Endoscopic Transoral Odontoidectomy for Bullet Extraction: A Case Study

This report presents a case of craniovertebral junction (CVJ) trauma caused by a gunshot injury, managed successfully with endoscopic transoral odontoidectomy. The procedure achieved ventral decompression, bullet extraction, and neurological improvement while addressing challenges like severe edema, fragmented dental structures, and cerebrospinal fluid (CSF) leaks using advanced tools and expert planning. A patient with a gunshot wound to the CVJ underwent endoscopic transoral odontoidectomy. Preoperative imaging revealed a bullet near vital structures, prompting surgery for decompression and removal. The patient was positioned with neuronavigation guidance, and a tracheostomy ensured airway management. Odontoid resection and bullet extraction were performed, and a CSF leak was repaired using Duragen and fibrin sealant. The surgery achieved complete bullet removal and cervicomedullary decompression without major complications. Imaging confirmed no residual fragments. Neurological improvement was observed postoperatively, though secondary stabilization was planned due to instability from odontoid resection. Complications, including a CSF leak and soft palate edema, were managed effectively, and the patient experienced progressive functional recovery. This case highlights the endoscopic transoral approach as an effective, minimally invasive technique for managing complex CVJ trauma. Advanced technology and expert planning ensured a successful outcome, emphasizing the need for tailored strategies and further research to validate its broader application.