2026 Poster Presentations
P064: TRAUMATIC OR INFLAMMATORY LESIONS OF C1-C2: SURGICAL TREATMENT WITH EXTENDED ENDONASAL ENDOSCOPIC APPROACHES
Ruggero Antonini, MD1; Denis Aiudi, MD1; Mario Chiapponi, MD1; Maurizio Gladi, MD1; Klaudia Musteqja, MD1; Marina Di Marcello, MD1; Mohamed Abdelkhalek S A Abdelkhalek S A, MD2; Maurizio Iacoangeli, Prof, MD1; 1Departement of Neurosurgery, Marche University Hospital, Ancona, Italy; 2Department of Neurosurgery, Al-Galaa Trauma Hospital, Benghazi, Libya
Introduction: In recent years, extended endonasal endoscopic approaches (EEA) have become increasingly central in the treatment of disorders involving the anterior craniovertebral junction (aCVJ). This type of surgical access has proven particularly useful in complex conditions such as bulbar compression associated with rheumatoid arthritis, basilar invagination secondary to congenital cranio-cervical malformations, and non-union fractures of the type CII odontoid process. Advances in endoscopic techniques have expanded the indications for this approach, offering less invasive yet effective solutions for managing potentially disabling clinical scenarios.
Materials and Methods: At our institution, we conducted a retrospective analysis of 33 patients with aCVJ pathologies treated using an endonasal endoscopic approach, either as a standalone procedure or in combination with traditional surgical techniques, between January 2015 and June 2025. Nine patients underwent anterior C1-C2 fixation using a combination of the endonasal endoscopic technique and a conventional anterior transcervical approach, all for the treatment of non-union odontoid fractures. Three patients with congenital CVJ malformations underwent C1-C2 decompression and fusion entirely through an endoscopic route. In thirteen patients with irreducible bulbar compression caused by odontoid process migration and/or a retro-odontoid inflammatory process, an endonasal odontoidectomy was performed. In these cases, the anterior arch of C1 was preserved and later used as a support point for anterior C1-C2 screw fixation. All patients were followed clinically and radiologically for at least five years, with periodic evaluations using MRI, CT scans, and endoscopic outpatient assessments.
Results: Clinically, all patients showed improvement in their Nurick scale scores. Radiologically confirmed bulbar decompression was effectively achieved and maintained in all cases. In patients treated with anterior endoscopic C1-C2 fixation, stable bony fusion was documented. Postoperative complications included cerebrospinal fluid leakage in two cases and mucosal incision dehiscence in another two. All complications were successfully managed without recurrence during subsequent follow-ups. Additionally, two patients underwent occipito-cervical posterior fixation due to pre-existing instability, and no long-term complications were observed in these cases.
Conclusions: The extended endonasal endoscopic approach proves to be a valid alternative to conventional surgical accesses—such as transcervical, transoral, or posterolateral routes—in the treatment of selected pathologies of the anterior craniovertebral junction. This technique offers direct visualization and improved control of the surgical field, reduces overall procedural invasiveness, and often allows preservation of key anatomical structures such as the anterior arch of C1. Moreover, the ability to perform both decompression and anterior C1-C2 fixation in the same surgical session presents a significant advantage, lowering the risk of cranial settling and reducing the need for additional posterior stabilization. The outcomes obtained at our center over a ten-year period demonstrate that, in selected cases, EEA is not only technically feasible but also safe and effective, yielding favorable long-term clinical and radiological results.