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P077: POSTOPERATIVE RECOVERY AFTER ENDOSCOPIC ENDONASAL ODONTOIDECTOMY: A META-ANALYSIS OF EARLY EXTUBATION AND HOSPITAL STAY
Khushal A Gupta, MBBS¹; Michael Karsy, MD, PhD, MSc, FAANS, FCNS²; ¹Bharat Ratna Late Shri Atal Bihari Vajpayee Memorial Medical College; ²University of Michigan Health

Introduction: Endoscopic endonasal odontoidectomy (EEO) has gained prominence as a minimally invasive alternative for ventral craniovertebral junction pathology, offering a direct surgical corridor with reduced morbidity compared to traditional transoral and transcranial routes. While technical feasibility and safety have been increasingly established, the postoperative recovery course—including airway management, nutrition, complications, and length of stay—remains poorly defined. This meta-analysis synthesizes available evidence to clarify recovery patterns following EEO.

Methods: This review was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, Embase, and Scopus was performed through 2025 to identify studies reporting outcomes after EEO. Eligible studies included ≥5 patients and provided extractable data on extubation, airway interventions, nutritional support, hospital length of stay, CSF leak, or perioperative mortality. Data extraction was performed independently by two reviewers. Proportional outcomes were analyzed using a random-effects model with Freeman–Tukey double arcsine transformation, while continuous outcomes were synthesized using inverse variance weighting. Heterogeneity was assessed with Chi² and I² statistics, and random-effects models were applied to account for interstudy variability.

Results: Nine studies comprising 136 patients were included. Most patients experienced a favorable recovery trajectory. Early extubation was achieved in the vast majority, with 94% extubated by the first postoperative day (95% CI: 0.87–0.99). The need for airway interventions such as reintubation or tracheostomy was uncommon, occurring in only 4% of cases (95% CI: 0.01–0.08), underscoring the safety of early weaning strategies. Nutritional outcomes were similarly reassuring. Dependence on feeding adjuncts was rare, with PEG or TPN required in only 4% of patients (95% CI: 0.01–0.08). Most patients resumed oral intake promptly, highlighting the functional recovery achievable with this approach. Complications were infrequent. The pooled CSF leak rate was 1% (95% CI: 0.00–0.04), indicating this complication is uncommon after EEO. Perioperative mortality was also rare, observed in only 2% of patients (95% CI: 0.00–0.06) across included series. Hospital course analysis revealed a mean length of stay of 4–5 days. While moderate heterogeneity was present (I²=60.4%), likely reflecting institutional protocols and baseline comorbidity differences, the overall trend supported relatively short hospitalizations for most patients.

Conclusion: This meta-analysis highlights that endoscopic endonasal odontoidectomy is generally associated with rapid and safe recovery. Nearly all patients are extubated by the first postoperative day, with rare requirements for tracheostomy, PEG/TPN, or reintubation. Complication rates, including CSF leak and mortality, remain low, while hospital stays average less than a week. These findings emphasize the favorable recovery profile of EEO and support its role as a safe and effective strategy for ventral craniovertebral junction decompression.

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