odontoid. Modification of this exposure with either a Le Fort osteotomy or a transmandibular osteotomy and circumglossal approach has increased the access to pathological conditions in this region. These traditional routes all require traversing the oral cavity and accepting the associated potential complications. The authors have developed a novel surgical approach, an endoscopic transcervical odontoidectomy, which allows access for resection of the odontoid and for brainstem and spinal cord decompression without traversing the oral cavity. In this paper they describe the technique and its advantages and present three cases in which patients underwent the endoscopic transcervical odontoidectomy for basilar invagination. Three consecutive patients (age range 42–74 years) who had irreducible basilar invagination underwent the endoscopic transcervical odontoidectomy. All were symptomatic and had neck pain and myelopathy. All were evaluated preoperatively and postoperatively with computed tomography and magnetic resonance imaging. In all cases the procedure resulted in complete decompression. There were no serious complications. No patient required prolonged intubation, tracheostomy, or enteral tube feeding. One patient had an intraoperative cerebrospinal fluid leak, which had no postoperative sequelae. The authors present an alternative surgical approach for treating ventral compression of the brainstem and spinal cord. The technique is safe and effective for decompression and provides a surgical route that can be added to the armamentarium of treatments for pathological conditions in this region.

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Posterior transdural approach for odontoidectomy in a child: case report

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.7.peds19337 ◽

2020 ◽

Vol 25 (1) ◽

pp. 8-12 ◽

Cited By ~ 1

Author(s):

Jacob Archer ◽

Meena Thatikunta ◽

Andrew Jea

Keyword(s):

Spinal Cord ◽

Tube Feeding ◽

Odontoid Process ◽

Cord Compression ◽

Basilar Invagination ◽

Craniocervical Junction ◽

Csf Leak ◽

Prolonged Intubation ◽

Soft Tissue Dissection ◽

Transdural Approach

The transoral transpharyngeal approach is the standard approach to resect the odontoid process and decompress the cervicomedullary spinal cord. There are some significant risks associated with this approach, however, including infection, CSF leak, prolonged intubation or tracheostomy, need for nasogastric tube feeding, extended hospitalization, and possible effects of phonation. Other ventral approaches, such as transmandibular and circumglossal, endoscopic transcervical, and endoscopic transnasal, are also viable alternatives but are technically challenging or may still traverse the nasopharyngeal cavity. Far-lateral and posterior extradural approaches to the craniocervical junction require extensive soft-tissue dissection. Recently, a posterior transdural approach was used to resect retro-odontoid cysts in 3 adult patients. The authors present the case of a 12-year-old girl with Down syndrome and significant spinal cord compression due to basilar invagination and a retro-flexed odontoid process. A posterior transdural odontoidectomy prior to occiptocervical fusion was performed. At 12 months after surgery, the authors report satisfactory clinical and radiographic outcomes with this approach.

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Posterior Transdural Approach for Odontoidectomy in a Child: Case Report

Neurosurgery ◽

10.1093/neuros/nyz310_423 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Jacob B Archer ◽

Meena Thatikunta ◽

Andrew H Jea

Keyword(s):

Spinal Cord ◽

Tube Feeding ◽

Odontoid Process ◽

Cord Compression ◽

Basilar Invagination ◽

Csf Leak ◽

Prolonged Intubation ◽

Radiographic Outcomes ◽

Viable Approach ◽

Transdural Approach

Abstract INTRODUCTION The transoral transpharyngeal approach is the standard approach to resect the odontoid process and decompress the cervicomedullary spinal cord. There are some significant risks associated with this approach, however, including infection, CSF leak, prolonged intubation or tracheostomy, need for nasogastric tube feeding, extended hospitalization, and possible effects of phonation. Recently, a posterior transdural approach was used to resect retro-odontoid cysts in 3 adult patients. We sought to use a similar approach to perform a posterior transdural odontoidectomy METHODS We present the case of a 12-yr-old girl with Down syndrome and significant spinal cord compression from basilar invagination and a retro-flexed odontoid process. We performed a posterior transdural odontoidectomy prior to occiptocervical fusion. RESULTS At 12-mo follow-up, we report satisfactory clinical and radiographic outcomes with this approach. CONCLUSION In carefully selected patients, a posterior odonoidectomy is a viable approach that can safely provide adequate ventral decompression of the spinal cord.

