2026 Poster Presentations
P068: ENDOSCOPIC TRANSNASAL ODONTOIDECTOMY: THE WHEN AND THE HOW
Vamsi K Yerramneni, Prof, Dr; Vasundhara S Rangan, Dr; Thirumal Yerragunta, Dr; Ramnadha Reddy Kanala, Dr; Nizam's institute of Medical Sciences
Aim: To explore the role of odontoidectomy in current neurosurgical practice and to discuss the various indications and technical aspects of the endoscopic transnasal route for odontoidectomy.
Materials and Methods: Five consecutive cases of endoscopic transnasal odontoidectomy performed at our institute over the past two years have been studied. The clinical history and radiological imaging have been collected along with surgical videos where feasible. Post-operative imaging has been studied and clinical outcomes at follow up noted.
Results: Four patients underwent odontoidectomy in order to achieve ventral decompression of the cervicomedullary junction (or brainstem) caused by bony CVJ pathologies such as basilar invagination and retroflexed odontoid process. Odontoidectomy was done as part of transclival anterior tumor decompression in one case. The combined apporach of trannasal and tranoral endoscopic was approach was used in one case. The technical nuances for case selection and surgical planning are presented along with a short operative video. All procedures were uneventful with no surgical complications and patients are doing well at last follow up.
Conclusion: Although posterior approaches have become the mainstay of treatment for CVJ pathologies, there remain very specific indications for ventral decompression. In cases where the ventral pathological indentation of the brainstem / CMJ simply cannot be addressed by the indirect posterior decompression, odontoidectomy is the ultimate choice. Tumor decompressions at CVJ by transnasal and combined transoral endoscopic can offer view below the subaxial spine acess. Endoscopic transnasal navigation-guided surgery has rendered the procedure well-visualised and safe. With informed case selection, this procedure can be an extremely effective tool in the neurosurgeon’s armamentarium.