Transoral approach to osteoid osteoma of axis

Background: Pediatric osteoid osteomas of the cervical spine are rare, representing a unique diagnostic and therapeutic challenge due to their proximity to critical neurovascular structures. Although benign, these bone-forming tumors can cause significant pain and functional limitation, often necessitating intervention. Lesions involving the axis, particularly at the base of the dens, require careful management given their relationship to the spinal cord and stabilizing elements of the craniovertebral junction. Case Description: We present a 9-year-old female with a 1-year history of progressive upper cervical pain refractory to medical therapy. Imaging demonstrated an osteoid osteoma of the axis at the base of the dens, with interval growth on surveillance studies. Given the lesion’s location and concern for preserving atlantoaxial stability, the patient underwent transoral resection, allowing direct midline access while minimizing disruption of posterior stabilizing structures. Gross total resection was achieved without complication. The accompanying surgical video demonstrates key steps of the transoral approach, including exposure, identification of midline landmarks, and lesion excision. Informed consent was obtained, and IRB approval was not required for this single-patient case report. To the best of our knowledge, a surgical video of this approach for dens-based osteoid osteoma has not been previously described and provides a focused illustration of relevant anatomy and technique. Conclusion: Osteoid osteomas of the dens in pediatric patients are rare and require a tailored approach that balances complete resection with preservation of stability. The transoral approach remains a valuable corridor for select midline craniovertebral lesions. This video contributes a practical technical reference to the limited literature on this approach.