gms | German Medical Science

Objective: Theendoscopicendonasal odontoidectomy (EEO) represents a minimally invasive approach through which the ventral pathology of cervicomedullary junction can be treated with reduced morbidity compared to the classic transoral approaches. The experience in the pediatric population is limited by the rare incidence of conditions requiring this treatment, resulting in basilar invagination, basilar impression or cervical settling.We report in this work our experience with EEO in two pediatric patients and a review of the literature.

Methods: The EEO was performed in a young female presenting with axial pain and in a 16-year-old male presenting with tetra-paresis, ataxy, hemihypestesia and axial pain. Radiological investigations of the first patient showed incomplete atlanto-occipital assimilation and basilar impression with platybasia. The second patient was diagnosed for odontoid dysplasia with an os odontoideum and resulting atlanto-axial instability.

Results: The first patient underwent EEO with partial anterior C1 arch resection and C0-C4 fusion as a single-staged procedure while the second patient required EEO with anterior C-1 arch and distal clivus resection as a two-staged operation after initial C0-C1 dorsal decompression and C1-C2 fusion by radiologically and clinically insufficient decompression. Postoperative placement of a gastrostomy tube was not needed in any case and one case required reintubation by postoperative swelling for two days. The second patient underwent 16 month after first operation an extension of dorsal instrumentation to C0-4 because of C2 screws loosening. At last follow-up head and neck pain had resolved in both cases and motor strength as well as ataxia of the second patient had improved or stabilized. All two patients were independently functioning and ambulatory at the last follow-up.

Conclusion: EEO permitted in the two patients a ventral craniocervical decompression without the need for prolonged intubation, enteral tube feeding, or major cosmetic problems or dyslalia. The experience with EEO in the pediatricpatients is limited and requires further investigations.