2026 Poster Presentations
P429: ENDOSCOPIC ENDONASAL ODONTOIDECTOMY FOR VENTRAL RETRO-ODONTOID EPIDURAL ABSCESS
Devan Patel, MD1; Sanjida Riea, BS1; Ryan P McSpadden, MD2; Hanna Algattas, MD1; 1University at Buffalo, Department of Neurosurgery; 2Roswell Comprehensive Cancer Center
Ventral cervical epidural abscesses (EDA) at the craniocervical junction (CCJ) are technically challenging. While direct decompression is preferred, ventral cervical EDAs at the CCJ are often managed with indirect posterior decompression due to increased simplicity and familiarity of the posterior approach1-3. Anteriorly, approaches include transcervical, transoral, and endonasal4. Transoral approaches are associated with increased complications such as dysphagia and infection/wound failures2,5-11. The endonasal technique is best-suited for compressive ventral pathologies above the nasopalatine line12-14. There are fewer reports on the endonasal approach in reaching ventral pathologies of the CCJ with limited elevation above the nasopalatine line15.
A male in his 60s presented with a large retropharyngeal abscess with ventral cervical epidural extension. He was initially managed via transoral drainage by another surgeon. He subsequently developed quadriparesis with worsening CCJ stenosis and edema in the medulla and cervical spinal cord. He underwent endonasal odontoidectomy and ventral epidural abscess decompression followed by posterior occipitocervical instrumented fusion. Due to the significant preoperative dysphagia and airway risks, tracheostomy and gastrostomy tubes were placed postoperatively. At three months, he had no focal neurologic deficits and was ambulatory with decannulation of his tracheostomy and gastrostomy tubes. Repeat imaging demonstrated complete CCJ decompression and improvement in brainstem/cord edema. Despite significant elevation of the ventral compression above the nasopalatine line and otherwise normal craniocervical alignment, the endonasal approach remains feasible and superior to the transoral approach for odontoidectomy and ventral CCJ decompression. Patient consent was obtained, Institutional Board Review approval was waived for this de-identified case report.