• Jau-Ching Wu, Wen-Cheng Huang, Henrich Cheng, Muh-Lii Liang, Ching-Yin Ho, Tai-Tong Wong, Yang-Hsin Shih, and Yu-Shu Yen.
• Neural Regeneration Laboratory, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan, Republic of China.
• Neurosurgery. 2008 Jul 1; 63 (1 Suppl 1): ONSE92-4; discussion ONSE94.

ObjectiveEndoscopic transnasal transclival resection of the odontoid process is less invasive than the standard transoral odontoidectomy. In this article, we describe our techniques, which are less invasive but provide successful decompression.Clinical PresentationFrom September 2004 to April 2007, three consecutive patients with basilar invagination and instability in the craniovertebral junction were enrolled. The causes for the invagination and instability included rheumatoid arthritis in two patients and trauma in one patient, and all patients presented with myelopathy and quadriparesis before intervention.InterventionAll three patients underwent an endoscopic transnasal transclival approach for anterior decompression and resection of the displaced odontoid process and pannus to decompress the underlying medulla. Subsequently, they received occipitocervical fixation by lateral mass screws and bone fusion to ensure stability. Remarkable neurological recovery was observed after surgery in all patients, and no adverse effects were noted.ConclusionCompared with the standard transoral approach, the transnasal transclival endoscopic approach for decompressing basilar invagination is a feasible and effective alternative that avoids common disadvantages like prolonged intubation, excessive tongue retraction, and the need for palatal incision.

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