Abstract:
OBJECT:The gold-standard surgical approach to the odontoid is via the transoral route. This approach necessitates opening of the oropharynx and is associated with risks of infection, and swallowing and breathing complications. The endoscopic endonasal approach has the potential to reduce these complications as the oral cavity is avoided. There are fewer than 25 such cases reported to date. The authors present a consecutive, single-institution series of 9 patients who underwent the endonasal endoscopic approach to the odontoid. METHODS:The charts of 9 patients who underwent endonasal endoscopic surgery to the odontoid between January 2005 and August 2013 were reviewed. The clinical presentation, radiographic findings, surgical management, complications, and outcome, particularly with respect to time to extubation and feeding, were analyzed. Radiographic measurements of the distance between the back of the odontoid and the front of the cervicomedullary junction (CMJ) were calculated, as well as the location of any residual bone fragments. RESULTS:There were 7 adult and 2 pediatric patients in this series. The mean age of the adults was 54.8 years; the pediatric patients were 7 and 14 years. There were 5 females and 4 males. The mean follow-up was 42.9 months. Symptoms were resolved or improved in all but 1 patient, who had concurrent polyneuropathy. The distance between the odontoid and CMJ increased by 2.34 ± 0.43 mm (p = 0.03). A small, clinically insignificant fragment remained after surgery, always on the left side, in 57% of patients. Mean times to extubation and oral feeding were on postoperative Days 0.3 and 1, respectively. There was one posterior cervical wound infection; there were 2 cases of epistaxis requiring repacking of the nose and no instances of breathing or swallowing complications or velopharyngeal insufficiency. CONCLUSIONS:This series of 9 cases of endonasal endoscopic odontoidectomy highlights the advantages of the approach in permitting early extubation and early feeding and minimizing complications compared with transoral surgery. Special attention must be given to bone on the left side of the odontoid if the surgeon is standing on the right side.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Goldschlager T,Härtl R,Greenfield JP,Anand VK,Schwartz THdoi
10.3171/2014.9.JNS14733subject
Has Abstractpub_date
2015-03-01 00:00:00pages
511-8issue
3eissn
0022-3085issn
1933-0693journal_volume
122pub_type
杂志文章abstract::The authors report the successful staged stenting and coil embolization of a large vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysm using the contralateral VA for access. A 67-year-old woman presented with a large ruptured VA-PICA aneurysm. Initial attempts to stent the wide-necked aneurysm fro...
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pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.3171/jns.1984.60.2.0431
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abstract::The authors used indicator fractionation techniques to determine blood flow in normal and bluntly traumatized spinal cords of Macaca rhesus monkeys. Normal flow rates were determined for several levels of spinal cord as well as differential values for white and gray matter from representative areas. Flow rates in trau...
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doi:10.3171/jns.2004.101.2.0210
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doi:10.3171/2017.5.JNS162897
更新日期:2018-09-01 00:00:00
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doi:10.3171/jns.1981.54.3.0304
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更新日期:2009-06-01 00:00:00
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更新日期:2018-03-23 00:00:00
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doi:10.3171/spi.2002.96.1.0022
更新日期:2002-01-01 00:00:00
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pub_type: 传,历史文章,杂志文章
doi:10.3171/jns.1991.75.5.0808
更新日期:1991-11-01 00:00:00
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pub_type: 杂志文章
doi:10.3171/jns.1980.53.5.0606
更新日期:1980-11-01 00:00:00
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doi:10.3171/PED-07/09/266
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doi:10.3171/jns.1993.78.6.0884
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更新日期:2008-08-01 00:00:00
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更新日期:2011-08-01 00:00:00
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更新日期:2014-11-01 00:00:00
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doi:10.3171/ped.2004.101.2.0214
更新日期:2004-11-01 00:00:00
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pub_type: 杂志文章
doi:10.3171/2014.6.JNS132405
更新日期:2014-10-01 00:00:00
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pub_type: 杂志文章
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更新日期:2017-06-01 00:00:00
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更新日期:1999-09-01 00:00:00
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更新日期:2013-12-01 00:00:00
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doi:10.3171/jns.2006.105.5.698
更新日期:2006-11-01 00:00:00
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pub_type: 杂志文章
doi:10.3171/jns.1981.55.6.0963
更新日期:1981-12-01 00:00:00