gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Endonasal resection of the odontoid

Meeting Abstract

  • J. Gempt - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität, München
  • J. Lehmberg - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität, München
  • A. Grams - Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität, München
  • B. Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität, München
  • M. Stoffel - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität, München

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.04-07

DOI: 10.3205/09dgnc133, URN: urn:nbn:de:0183-09dgnc1339

Published: May 20, 2009

© 2009 Gempt et al.
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Outline

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Objective: Nowadays anterior resection of the odontoid process is rarely indicated.

Removal of the odontoid is for instance conducted for decompression in patients with rheumatoid arthritis and basilar invagination. The transoral approach to the odontoid process is well established for many years despite its associated complications. An endoscopic transnasal approach to the odontoid process was introduced recently. Experience with the endonasal novel approach is limited and range of indication for this approach is still inexplicit.

Methods: With a case of a 77-year-old woman with retrodental tumor and cervical myelopathy who underwent dorsal fusion a week prior to odontoid resection and a case of a 64-year-old woman with rheumatoid arthritis and severe symptomatic basilar impression who already underwent dorsal atlantoaxial fusion more than 20 years ago the technique of endoscopic transnasal odontoid resection is demonstrated. A pure endoscopic transnasal approach was used; neuronavigation on the basis of a computer tomography was performed.

Results: Resection without complications was performed in both cases. The extent of the resection was shown in postoperative CT and MRI scans. The symptoms of cervical myelopathy as well as the symptoms of the basilar impression (swallowing disturbances, bulbar speech) improved in both patients and were verified by clinical and radiological follow-up.

Conclusions: The transnasal endoscopic odontoid resection seems to be a good alternative to the well-established techniques. Though this novel route appears to be less traumatic and could have certain advantages compared to other approaches to the odontoid, further experience will be necessary to evaluate this approach and its range of indication.