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Endoscopic endonasal odontoid resection with real-time intraoperative image-guided computed tomography: report of 4 cases.

TitleEndoscopic endonasal odontoid resection with real-time intraoperative image-guided computed tomography: report of 4 cases.
Publication TypeJournal Article
Year of Publication2018
AuthorsSingh H, Rote S, Jada A, Bander ED, Almodovar-Mercado GJ, Essayed WI, Härtl R, Anand VK, Schwartz TH, Greenfield JP
JournalJ Neurosurg
Volume128
Issue5
Pagination1486-1491
Date Published2018 05
ISSN1933-0693
KeywordsAdult, Female, Humans, Male, Middle Aged, Natural Orifice Endoscopic Surgery, Odontoid Process, Patient Positioning, Surgery, Computer-Assisted, Tomography, X-Ray Computed, Young Adult
Abstract

The authors present 4 cases in which they used intraoperative CT (iCT) scanning to provide real-time image guidance during endonasal odontoid resection. While intraoperative CT has previously been used as a confirmatory test after resection, to the authors' knowledge this is the first time it has been used to provide real-time image guidance during endonasal odontoid resection. The operating room setup, as well as the advantages and pitfalls of this approach, are discussed. A mobile intraoperative CT scanner was used in conjunction with real-time craniospinal neuronavigation in 4 patients who underwent endoscopic endonasal odontoidectomy for basilar invagination. All patients underwent a successful decompression. In 3 of the 4 patients, real-time intraoperative CT image guidance was instrumental in achieving a comprehensive decompression. In 3 (75%) cases in which the right nostril was the predominant working channel, there was a tendency for asymmetrical decompression toward the right side, meaning that residual bone was seen on the left, which was subsequently removed prior to completion of the surgery. Endoscopic endonasal odontoid resection with real-time intraoperative image-guided CT scanning is feasible and provides accurate intraoperative localization of pathology, thereby increasing the chance of a complete odontoidectomy. For right-handed surgeons operating predominantly through the right nostril, special attention should be paid to the contralateral side of the resection, where there is often a tendency for residual pathology.

DOI10.3171/2017.1.JNS162601
Alternate JournalJ Neurosurg
PubMed ID28621629