Publication Type Case Report
Authors Singh H, Rote S, Jada A, Bander E, Almodovar-Mercado G, Essayed W, Härtl R, Anand V, Schwartz T, Greenfield J
Journal J Neurosurg
Volume 128
Issue 5
Pagination 1486-1491
Date Published 06/16/2017
ISSN 1933-0693
Keywords Natural Orifice Endoscopic Surgery, Odontoid Process, Surgery, Computer-Assisted, Tomography, X-Ray Computed
Abstract The authors present 4 cases in which they used intraoperative CT (iCT) scanning to provide real-time image guidance during endonasal odontoid resection. While intraoperative CT has previously been used as a confirmatory test after resection, to the authors' knowledge this is the first time it has been used to provide real-time image guidance during endonasal odontoid resection. The operating room setup, as well as the advantages and pitfalls of this approach, are discussed. A mobile intraoperative CT scanner was used in conjunction with real-time craniospinal neuronavigation in 4 patients who underwent endoscopic endonasal odontoidectomy for basilar invagination. All patients underwent a successful decompression. In 3 of the 4 patients, real-time intraoperative CT image guidance was instrumental in achieving a comprehensive decompression. In 3 (75%) cases in which the right nostril was the predominant working channel, there was a tendency for asymmetrical decompression toward the right side, meaning that residual bone was seen on the left, which was subsequently removed prior to completion of the surgery. Endoscopic endonasal odontoid resection with real-time intraoperative image-guided CT scanning is feasible and provides accurate intraoperative localization of pathology, thereby increasing the chance of a complete odontoidectomy. For right-handed surgeons operating predominantly through the right nostril, special attention should be paid to the contralateral side of the resection, where there is often a tendency for residual pathology.
DOI 10.3171/2017.1.JNS162601
PubMed ID 28621629
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