Posterior transdural approach for odontoidectomy in a child: case report

View More View Less
  • 1 Section of Pediatric Neurosurgery, Riley Hospital for Children, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana; and
  • 2 Department of Neurological Surgery, University of Louisville Hospital School of Medicine, Louisville, Kentucky
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

The transoral transpharyngeal approach is the standard approach to resect the odontoid process and decompress the cervicomedullary spinal cord. There are some significant risks associated with this approach, however, including infection, CSF leak, prolonged intubation or tracheostomy, need for nasogastric tube feeding, extended hospitalization, and possible effects of phonation. Other ventral approaches, such as transmandibular and circumglossal, endoscopic transcervical, and endoscopic transnasal, are also viable alternatives but are technically challenging or may still traverse the nasopharyngeal cavity. Far-lateral and posterior extradural approaches to the craniocervical junction require extensive soft-tissue dissection. Recently, a posterior transdural approach was used to resect retro-odontoid cysts in 3 adult patients. The authors present the case of a 12-year-old girl with Down syndrome and significant spinal cord compression due to basilar invagination and a retro-flexed odontoid process. A posterior transdural odontoidectomy prior to occiptocervical fusion was performed. At 12 months after surgery, the authors report satisfactory clinical and radiographic outcomes with this approach.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Andrew Jea: Riley Hospital for Children, Indianapolis, IN. ajea@iuhealth.org.

INCLUDE WHEN CITING Published online October 11, 2019; DOI: 10.3171/2019.7.PEDS19337.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Alzhrani G, Gozal YM, Eli I, Sivakumar W, Raheja A, Brockmeyer DL, : Extreme lateral transodontoid approach to the ventral craniocervical junction: cadaveric dissection and case illustrations. J Neurosurg 131:920930, 2019

    • Search Google Scholar
    • Export Citation
  • 2

    Apuzzo ML, Weiss MH, Heiden JS: Transoral exposure of the atlantoaxial region. Neurosurgery 3:201207, 1978

  • 3

    Crockard HA: Transoral surgery: some lessons learned. Br J Neurosurg 9:283293, 1995

  • 4

    Fielding JW, Hawkins RJ: Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am 59:3744, 1977

    • Search Google Scholar
    • Export Citation
  • 5

    Fujiwara Y, Manabe H, Sumida T, Tanaka N, Hamasaki T: Microscopic posterior transdural resection of cervical retro-odontoid pseudotumors. J Spinal Disord Tech 28:363369, 2015

    • Search Google Scholar
    • Export Citation
  • 6

    Goel A, Bhatjiwale M, Desai K: Basilar invagination: a study based on 190 surgically treated patients. J Neurosurg 88:962968, 1998

  • 7

    Hadley MN, Martin NA, Spetzler RF, Sonntag VK, Johnson PC: Comparative transoral dural closure techniques: a canine model. Neurosurgery 22:392397, 1988

    • Search Google Scholar
    • Export Citation
  • 8

    Hadley MN, Spetzler RF, Sonntag VK: The transoral approach to the superior cervical spine. A review of 53 cases of extradural cervicomedullary compression. J Neurosurg 71:1623, 1989

    • Search Google Scholar
    • Export Citation
  • 9

    Hankinson TC, Grunstein E, Gardner P, Spinks TJ, Anderson RC: Transnasal odontoid resection followed by posterior decompression and occipitocervical fusion in children with Chiari malformation Type I and ventral brainstem compression. J Neurosurg Pediatr 5:549553, 2010

    • Search Google Scholar
    • Export Citation
  • 10

    Husain M, Rastogi M, Jha DK, Husain N, Gupta RK: Endoscopic transaqueductal removal of fourth ventricular neurocysticercosis with an angiographic catheter. Neurosurgery 60 (4 Suppl 2):249254, 2007

    • Search Google Scholar
    • Export Citation
  • 11

    Kassam AB, Snyderman C, Gardner P, Carrau R, Spiro R: The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery 57 (1 Suppl):E213, 2005

    • Search Google Scholar
    • Export Citation
  • 12

    Kingdom TT, Nockels RP, Kaplan MJ: Transoral-transpharyngeal approach to the craniocervical junction. Otolaryngol Head Neck Surg 113:393400, 1995

