Abstract
J.V. Nayak*; P.A. Gardner*; A.D.
Vescan; R.L. Carrau; A.B. Kassam; C.H. Snyderman
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.