Transoral Odontoid Resection

Abstract

The transoral approach offers an excellent access to the anterior cranio-cervical junction but is blamed for invasiveness, complications and need for tracheostomy. When only retrodental stenosis has to be treated, the atlas-sparing transoral odontoid resection allows for less invasive though safe decompression without soft palate split, opening of the atlas ring or tracheostomy. As the main feature of this technique, the base of the odontoid is removed first, and the peg then in sequence is levered caudally and shortened until its tip can be grasped below the anterior atlas ring. Then the bed of the odontoid under control of the surgical microscope can be thoroughly inspected and the dura decompressed. Mechanical stability of C1 and preserved relations of the occipital joints allow for monosegmental fusion. Since decortication of the atlanto-axial joints can be performed from the anterior, the necessary fixation can be restricted to percutaneous transarticular screws from the posterior.