Comparative analysis of endoscopic transnasal and microsurgical transoral odontoidectomy: Literature review and own experience

Abstract

BACKGROUND: Odontoidectomy is indicated in the case of anterior compression of brainstem structures by an invaginated dentoid process, and it is currently possible to perform both transoral microsurgical and transnasal endoscopic access. OBJECTIVE: To conduct a comparative analysis of endoscopic transnasal and microsurgical transoral odontoidectomy performed by the first author. MATERIALS AND METHODS: The treatment results of 29 patients with pathological conditions, including anterior compression of stem structures with an invaginated dentoid process, were analyzed. Of 29 patients, 5 (17%) underwent surgery transnasally endoscopically, and 24 (83%) underwent surgery transorally microsurgically. RESULTS: Decompression of brainstem structures was achieved in all cases. The absence of the need to install a tracheostomy before surgery and the smaller volume of oropharyngeal trauma allow patients to undergo transnasal removal of the dentoid process and endure the postoperative period easier and faster. CONCLUSION: Currently, endoscopic transnasal access is gradually replacing transoral access in certain patients who are indicated for anterior odontoidectomy. Moreover, the literature analysis shows an ever deeper development of this technique; however, unambiguous indications of the use of transoral or transnasal access have not been formed at present.