    • Search Google Scholar
    • Export Citation
  • 13

    Laufer I, Greenfield JP, Anand VK, Hartl R, Schwartz TH: Endonasal endoscopic resection of the odontoid in a nonachondroplastic dwarf with juvenile rheumatoid arthritis: feasibility of the approach and utility of intraoperative iso-C 3D navigation. J Neurosurg Spine 8:366370, 2008

    • Search Google Scholar
    • Export Citation
  • 14

    Madhavan K, Chieng LO, Gaynor BG, Levi AD: Transdural approach to resection of retro-odontoid cysts in elderly patients: report of 3 cases. J Neurosurg Spine 28:236243, 2018

    • Search Google Scholar
    • Export Citation
  • 15

    Magrini S, Pasquini E, Mazzatenta D, Mascari C, Galassi E, Frank G: Endoscopic endonasal odontoidectomy in a patient affected by Down syndrome: technical case report. Neurosurgery 63:E373E374, 2008

    • Search Google Scholar
    • Export Citation
  • 16

    McGirt MJ, Attenello FJ, Sciubba DM, Gokaslan ZL, Wolinsky JP: Endoscopic transcervical odontoidectomy for pediatric basilar invagination and cranial settling. Report of 4 cases. J Neurosurg Pediatr 1:337342, 2008

    • Search Google Scholar
    • Export Citation
  • 17

    Menezes AH, VanGilder JC: Transoral-transpharyngeal approach to the anterior craniocervical junction. Ten-year experience with 72 patients. J Neurosurg 69:895903, 1988

    • Search Google Scholar
    • Export Citation
  • 18

    Menezes AH, VanGilder JC, Clark CR, el-Khoury G: Odontoid upward migration in rheumatoid arthritis. An analysis of 45 patients with “cranial settling.” J Neurosurg 63:500509, 1985

    • Search Google Scholar
    • Export Citation
  • 19

    Menezes AH, VanGilder JC, Graf CJ, McDonnell DE: Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 53:444455, 1980

    • Search Google Scholar
    • Export Citation
  • 20

    Messina A, Bruno MC, Decq P, Coste A, Cavallo LM, de Divittis E, : Pure endoscopic endonasal odontoidectomy: anatomical study. Neurosurg Rev 30:189194, 2007

    • Search Google Scholar
    • Export Citation
  • 21

    Nayak JV, Gardner PA, Vescan AD, Carrau RL, Kassam AB, Snyderman CH: Experience with the expanded endonasal approach for resection of the odontoid process in rheumatoid disease. Am J Rhinol 21:601606, 2007

    • Search Google Scholar
    • Export Citation
  • 22

    Patel AJ, Boatey J, Muns J, Bollo RJ, Whitehead WE, Giannoni CM, : Endoscopic endonasal odontoidectomy in a child with chronic type 3 atlantoaxial rotatory fixation: case report and literature review. Childs Nerv Syst 28:19711975, 2012

    • Search Google Scholar
    • Export Citation
  • 23

    Sakou T, Morizono Y, Morimoto N: Transoral atlantoaxial anterior decompression and fusion. Clin Orthop Relat Res 187:134138, 1984

  • 24

    Shaha AR, Johnson R, Miller J, Milhorat T: Transoral-transpharyngeal approach to the upper cervical vertebrae. Am J Surg 166:336340, 1993

    • Search Google Scholar
    • Export Citation
  • 25

    Spetzler RF, Hadley MN, Sonntag VK: The transoral approach to the anterior superior cervical spine. A review of 29 cases. Acta Neurochir Suppl (Wien) 43:6974, 1988

    • Search Google Scholar
    • Export Citation
  • 26

    Stookey B: Compression of the spinal cord due to ventral extradural cervical chondromas: diagnosis and surgical treatment. Arch NeuroPsych 20:275291, 1928

    • Search Google Scholar
    • Export Citation
  • 27

    Wolinsky JP, Sciubba DM, Suk I, Gokaslan ZL: Endoscopic image-guided odontoidectomy for decompression of basilar invagination via a standard anterior cervical approach. Technical note. J Neurosurg Spine 6:184191, 2007

    • Search Google Scholar
    • Export Citation
  • 28

    Wu JC, Huang WC, Cheng H, Liang ML, Ho CY, Wong TT, : Endoscopic transnasal transclival odontoidectomy: a new approach to decompression: technical case report. Neurosurgery 63 (1 Suppl 1):ONSE92ONSE94, 2008

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 625 348 25
Full Text Views 133 36 2
PDF Downloads 131 32 1
EPUB Downloads 0 0 0