Comparative analysis of endoscopic transnasal and microsurgical transoral odontoidectomy: Literature review and own experience

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BACKGROUND: Odontoidectomy is indicated in the case of anterior compression of brainstem structures by an invaginated dentoid process, and it is currently possible to perform both transoral microsurgical and transnasal endoscopic access.

OBJECTIVE: To conduct a comparative analysis of endoscopic transnasal and microsurgical transoral odontoidectomy performed by the first author.

MATERIALS AND METHODS: The treatment results of 29 patients with pathological conditions, including anterior compression of stem structures with an invaginated dentoid process, were analyzed. Of 29 patients, 5 (17%) underwent surgery transnasally endoscopically, and 24 (83%) underwent surgery transorally microsurgically.

RESULTS: Decompression of brainstem structures was achieved in all cases. The absence of the need to install a tracheostomy before surgery and the smaller volume of oropharyngeal trauma allow patients to undergo transnasal removal of the dentoid process and endure the postoperative period easier and faster.

CONCLUSION: Currently, endoscopic transnasal access is gradually replacing transoral access in certain patients who are indicated for anterior odontoidectomy. Moreover, the literature analysis shows an ever deeper development of this technique; however, unambiguous indications of the use of transoral or transnasal access have not been formed at present.

作者简介

Alexey Shkarubo

Burdenko National Medical Research Center of Neurosurgery; Russian Medical Academy of Continuous Professional Education

Email: ashkarubo@nsi.ru
ORCID iD: 0000-0003-3445-3115
SPIN 代码: 3420-3394

MD, Dr. Sci. (Med.), neurosurgeon

俄罗斯联邦, 16 Tverskaya-Yamskaya Str., 125047 Moscow; 2/1, building 1, Barrikadnaya st., 123242 Moscow

Anton Nazarenko

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: cito@cito-priorov.ru
ORCID iD: 0000-0003-1314-2887
SPIN 代码: 1402-5186

professor of RAS, traumatologist-orthopedist

俄罗斯联邦, 10, st. Priorova, 127299 Moscow

Ilya Chernov

Burdenko National Medical Research Center of Neurosurgery

编辑信件的主要联系方式.
Email: ichernov@nsi.ru
ORCID iD: 0000-0002-9789-3452
SPIN 代码: 3550-1153

MD, Cand. Sci. (Med.), neurosurgeon

俄罗斯联邦, 16 Tverskaya-Yamskaya Str., 125047 Moscow

Dmitry Andreev

Burdenko National Medical Research Center of Neurosurgery

Email: dandreev@nsi.ru
ORCID iD: 0000-0001-5473-4905
SPIN 代码: 8516-7994

MD, Cand. Sci. (Med.), neurosurgeon

俄罗斯联邦, 16 Tverskaya-Yamskaya Str., 125047 Moscow

Alexandr Kuleshov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: Cito-spine@mail.ru

MD, Dr. Sci. (Med.), traumatologist-orthopedist

俄罗斯联邦, 10, st. Priorova, 127299 Moscow

Nikolai Konovalov

Burdenko National Medical Research Center of Neurosurgery

Email: NAKonovalov@nsi.ru
ORCID iD: 0000-0003-0824-1848
SPIN 代码: 9436-3719

MD, Dr. Sci. (Med.), corresponding member of RAS, neurosurgeon

俄罗斯联邦, 16 Tverskaya-Yamskaya Str., 125047 Moscow

Igor Lisyanskiy

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: lisigornik@list.ru
SPIN 代码: 9845-1251

MD, Cand. Sci. (Med.), traumatologist-orthopedist

俄罗斯联邦, 10, st. Priorova, 127299 Moscow

Mikhail Sinelnikov

Sechenov First Moscow State Medical University (Sechenov University)

Email: snlnkv15@icloud.com
ORCID iD: 0000-0002-0862-6011
SPIN 代码: 6341-0943

MD, Cand. Sci. (Med.), oncologist

俄罗斯联邦, 8, building 2, st. Trubetskaya, Moscow 119991

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2. Fig. 1. Distribution of patients in the control group by nosology.

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3. Fig. 2. Neuroimaging studies of patient K., 27 years old, before and after surgery.

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4. Fig. 3. Symptoms dynamics after surgery in the main group of patients (according to the number of patients).

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5. Fig. 4. Symptoms dynamics after surgery in the control group of patients (according to the number of patients).

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6. Fig. 5. Neuroimaging studies of patient N., 13 years old, before and after surgery.

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