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Abaunza-Camacho JF, Gomez-Niebles S, Madrinan-Navia H, Daza-Ovalle A, Guevara-Moriones N, Rodríguez MF, Torres Mancera J, Peña C, Riveros-Castillo WM, Saavedra JM. Navigated Anterior Full-Endoscopic Transcervical Approach Odontoidectomy for Traumatic Posterior Atlantoaxial Dislocation Without Odontoid Fracture. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01172. [PMID: 38771087 DOI: 10.1227/ons.0000000000001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/24/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND AND IMPORTANCE Complete posterior atlantoaxial dislocation (PAAD) with an unfractured odontoid process is a rare condition where a dislocated but intact odontoid process is positioned ventrally to the anterior arch of C1. This lesion is related to transverse and alar ligament rupture secondary to hyperextension and rotatory traumatic injury and is often associated with neurological deficit. The treatment strategy remains controversial, and in many cases, odontoidectomy is required. Traditional approaches for odontoidectomy (transnasal and transoral) are technically demanding and are related to several complications. This article describes a 360° reduction and stabilization technique through a navigated anterior full-endoscopic transcervical approach (nAFETA) as a novel technique for odontoidectomy and C1-C2 anterior transarticular fixation supplemented with posterior fusion. CLINICAL PRESENTATION A 21-year-old man presented to the emergency room by ambulance after a motorcycle accident. On evaluation, incomplete ASIA B spinal cord injury was documented. Imaging revealed a complete PAAD. We performed a two-staged procedure, a nAFETA odontoidectomy plus C1-C2 anterior transarticular fixation followed by posterior C1-C2 wired fusion. At a 2-year follow-up, the patient had a 10-point Oswestry Disability Index score and neurological improvement to ASIA E. CONCLUSION PAAD can be successfully treated through minimally invasive nAFETA. Noteworthy, the risks of the transoral and endonasal routes were avoided through this approach. In addition, nAFETA allows anterior transarticular fixation during the same procedure providing spinal stability. Further studies are required to expand the use of nAFETA in this field.
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Affiliation(s)
- Juan Felipe Abaunza-Camacho
- Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá, Colombia
- Department of Neurosurgery, Hospital Universitario Mayor- Mederi, Bogotá, Colombia
- Universidad del Rosario School of Medicine and Health Sciences, Bogotá, Colombia
| | - Sara Gomez-Niebles
- Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá, Colombia
- Universidad del Rosario School of Medicine and Health Sciences, Bogotá, Colombia
| | - Humberto Madrinan-Navia
- Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá, Colombia
- Department of Neurosurgery, Hospital Universitario Mayor- Mederi, Bogotá, Colombia
- Universidad del Rosario School of Medicine and Health Sciences, Bogotá, Colombia
| | - Alberto Daza-Ovalle
- Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá, Colombia
- Department of Neurosurgery, Hospital Universitario Mayor- Mederi, Bogotá, Colombia
- Universidad del Rosario School of Medicine and Health Sciences, Bogotá, Colombia
| | - Natalia Guevara-Moriones
- Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá, Colombia
| | - Mario Fernando Rodríguez
- Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá, Colombia
- Department of Neurosurgery, Hospital Universitario Mayor- Mederi, Bogotá, Colombia
- Universidad del Rosario School of Medicine and Health Sciences, Bogotá, Colombia
| | - Jorge Torres Mancera
- Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá, Colombia
- Department of Neurosurgery, Hospital Universitario Mayor- Mederi, Bogotá, Colombia
- Universidad del Rosario School of Medicine and Health Sciences, Bogotá, Colombia
| | - Camilo Peña
- Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá, Colombia
- Department of Neurosurgery, Hospital Universitario Mayor- Mederi, Bogotá, Colombia
- Universidad del Rosario School of Medicine and Health Sciences, Bogotá, Colombia
| | - William Mauricio Riveros-Castillo
- Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá, Colombia
- Department of Neurosurgery, Hospital Universitario Mayor- Mederi, Bogotá, Colombia
- Universidad del Rosario School of Medicine and Health Sciences, Bogotá, Colombia
| | - Javier M Saavedra
- Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá, Colombia
- Department of Neurosurgery, Hospital Universitario Mayor- Mederi, Bogotá, Colombia
- Universidad del Rosario School of Medicine and Health Sciences, Bogotá, Colombia
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Shkarubo AN, Chernov IV, Andreev DN, Konovalov NA, Sinelnikov ME. [Minimally invasive surgery for invaginated CII odontoid process]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:5-12. [PMID: 37325821 DOI: 10.17116/neiro2023870315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Odontoidectomy is indicated for anterior compression of the brainstem by invaginated odontoid process. This procedure can currently be performed via transoral microsurgical and transnasal endoscopic access. OBJECTIVE To analyze the results of endoscopic transnasal odontoidectomy. MATERIAL AND METHODS We assessed treatment outcomes in 10 patients with anterior compression of the brainstem by invaginated odontoid process. All patients underwent endoscopic transnasal odontoidectomy. RESULTS Brainstem decompression was achieved in all cases. CONCLUSION Currently, endoscopic transnasal approach is gradually replacing the transoral one in some patients requiring anterior odontoidectomy. Analysis of literature data reflects the development of this technique taking into account various features of surgical treatment including optimization of dimensions of surgical field, attempts to perform C1-sparing surgeries and analysis of sufficient size of trepanation. Nasopalatine and nasoclival lines are used to select optimal access. Nevertheless, the choice of access depends on equipment of the hospital and surgical experience in most cases.
