{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:24:14Z","timestamp":1794324254893,"version":"4.9.0"},"reference-count":31,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECT<\/jats:title>\n                    <jats:p>The gold-standard surgical approach to the odontoid is via the transoral route. This approach necessitates opening of the oropharynx and is associated with risks of infection, and swallowing and breathing complications. The endoscopic endonasal approach has the potential to reduce these complications as the oral cavity is avoided. There are fewer than 25 such cases reported to date. The authors present a consecutive, single-institution series of 9 patients who underwent the endonasal endoscopic approach to the odontoid.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The charts of 9 patients who underwent endonasal endoscopic surgery to the odontoid between January 2005 and August 2013 were reviewed. The clinical presentation, radiographic findings, surgical management, complications, and outcome, particularly with respect to time to extubation and feeding, were analyzed. Radiographic measurements of the distance between the back of the odontoid and the front of the cervicomedullary junction (CMJ) were calculated, as well as the location of any residual bone fragments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>There were 7 adult and 2 pediatric patients in this series. The mean age of the adults was 54.8 years; the pediatric patients were 7 and 14 years. There were 5 females and 4 males. The mean follow-up was 42.9 months. Symptoms were resolved or improved in all but 1 patient, who had concurrent polyneuropathy. The distance between the odontoid and CMJ increased by 2.34 \u00b1 0.43 mm (p = 0.03). A small, clinically insignificant fragment remained after surgery, always on the left side, in 57% of patients. Mean times to extubation and oral feeding were on postoperative Days 0.3 and 1, respectively. There was one posterior cervical wound infection; there were 2 cases of epistaxis requiring repacking of the nose and no instances of breathing or swallowing complications or velopharyngeal insufficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This series of 9 cases of endonasal endoscopic odontoidectomy highlights the advantages of the approach in permitting early extubation and early feeding and minimizing complications compared with transoral surgery. Special attention must be given to bone on the left side of the odontoid if the surgeon is standing on the right side.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2014.9.jns14733","type":"journal-article","created":{"date-parts":[[2014,10,31]],"date-time":"2014-10-31T10:03:24Z","timestamp":1414749804000},"page":"511-518","source":"Crossref","is-referenced-by-count":67,"title":["The endoscopic endonasal approach to the odontoid and its impact on early extubation and feeding"],"prefix":"10.3171","volume":"122","author":[{"given":"Tony","family":"Goldschlager","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Department of Neurosurgery, Monash Health; and"},{"name":"Department of Surgery, Monash University, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"H\u00e4rtl","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Greenfield","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay K.","family":"Anand","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore H.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology, and"},{"name":"Otorhinolaryngology, and"},{"name":"Neurology, Weill Cornell Medical College, Sackler Brain and Spine Center, NewYork-Presbyterian Hospital, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6 Suppl","key":"b1-jns14733","series-title":"Neurosurgery","first-page":"158","article-title":"Radiographic and anatomic basis of endoscopic anterior craniocervical decompression: a comparison of endonasal, transoral, and transcervical approaches","volume":"65","author":"Baird","year":"2009"},{"key":"b2-jns14733","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/j.jocn.2007.08.014","article-title":"The role of evidence-based medicine in neurosurgery","volume":"15","author":"Bandopadhayay","year":"2008"},{"key":"b3-jns14733","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.1007\/s00381-012-1791-z","article-title":"Endoscopic endonasal resection of the odontoid peg\u2014case report and literature review","volume":"28","author":"Beech","year":"2012"},{"issue":"359","key":"b4-jns14733","series-title":"Clin Orthop Relat Res","first-page":"115","article-title":"Transmaxillary anterior decompressions in patients with severe basilar impression","author":"Bhangoo","year":"1999"},{"key":"b5-jns14733","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1227\/01.neu.0000430324.24623.10","article-title":"Evolution of transoral surgery: three decades of change in patients, pathologies, and indications","volume":"73","author":"Choi","year":"2013"},{"key":"b6-jns14733","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1080\/02688699550041304","article-title":"Transoral surgery: some lessons learned","volume":"9","author":"Crockard","year":"1995"},{"key":"b7-jns14733","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1227\/NEU.0b013e318230e59a","article-title":"Endoscopic image-guided transcervical odontoidectomy: outcomes of 15 patients with basilar invagination","volume":"70","author":"Dasenbrock","year":"2012"},{"key":"b8-jns14733","series-title":"Laryngoscope","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1002\/lary.20108","article-title":"Defining the nasopalatine line: the limit for endonasal surgery of the spine","volume":"119","author":"de Almeida","year":"2009"},{"key":"b9-jns14733","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.wneu.2011.02.018","article-title":"The importance of platybasia and the palatine line in patient selection for endonasal surgery of the craniocervical junction: a radiographic study of 12 patients","volume":"76","author":"El-Sayed","year":"2011"},{"key":"b10-jns14733","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"61","DOI":"10.3171\/SPI-07\/07\/061","article-title":"Endoscopic biopsy sampling of tophaceous gout of the odontoid process. 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