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Endonasal endoscopic versus transoral microscopic odontoid resection

Abstract Objectives: Surgical approaches for odontoid resection have traditionally utilized a transoral microscopic technique, which may carry significant morbidity. Endonasal endoscopic odontoid resection represents a new technique that provides direct, minimal access to the odontoid process. We conducted a systematic review of case series and case reports to assess the role of endoscopy in the management of ventral cervicomedullary compression. Methods: MEDLINE (1950–2010) database search to identify relevant studies. Clinical outcomes were classified into “improved”, “stable”, or “deteriorated” groups. Statistical analyses of categorical variables were carried out by using χ2 and Fisher’s exact tests. Results: The endonasal cohort had a significantly lower rate of soft palate incision (0.0% vs. 33.6%; P=0.005). In the endonasal cohort, there were no cases of postoperative soft palate repair, atlanto-occipital instability, cerebrospinal fluid leak, or meningitis. Patients in the endonasal group had a shorter time to extubation (P<0.0001) and oral feeding (P=0.0025). There was a significantly higher percentage of patients with improved outcome in the endonasal cohort (100% vs. 73.3%; P=0.009). Conclusions: Our systematic review supports the endonasal endoscopic approach as a safe and effective alternative to traditional transoral surgery for odontoid lesions. Careful patient selection is critical to obtaining satisfactory removal and low postoperative complications.