Endoscopic endonasal odontoidectomy has increasingly replaced historical transoral approaches for selected craniovertebral junction pathology because it provides direct midline access with lower airway- and feeding-related morbidity. As these complications have become less frequent, reliable nasopharyngeal mucosal reconstruction has become increasingly important to postoperative recovery. However, reproducible techniques for flap resuspension in the narrow endonasal corridor remain limited. We present a novel use of the DuraStat suturing device for resuspension of an inverted U-shaped nasopharyngeal flap following endonasal odontoidectomy.

A 35-year-old man with hypermobile Ehlers-Danlos syndrome and recurrent type II basilar invagination after prior occiput-C2 instrumentation presented with persistent imbalance, falls, bilateral hand paresthesias, extremity weakness, and bowel and bladder dysfunction. Imaging demonstrated a retroflexed odontoid causing persistent ventral cervicomedullary compression. He underwent endoscopic endonasal odontoidectomy with exposure through an inverted U-shaped nasopharyngeal flap.

After decompression, the flap was reconstructed using the DuraStat device, which enabled controlled deployment of a double-armed 5-0 polytetrafluoroethylene suture to resuspend the flap to the nasopharyngeal roof in a tension-free fashion.

Postoperative imaging confirmed satisfactory decompression. The patient was discharged on postoperative day 1, and early follow-up demonstrated improved gait, less frequent paresthesias, and appropriate mucosal healing.

This case demonstrates that DuraStat-assisted resuspension of an inverted U-shaped nasopharyngeal flap is feasible following endoscopic endonasal odontoidectomy. This technique may improve reconstructive precision in constrained endonasal corridors and adds a practical, reproducible option to the limited literature on nasopharyngeal flap repair after ventral craniovertebral junction decompression