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Endoscopic transcervical odontoidectomy for pediatric basilar invagination and cranial settling

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/4/337 ◽

2008 ◽

Vol 1 (4) ◽

pp. 337-342 ◽

Cited By ~ 42

Author(s):

Matthew J. McGirt ◽

Frank J. Attenello ◽

Daniel M. Sciubba ◽

Ziya L. Gokaslan ◽

Jean-Paul Wolinsky

Keyword(s):

Pediatric Patients ◽

Pediatric Population ◽

Tube Feeding ◽

Basilar Invagination ◽

Craniocervical Junction ◽

Consecutive Series ◽

Initial Experience ◽

Prolonged Intubation ◽

Alternative Approach

✓ Pediatric basilar invagination and cranial settling have traditionally been approached through a transoral–transpharyngeal route with or without extended maxillotomy or mandibulotomy for resection of the anterior portion of C-1 and the odontoid. The authors hypothesize that application of a recently described endoscopic transcervical odontoidectomy (ETO) technique would allow an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients. The authors performed ETO in a consecutive series of pediatric patients presenting with myelopathy or bulbar dysfunction resulting from basilar invagination or cranial settling. All clinical, radiographic, surgical, and follow-up data were prospectively collected. The initial experience with ETO in the pediatric population is analyzed and outcomes are reported. Three patients required ETO for basilar invagination and 1 required ETO with anterior C-1 arch and distal clivus resection for cranial settling. All patients presented with myelopathy. One patient was wheelchair bound with severe quadriparesis. The mean age was 14 ± 3 years (mean ± standard deviation [SD]) in the 2 male and 2 female patients. The ETO and posterior fusion were performed as a 2-stage procedure in 2 (50%) and as a single-stage procedure in 2 (50%) cases. Prolonged intubation or postoperative placement of a gastrostomy tube was not needed in any case. The postoperative hospitalization lasted 9 ± 4 days (mean ± SD). At last follow-up (mean 5 months), head and neck pain had resolved and motor strength had improved or stabilized in all cases. All 4 children were independently functioning and ambulatory at the last follow-up. In the authors' initial experience, ETO has allowed ventral brainstem decompression without the need for prolonged intubation, worsening dysphagia requiring enteral tube feeding, or prolonged hospitalization, and has resulted in cosmetically appealing results. The ETO technique allows an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients.

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Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances

Neurosurgical FOCUS ◽

10.3171/2015.1.focus14813 ◽

2015 ◽

Vol 38 (4) ◽

pp. E17 ◽

Cited By ~ 30

Author(s):

James K. Liu ◽

Jimmy Patel ◽

Ira M. Goldstein ◽

Jean Anderson Eloy

Keyword(s):

