{"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":1783776731433,"version":"3.55.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2008,4]]},"abstract":"<jats:p>\u2713 Pediatric basilar invagination and cranial settling have traditionally been approached through a transoral\u2013transpharyngeal route with or without extended maxillotomy or mandibulotomy for resection of the anterior portion of C-1 and the odontoid. The authors hypothesize that application of a recently described endoscopic transcervical odontoidectomy (ETO) technique would allow an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients.<\/jats:p>\n<jats:p>The authors performed ETO in a consecutive series of pediatric patients presenting with myelopathy or bulbar dysfunction resulting from basilar invagination or cranial settling. All clinical, radiographic, surgical, and follow-up data were prospectively collected. The initial experience with ETO in the pediatric population is analyzed and outcomes are reported. Three patients required ETO for basilar invagination and 1 required ETO with anterior C-1 arch and distal clivus resection for cranial settling. All patients presented with myelopathy. One patient was wheelchair bound with severe quadriparesis. The mean age was 14 \u00b1 3 years (mean \u00b1 standard deviation [SD]) in the 2 male and 2 female patients. The ETO and posterior fusion were performed as a 2-stage procedure in 2 (50%) and as a single-stage procedure in 2 (50%) cases. Prolonged intubation or postoperative placement of a gastrostomy tube was not needed in any case. The postoperative hospitalization lasted 9 \u00b1 4 days (mean \u00b1 SD). At last follow-up (mean 5 months), head and neck pain had resolved and motor strength had improved or stabilized in all cases. All 4 children were independently functioning and ambulatory at the last follow-up.<\/jats:p>\n<jats:p>In the authors' initial experience, ETO has allowed ventral brainstem decompression without the need for prolonged intubation, worsening dysphagia requiring enteral tube feeding, or prolonged hospitalization, and has resulted in cosmetically appealing results. The ETO technique allows an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients.<\/jats:p>","DOI":"10.3171\/ped\/2008\/1\/4\/337","type":"journal-article","created":{"date-parts":[[2008,3,31]],"date-time":"2008-03-31T18:11:23Z","timestamp":1206987083000},"page":"337-342","source":"Crossref","is-referenced-by-count":57,"title":["Endoscopic transcervical odontoidectomy for pediatric basilar invagination and cranial settling"],"prefix":"10.3171","volume":"1","author":[{"given":"Matthew J.","family":"McGirt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J.","family":"Attenello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Sciubba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziya L.","family":"Gokaslan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul","family":"Wolinsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0010337","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s007010200029","article-title":"Endoscopic endonasal approach to the ventral cranio-cervical junction: anatomical study","volume":"144","author":"Alfieri","year":"2002"},{"key":"b2-0010337","series-title":"Skull Base Surg","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1055\/s-2008-1057101","article-title":"Open-door maxillotomy approach for lesions of the clivus","volume":"1","author":"Anand","year":"1991"},{"key":"b3-0010337","series-title":"Neurosurgical Operative Atlas","first-page":"189","article-title":"Anterior screw fixation for odontoid fractures","volume":"Vol 2","author":"Apfelbaum","year":"1992"},{"issue":"2 Suppl","key":"b4-0010337","series-title":"J Neurosurg","first-page":"227","article-title":"Direct anterior screw fixation for recent and remote odontoid fractures","volume":"93","author":"Apfelbaum","year":"2000"},{"key":"b5-0010337","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1227\/00006123-197809000-00012","article-title":"Transoral exposure of the atlantoaxial region","volume":"3","author":"Apuzzo","year":"1978"},{"key":"b6-0010337","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1227\/00006123-198106000-00006","article-title":"Combined transoral and median labio-mandibular glossotomy approach to the upper cervical spine","volume":"8","author":"Arbit","year":"1981"},{"key":"b7-0010337","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"301","DOI":"10.3171\/jns.2006.105.2.301","article-title":"Anatomical analysis of transoral surgical approaches to the clivus","volume":"105","author":"Balasingam","year":"2006"},{"key":"b8-0010337","series-title":"Head Neck","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1002\/1097-0347(200007)22:4<323::AID-HED2>3.0.CO;2-8","article-title":"Anterior mandibular osteotomy for tumor extirpation: a critical evaluation","volume":"22","author":"Bertrand","year":"2000"},{"issue":"1 Suppl","key":"b9-0010337","series-title":"Neurosurgery","first-page":"ONS20","article-title":"Anatomical variations of the V2 segment of the vertebral artery","volume":"59","author":"Bruneau","year":"2006"},{"key":"b10-0010337","series-title":"Brain","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1093\/brain\/78.2.229","article-title":"The radiological criteria and familial occurrence of primary basilar impression","volume":"78","author":"Bull","year":"1955"},{"key":"b11-0010337","series-title":"J Neurosurg Sci","first-page":"51","article-title":"A possible sequela of transoral approach to the upper cervical spine. 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