An Endoscopic Transnasal Odontoidectomy to Treat Cervicomedullary Compression with Basilar Invagination

The transoral approach to the upper cervical spine and clivus with resection of the odontoid is associated with significant morbidity and limitations. The endoscopic transnasal approach represents a viable alternative to the transoral approach to the craniocervical junction. The endoscopic approach possesses some inherent advantages, including decreased exposure to oral flora and a more rostral-to-caudal trajectory, which is ideal for pathology located superiorly in this region. It also provides excellent visualization while avoiding the use of prolonged retraction and the need for extensive exposure. We detail the operative technique used for an endoscopic transnasal resection of the odontoid process in a 68-year-old woman with pannus compressing her brain stem. A successful resection was achieved without significant morbidity. Clinical evidence will be needed to establish the role of this approach in terms of morbidity, patient satisfaction, and clinical outcomes.