{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:32:11Z","timestamp":1783776731451,"version":"3.55.0"},"reference-count":9,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2010,6]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>In rare cases, children with a Chiari malformation Type I (CM-I) suffer from concomitant, irreducible, ventral brainstem compression that may result in cranial neuropathies or brainstem dysfunction. In these circumstances, a 360\u00b0 decompression supplemented by posterior stabilization and fusion is required. In this report, the authors present the first experience with using an endoscopic transnasal corridor to accomplish ventral decompression in children with CM-I that is complicated by ventral brainstem compression.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Two children presented with a combination of occipital headaches, swallowing dysfunction, myelopathy, and\/or progressive scoliosis. Imaging studies demonstrated CM-I with severely retroflexed odontoid processes and ventral brainstem compression. Both patients underwent an endoscopic transnasal approach for ventral decompression, followed by posterior decompression, expansive duraplasty, and occipital-cervical fusion.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>In both patients the endoscopic transnasal approach provided excellent ventral access to decompress the brainstem. When compared with the transoral approach, endoscopic transnasal access presents 4 potential advantages: 1) excellent prevertebral exposure in patients with small oral cavities; 2) a surgical corridor located above the hard palate to decompress rostral pathological entities more easily; 3) avoidance of the oral trauma and edema that follows oral retractor placement; and 4) avoidance of splitting the soft or hard palate in patients with oral-palatal dysfunction from ventral brainstem compression.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The endoscopic transnasal approach is atraumatic to the oral cavity, and offers a more superior region of exposure when compared with the standard transoral approach. Depending on their comfort level with endoscopic surgical techniques, pediatric neurosurgeons should consider this approach in children with pathological entities requiring ventral brainstem decompression.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.2.peds09362","type":"journal-article","created":{"date-parts":[[2010,6,1]],"date-time":"2010-06-01T13:59:20Z","timestamp":1275400760000},"page":"549-553","source":"Crossref","is-referenced-by-count":69,"title":["Transnasal odontoid resection followed by posterior decompression and occipitocervical fusion in children with Chiari malformation Type I and ventral brainstem compression"],"prefix":"10.3171","volume":"5","author":[{"given":"Todd C.","family":"Hankinson","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Columbia University, College of Physicians and Surgeons,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eli","family":"Grunstein","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Gardner","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore J.","family":"Spinks","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Scott and White Neurosciences Institute, Texas A&M College of Medicine, Temple, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C. E.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Columbia University, College of Physicians and Surgeons,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0050549","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1097\/00006123-199903000-00050","article-title":"Ventral brain stem compression in pediatric and young adult patients with Chiari I malformations","volume":"44","author":"Grabb","year":"1999"},{"issue":"6","key":"b2-0050549","series-title":"Neurosurg Focus","first-page":"e4","article-title":"Comprehensive approach to Chiari malformation in pediatric patients","volume":"6","author":"Greenlee","year":"1999"},{"key":"b3-0050549","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"16","DOI":"10.3171\/jns.1989.71.1.0016","article-title":"The transoral approach to the superior cervical spine. A review of 53 cases of extradural cervicomedullary compression","volume":"71","author":"Hadley","year":"1989"},{"issue":"1 Suppl","key":"b4-0050549","series-title":"Neurosurgery","first-page":"E213","article-title":"The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report","volume":"57","author":"Kassam","year":"2005"},{"key":"b5-0050549","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"376","DOI":"10.3171\/SPI\/2008\/8\/4\/376","article-title":"Endonasal endoscopic resection of the odontoid process in a nonachondroplastic dwarf with juvenile rheumatoid arthritis: feasibility of the approach and utility of the intraoperative Iso-C three-dimensional navigation. Case report","volume":"8","author":"Laufer","year":"2008"},{"key":"b6-0050549","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"E373","DOI":"10.1227\/01.NEU.0000315285.84524.74","article-title":"Endoscopic endonasal odontoidectomy in a patient affected by Down syndrome: technical case report","volume":"63","author":"Magrini","year":"2008"},{"key":"b7-0050549","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"895","DOI":"10.3171\/jns.1988.69.6.0895","article-title":"Transoral-transpharyngeal approach to the anterior craniocervical junction. Ten-year experience with 72 patients","volume":"69","author":"Menezes","year":"1988"},{"key":"b8-0050549","series-title":"Acta Neurochir Suppl (Wien)","first-page":"69","article-title":"The transoral approach to the anterior superior cervical spine. A review of 29 cases","volume":"43","author":"Spetzler","year":"1988"},{"issue":"1 Suppl 1","key":"b9-0050549","series-title":"Neurosurgery","first-page":"ONSE92","article-title":"Endoscopic transnasal transclival odontoidectomy: a new approach to decompression: technical case report","volume":"63","author":"Wu","year":"2008"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/5\/6\/article-p549.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/5\/6\/article-p549.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/5\/6\/article-p549.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T12:37:57Z","timestamp":1681562277000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/5\/6\/article-p549.xml"}},"subtitle":["Report of 2 cases"],"short-title":[],"issued":{"date-parts":[[2010,6]]},"references-count":9,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2010.2.peds09362","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,6]]}}}