• Maurizio Gladi, Maurizio Iacoangeli, Nicola Specchia, Massimo Re, Mauro Dobran, Lorenzo Alvaro, Elisa Moriconi, and Massimo Scerrati.
• Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy. mauriziogladi@gmail.com
• Eur Spine J. 2012 May 1;21 Suppl 1:S55-60.

PurposeAnterior decompression of the craniovertebral junction is reserved to patients with irreducible ventral bulbo-medullary lesions and rapidly deteriorating neurological functions. Classically performed through the transoral approach, the exposure of this region can be now achieved by a minimally invasive endonasal endoscopic approach (EEA).MethodsFour patients with irreducible, anterior bulbo-medullary compression due to rheumatoid pannus and basilar invagination were enrolled. The imaged-guided EEA was used to resect the odontoid process, trying to preserve the C1 anterior arch.ResultsNeurological improvement and adequate bulbo-medullary decompression were obtained in all patients. In two cases, anterior C1 ring was preserved. These patients did not required a posterior fusion.ConclusionsCompared with the standard transoral technique, the EEA provides the same good exposure but with potentially less complications. The preservation of the anterior C1 arch can contribute to avoid cranial settling and posterior fusion with its related risk of subaxial instability.

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