Craniovertebral Junction ◽

Basilar Invagination ◽

Postoperative Recovery ◽

Velopharyngeal Insufficiency ◽

Endoscopic Endonasal ◽

Prolonged Intubation ◽

Minimally Invasive Surgical ◽

Pathological Conditions ◽

Tongue Swelling ◽

Hospital Stays

The transoral approach is considered the gold-standard surgical route for performing anterior odontoidectomy and ventral decompression of the craniovertebral junction for pathological conditions that result in symptomatic cervicomedullary compression, including basilar invagination, rheumatoid pannus, platybasia with retroflexed odontoid processes, and neoplasms. Extended modifications to increase the operative corridor and exposure include the transmaxillary, extended “open-door” maxillotomy, transpalatal, and transmandibular approaches. With the advent of extended endoscopic endonasal skull base techniques, there has been increased interest in the last decade in the endoscopic endonasal transclival transodontoid approach to the craniovertebral junction. The endonasal route represents an attractive minimally invasive surgical alternative, especially in cases of irreducible basilar invagination in which the pathology is situated well above the palatine line. Angled endoscopes and instrumentation can also be used for lower-lying pathology. By avoiding the oral cavity and subsequently using a transoral retractor, the endonasal route has the advantages of avoiding complications related to tongue swelling, tracheal swelling, prolonged intubation, velopharyngeal insufficiency, dysphagia, and dysphonia. Postoperative recovery is quicker, and hospital stays are shorter. In this report, the authors describe and illustrate their method of purely endoscopic endonasal transclival odonotoidectomy for anterior decompression of the craniovertebral junction and describe various operative pearls and nuances of the technique for avoiding complications.

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Morphological and elemental analysis of isolated incubated frog retina-choroid

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100111604 ◽

1984 ◽

Vol 42 ◽

pp. 298-299

Author(s):

B. J. Panessa-Warren ◽

J. B. Warren ◽

H. W. Kraner

Keyword(s):

Elemental Analysis ◽

Pigment Epithelium ◽

Human Retina ◽

Healthy Individuals ◽

Anterior Portion ◽

Pathological Conditions ◽

Frog Retina ◽

Isolated Retina ◽

Vertebrate Eye ◽

Retina Pigment Epithelium

Our previous studies have demonstrated that abnormally high amounts of calcium (Ca) and zinc (Zn) can be accumulated in human retina-choroid under pathological conditions and that barium (Ba), which was not detected in the eyes of healthy individuals, is deposited in the retina pigment epithelium (RPE), and to a lesser extent in the sensory retina and iris. In an attempt to understand how these cations can be accumulated in the vertebrate eye, a morphological and microanalytical study of the uptake and loss of specific cations (K, Ca,Ba,Zn) was undertaken with incubated Rana catesbiana isolated retina and RPE preparations. Large frogs (650-800 gms) were dark adapted, guillotined and their eyes enucleated in deep ruby light. The eyes were hemisected behind the ora serrata and the anterior portion of the eye removed. The eyecup was bisected along the plane of the optic disc and the two segments of retina peeled away from the RPE and incubated.

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Is there a right time for surgery in paraplegic patients secondary to non traumatic spinal cord compression?

Einstein (São Paulo) ◽

10.1590/s1679-45082012000400020 ◽

2012 ◽

Vol 10 (4) ◽

pp. 508-511 ◽

Cited By ~ 2

Author(s):

Leonardo Giacomini ◽

Roger Neves Mathias ◽

Andrei Fernandes Joaquim ◽

Mateus Dal Fabbro ◽

Enrico Ghizoni ◽

...

Keyword(s):

Spinal Cord ◽

Prognostic Factor ◽

Spinal Cord Compression ◽

Cord Compression ◽

Lower Limbs ◽

Motor Deficit ◽

Indication For Surgery ◽

Sensory Deficits ◽

Sensory Involvement ◽

Spinal Cord Decompression

Paraplegia is a well-defined state of complete motor deficit in lower limbs, regardless of sensory involvement. The cause of paraplegia usually guides treatment, however, some controversies remain about the time and benefits for spinal cord decompression in nontraumatic paraplegic patients, especially after 48 hours of the onset of paraplegia. The objective of this study was to evaluate the benefits of spinal cord decompression in such patients. We describe three patients with paraplegia secondary to non-traumatic spinal cord compression without sensory deficits, and who were surgically treated after more than 48 hours of the onset of symptoms. All patients, even those with paraplegia during more than 48 hours, had benefits from spinal cord decompression like recovery of gait ability. The duration of paraplegia, which influences prognosis, is not a contra-indication for surgery. The preservation of sensitivity in this group of patients should be considered as a positive prognostic factor when surgery is taken into account.

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