{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T03:24:46Z","timestamp":1789010686757,"version":"build-2803163510"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Endonasal endoscopic odontoidectomy (EEO) is an alternative to transoral surgery for symptomatic ventral compression of the anterior cervicomedullary junction (CMJ), allowing for earlier extubation and feeding. Because the procedure destabilizes the C1\u20132 ligamentous complex, posterior cervical fusion is often performed concomitantly. The authors\u2019 institutional experience was reviewed to describe the indications, outcomes, and complications in a large series of EEO surgical procedures in which EEO was combined with posterior decompression and fusion.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A consecutive, prospective series of patients who underwent EEO between 2011 and 2021 was studied. Demographic and outcome metrics, radiographic parameters, extent of ventral compression, extent of dens removal, and increase in CSF space ventral to the brainstem were measured on the preoperative and postoperative scans (first and most recent scans).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Forty-two patients (26.2% pediatric) underwent EEO: 78.6% had basilar invagination, and 76.2% had Chiari type I malformation. The mean \u00b1 SD age was 33.6 \u00b1 3.0 years, with a mean follow-up of 32.3 \u00b1 4.0 months. The majority of patients (95.2%) underwent posterior decompression and fusion immediately before EEO. Two patients underwent prior fusion. There were 7 intraoperative CSF leaks but no postoperative CSF leaks. The inferior limit of decompression fell between the nasoaxial and rhinopalatine lines. The mean \u00b1 SD vertical height of dens resection was 11.98 \u00b1 0.45 mm, equivalent to a mean \u00b1 SD resection of 74.18% \u00b1 2.56%. The mean increase in ventral CSF space immediately postoperatively was 1.68 \u00b1 0.17 mm (p &lt; 0.0001), which increased to 2.75 \u00b1 0.23 mm (p &lt; 0.0001) at the most recent follow-up (p &lt; 0.0001). The median (range) length of stay was 5 (2\u201333) days. The median time to extubation was 0 (0\u20133) days. The median time to oral feeding (defined as, at minimum, toleration of a clear liquid diet) was 1 (0\u20133) day. Symptoms improved in 97.6% of patients. Complications were rare and mostly associated with the cervical fusion portion of the combined surgical procedures.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>EEO is safe and effective for achieving anterior CMJ decompression and is often accompanied by posterior cervical stabilization. Ventral decompression improves over time. EEO should be considered for patients with appropriate indications.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.1.jns222404","type":"journal-article","created":{"date-parts":[[2023,3,17]],"date-time":"2023-03-17T16:31:01Z","timestamp":1679070661000},"page":"1152-1159","source":"Crossref","is-referenced-by-count":11,"title":["Endoscopic odontoidectomy for brainstem compression in association with posterior fossa decompression and occipitocervical fusion"],"prefix":"10.3171","volume":"139","author":[{"given":"Umberto","family":"Tosi","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Giantini-Larsen","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Mathios","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh","family":"Kacker","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay K.","family":"Anand","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiarash","family":"Ferdowssian","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Baaj","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"H\u00e4rtl","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin I.","family":"Rapoport","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Greenfield","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore H.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Otorhinolaryngology, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Neurosurg Focus","first-page":"E16","article-title":"The rhinopalatine line as a reliable predictor of the inferior extent of endonasal odontoidectomies","volume":"38","author":"La Corte E","year":"2015","unstructured":"La Corte E, Aldana PR, Ferroli P,  The rhinopalatine line as a reliable predictor of the inferior extent of endonasal odontoidectomies. 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