Transnasal versus Transoral Odontoidectomy for Congenital Craniocervical Junction Anomalies in Adults: A Systematic Review and Meta-analysis

Introduction: Congenital craniocervical junction (CCJ) anomalies, such as basilar invagination and atlantoaxial dislocation, often result in significant neurological impairment due to ventral compression of the spinal cord. Odontoidectomy has been traditionally employed to alleviate this compression and improve patient outcomes. However, there are no guidelines in the literature for craniocervical decompression regarding approaches for odontoidectomy. With this systematic review, the authors seek to evaluate the surgical and neurological outcomes of adult patients with congenital junction abnormalities who underwent odontoidectomy by comparing two different approaches, transnasal and transoral.

Materials and Methods: We performed a systematic review under PRISMA guidelines up to January 2024 that included Medline, Web of Science, and Google Scholar databases for patients with indication for odontoidectomy in the context of congenital craniocervical junction anomalies. We used a comprehensive combination of search terms: platybasia, basilar invagination, craniocervical junction, and odontoidectomy. Reviews, abstracts without complete articles, and poster presentations were excluded. The selection was not limited by publication date. Outcomes regarding perioperative comorbidities, craniocervical malformations, perioperative neurological deficit, requirement for posterior fixation, and complications were recollected and assessed.

Results: From 733 articles, a total of 14 articles were included with 9 patients who underwent transoral odontoidectomy approach and 5 patients who underwent transnasal approach. There were no significant differences between groups regarding age and preoperative neurological deficit (p > 0.05). Chiari malformation and syringomyelia were statistically higher in the transoral route group (p < 0.05). On the other hand, the prevalence of congenital conditions such as Klippel–Feil syndrome and osteogenesis imperfecta was more common in the transnasal approach group (p < 0.05). In the postoperative course, the transoral approach had a higher rate of postoperative neurological deficit (p < 0.01), which included dysphagia, dysphonia, weakness, and spasticity. In both groups, an additional surgical procedure was indicated, most commonly an occipitocervical fixation in the transnasal group and with posterior fossa decompression in the transoral group. C1–C2 posterior fusion was more widely presented in the transoral group in 11.1 versus 0% in the transnasal group. No significant differences were documented regarding postoperative infection rate, which is related to the low documentation of this outcome in the collected articles.

Conclusion: Odontoidectomy through the transnasal route is the preferred approach for craniocervical decompression in the context of congenital conditions such as Chiari malformation, Klippel-Field syndrome, and osteogenesis imperfecta. There is still scarce evidence regarding the appropriate type of cervical posterior fixation in cases of craniocervical decompression through odontoidectomy.

Fig. 1 PRISMA flowchart. *Newcastle Ottawa scale based.

Table 1 Demographic and associated comorbidities rate.

Table 2 Postoperative outcomes and additional surgical procedures.

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Artikel online veröffentlicht:
07. Februar 2025