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Case Reports
. 2025 Apr;34(4):1256-1262.
doi: 10.1007/s00586-025-08688-1. Epub 2025 Feb 3.

A new technique: endoscopic transmass odontoidotomy

Ismail Bozkurt  1   2 , Ulkun Unlu Unsal  3 , Salim Senturk  4 , Ali Fahir Ozer  5
Affiliations
Case Reports

A new technique: endoscopic transmass odontoidotomy

Ismail Bozkurt et al. Eur Spine J. 2025 Apr.

Abstract

Background & objectives: Basilar invagination (BI) represents a complex anomaly of the craniovertebral junction, characterized by the displacement of the odontoid process towards the foramen magnum. Current surgical interventions include anterior decompression and combined anterior-posterior decompression with posterior fusion. Traditional methods for odontoid resection encompass transoral, transnasal, and endonasal approaches. However, these techniques are fraught with significant risks. Furthermore, the restricted exposure provided by the endonasal corridor's anatomical limitations hampers surgical manipulation, prompting spine surgeons to seek alternative techniques. This report details a case of BI managed through an endoscopic posterolateral odontoidotomy, showcasing an innovative surgical approach. We aim to describe our experience in partially removing the odontoid via posterolateral approach with a novel endoscopic technique, preventing the need for additional approach and related complications.

Methods: A 16-year-old male patient presented with complaints of imbalance and difficulty swallowing. Clinical examination revealed upper extremity muscle weakness, ataxic gait, and dysphagia. Upon the diagnosis of BI, a posterior occipito-cervical fusion was performed. However, six months postoperatively, the patient returned with exacerbated symptoms. During the subsequent surgical intervention, the odontoid body was resected using a posterolateral transmass endoscopic approach. Due to the patient's neck and shoulder anatomy, cranial angulation of the endoscope was restricted, necessitating the retention of the odontoid tip.

Results: Post-operative CT revealed that the tip was closer to the base and a subarachnoid space was formed. Follow-up CT after a year showed a complete migration of the tip to the base of C2 with a clear decompression of the brainstem.

Conclusion: Our findings demonstrate that partial or total resection of the odontoid process via a posterolateral approach is feasible using endoscopic techniques. The endoscopic posterolateral transmass odontoidotomy should be considered a viable alternative method and route for patients necessitating partial or total odontoidectomy.

Keywords: Basilar invagination; Endoscopic; Lateral mass; Odontoid; Resection.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was carried out according to the latest revision of the Helsinki Declaration regarding medical research involving human subjects. Informed written consent was acquired from the patient and legal guardians before the study. Consent for publication: A written patient consent form from the patient and parents was obtained. Informed consent: Patient consent was obtained from the patient and legal guardians prior to the study to allow the publication of the results and all radiological images. Disclosure: No potential conflict of interest was reported by the authors. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Competing interests: The authors have no competing interests related to this study.

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