Endoscopic Transnasal Odontoidectomy for Basilar Invagination-A Novel Treatment Method

Transoral resection of the odontoid has been accepted as a standard procedure to decompress the cervico-medullary junction during the past several decades. Endoscopic transnasal odontoidectomy is emerging as a feasible surgical alternative to conventional microscopic transoral approach. In this case report, we describe our experience about this approach, which provided successful decompression.Methods A patient with basilar invagination with trismus(due to tobacco,pan chewing),underwent endoscopic transnasal odontoidectomy. He also received occipitocervical fixation during the same admission to ensure stability. ResultsThe patient was extubated after recovery from anesthesia,and underwent elective tracheostomy,since patient was having trismus due to tobacco pan chewing.Remarkable neurological recovery was observed postoperative period.ConclusionThe endoscopic transnasal odontoidectomy is a feasible approach for anterior decompression of pathology at the cervicomedullary junction. The advantages over the standard transoral odontoidectomy include alternative route for anterior decompression when oral pathology is present, elimination of risk of tongue swelling and teeth damage, improvement of visualization, alleviation of prolonged intubation, reduction of need for enteral tube feeding and less risk of affecting phonation. The minimally invasive access and faster recovery associated with this technique make it a valid alternative for decompression of the ventral side of the cervicomedullary junction.