Odontoid-sparing transnasal approach for drainage of craniocervical epidural abscess; a novel technique and review of the literature

This represents the first clinical report of accessing the spinal canal at the CVJ without resection of the odontoid or the anterior arch of the atlas. The addition of endoscopic-assisted supra-dental approach to the transoral one improved visibility, and allowed access to the most cranial part of spinal canal without the need for dens resection, a procedure that significantly compromises C0-1-2 stability necessitating stabilization. This novel odontoid-sparing approach showed a favorable outcome in our first two cases with retro-odontoid abscess; however, it would likely pose a high risk in other pathologies including tumors.