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Affiliation(s)
| | - I V Chernov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - D N Andreev
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - M E Sinelnikov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Niwa R, Takai K, Taniguchi M. Nonrheumatoid Retro-Odontoid Pseudotumors: Characteristics, Surgical Outcomes, and Time-Dependent Regression After Posterior Fixation. Neurospine 2021; 18:177-187. [PMID: 33819944 PMCID: PMC8021830 DOI: 10.14245/ns.2040526.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
Objective Although a retro-odontoid pseudotumor associated with rheumatoid arthritis is a well-known clinical entity, little is known about retro-odontoid pseudotumors not associated with rheumatoid arthritis due to their rarity.
Methods Between 2006 and 2019, consecutive patients with nonrheumatoid pseudotumors were included and retrospectively compared with patients with rheumatoid pseudotumors.
Results Nineteen patients had nonrheumatoid pseudotumors (mean age, 73 ± 6 years; male, 53%). All had cervical lesions including ossified anterior and posterior longitudinal ligaments with a history of cervical surgery in 5. The mean thickness of the pseudotumors at diagnosis was 8.1 mm (range, 4.2–17.2 mm). Pseudotumor thickness had a significant negative correlation with the atlantodental interval (p = 0.008) and the subaxial range of motion (p = 0.049). In comparison with 7 rheumatoid pseudotumor patients, nonrheumatoid pseudotumor patients were older (p = 0.042), had a higher proportion of males (p = 0.023), had a smaller atlantodental interval (p = 0.007), and had larger pseudotumors at diagnosis (p = 0.030). Of the 19 patients, 18 received posterior fixation with or without C1 laminectomy, while the other received C1 laminectomy alone. The percent pseudotumor thickness at follow-up to those at diagnosis was 91%, 77%, 68%, 46%, 58%, and 49% at 1, 3, 6, 12, 24, and 36 months after surgery, respectively.
Conclusion This study revealed markedly clinical and radiological differences between nonrheumatoid and rheumatoid pseudotumors. The main etiology for nonrheumatoid pseudotumors was subaxial cervical degeneration and ossified lesions. There were good outcomes following posterior fixation and time-dependent pseudotumor regression within 12 months.
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Affiliation(s)
- Ryoko Niwa
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Makoto Taniguchi
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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Butenschoen VM, Wostrack M, Meyer B, Gempt J. Endoscopic Transnasal Odontoidectomy for Ventral Decompression of the Craniovertebral Junction: Surgical Technique and Clinical Outcome in a Case Series of 19 Patients. Oper Neurosurg (Hagerstown) 2020; 20:24-31. [PMID: 33094804 DOI: 10.1093/ons/opaa331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Abnormalities and pathologies of the craniovertebral junction as well as space-occupying lesions of the odontoid process can result in myelopathy symptoms. A staged procedure with posterior stabilization and anterior transnasal endoscopic decompression is recently considered a less invasive alternative to the transoral approach. We present a considerably large case series focused on the operative technique and the long-term neurological clinical outcome. OBJECTIVE To determine the safety and efficacy of odontoidectomy performed via an endoscopic transnasal approach. METHODS We retrospectively reviewed all patients treated in our neurosurgical department from January 2009 to January 2020. Demographics, pre- and postoperative clinical status, and operative technique and complications were extracted and analyzed. RESULTS In total, 22 transnasal operations were performed in 19 patients from January 2009 to January 2020. All but one patient underwent posterior C1-C2 instrumentation prior to the anterior transnasal computed tomography (CT)-navigated full-endoscopic decompression. The median duration of symptoms before surgery was 3 mo. Complications occurred in 1 patient who died from septic organ failure because of his initial diagnosis of osteomyelitis. Postoperative CT imaging showed sufficient decompression in 16 patients, and 3 patients underwent a transnasal endoscopic re-decompression (16%). CONCLUSION Transnasal endoscopic odontoidectomy presents a safe procedure with a satisfying clinical and radiological postoperative outcome.
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Affiliation(s)
- Vicki M Butenschoen
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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