Transnasal Endoscopic Odontoidectomy

had surgery with the use of a navigation device had an average score improvement of 3.4 mm and those without, an improvement of 3.7 mm. 95% of patients were satisfied with improvement of symptoms. CONCLUSION: Patients who had lateral orbital/MOW decompression had better improvement of Hertell scores. There was no difference in outcomes in patients where a surgical navigation device was used. Patient satisfaction was high despite the use of different decompression approaches. Transnasal Endoscopic Management of Recurrent Angiofibroma Shawky Elmorsy, MD (presenter) OBJECTIVE: To study the utility of transnasal endoscopic surgery in managing recurrent angiofibroma without embolization, and to know the most common sites of angiofibroma recurrence. METHOD: This study includes 13 male adolescence patients with recurrent nasopharyngeal angiofibroma who received treatment at our department between 2003 and 2008. The patient age ranged from 12 to 21 years (mean age, 15.7 y). Endoscopic two-surgeons technique had been used. Follow up MRI every 4 months. RESULTS: In 10 patients complete removal of the tumor was achieved. We have 3 patients with further recurrence, 2 in lateral wall of sphenoids, and one in the soft palate. CONCLUSION: Anatomic complexity and high vascularity together with difficult embolization should be kept in mind when dealing with recurrent angiofibroma endoscopically. Soft tissue invasion to longus coli and longus capitis muscles as well as ptyrgoid muscles and soft palate should be attended to well to avoid further recurrence. Transnasal Endoscopic Odontoidectomy Romain Kania, MD, PhD (presenter) OBJECTIVE: A purely transnasal endoscopic approach (TNEA) to the cranio-cervical junction has been recently described in cadaver and in two clinical cases allowing for atlanto-axial decompression. As this new approach has only been used in some cases reports by few experienced teams, further investigation are needed to define the possibilities and limits of this purely transnasal approach. In this report, we provide a detailed description of a surgical procedure of TNEA after previous posterior fusion and discuss the feasibility, safety, hints and pints of this approach. METHOD: A 57-year-old men who presented a slowly cervicomedullary junction compression with neck pain, dysphagia and fever was referred to our department for surgical decompression of the bulbo-medullary junction. The operation was carried out with the use of (i) a CT-based neuronavigation system (Stealth-station, Medtronic, USA), (ii) 0- and 30-angled

P295 endoscopes with a HDD camera (Storz, Germany) and (iii) dedicated endoscopic instrumentation (Storz, Aesculap, Germany). RESULTS: Surgery was initiated by bilateral resection of the medial conchae, resection of the posterior part of the nasal septum and partial resection of the rostrum. Once the sphenoid ostium was opened on each side, wide bilateral sphenoidotomies were performed and joined in order to obtain wide exposure of the sphenoid sinus from one carotid canal to the another. The floor of the sphenoid sinus was then drilled in order to obtain visualization of the surgical field from the jugum to the soft palate vertically and from each right and left lateral wall of the sphenoid sinus, pterygoid plates and Eustachian tubes laterally. These intra-operative land-marks were checked by the navigation system and allowed for enough space for 4-hand surgery. The posterior surgical field exposed the nasopharyngeal mucosa in the depth and the caudal end of the clivus was reached and pointed using the navigation system. Along a rostral to caudal route, the feasibility of the approach of the craniocervical junction was ascertained by the navigation system. Whereas the soft palate was pushed caudally, no manipulation of the hard palate was associated. An inferiorly based U-shaped muco-pharyngeal flap was prepared with a diode laser. It was elevated from the level of the sphenoidotomy floor to the level of the soft palate and was reflected caudally into the oro-pharynx. Then using the navigation system, the clivus was pointed, the basipharyngeal facia was dissected and, inferiorly, a second U-shaped paraspinal muscles flap was dissected caudally. The anterior ring of C1 was exposed. A Kerisson rongeur was slid over the anterior arch of C1 to resect its ring and attend the odontoid process. The odontoid process was then drilled at its base and its tip was carefully resected with a Kerisson rongueur acting more as a smooth hook than a rongueur actually. Complete odontoid resection was achieved until visualization of pulsations of the dura. There was no dura breach. The paraspinal muscle and muco-pharyngeal flaps were applied and fixed with biological glue (Tissucol, Baxter, USA). CONCLUSION: The transnasal endoscopic approach (TNEA) allows safe anterior decompression at the craniocervical junction by performing odontoidectomy. Compared with the transoral approach which reaches C4, the lower limit of the TNEA is the bottom of C2 vertebral body. This limit may be more cranially after posterior fusion and must be considered in the pre-operative planning.

Transorbital Endoscopic Management of Sinusitis Complication Kris Moe, MD (presenter) OBJECTIVE: 1) To demonstrate access to the orbit, frontal sinus and anterior skull base using transorbital neuroendoscopic (TONES) approach in cadavers. 2) To demonstrate the

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