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European Journal of Radiology Nov 2020
Topics: Humans; Magnetic Resonance Imaging; Platybasia; Radiography; Radiology
PubMed: 32950798
DOI: 10.1016/j.ejrad.2020.109280 -
Medicina (Kaunas, Lithuania) Apr 2024: To present a novel technique of treatment for a patient with basilar invagination. Basilar invagination (BI) is a congenital condition that can compress the... (Review)
Review
: To present a novel technique of treatment for a patient with basilar invagination. Basilar invagination (BI) is a congenital condition that can compress the cervicomedullary junction, leading to neurological deficits. Severe cases require surgical intervention, but there is debate over the choice of approach. The anterior approach allows direct decompression but carries high complication rates, while the posterior approach provides indirect decompression and offers good stability with fewer complications. : A 15-year-old boy with severe myelopathy presented to our hospital with neck pain, bilateral upper limb muscle weakness, and hand numbness persisting for 4 years. Additionally, he experienced increased numbness and gait disturbance three months before his visit. On examination, he exhibited hyperreflexia in both upper and lower limbs, muscle weakness in the bilateral upper limbs (MMT 4), bilateral hypoesthesia below the elbow and in both legs, mild urinary and bowel incontinence, and a spastic gait. Radiographs revealed severe basilar invagination (BI). Preoperative images showed severe BI and that the spinal cord was severely compressed with odontoid process. : The patient underwent posterior surgery with the C-arm free technique. All screws including occipital screws were inserted into the adequate position under navigation guidance. Reduction was achieved with skull rotation and distraction. A follow-up at one year showed the following results: Manual muscle testing results and sensory function tests showed almost full recovery, with bilateral arm recovery (MMT 5) and smooth walking. The cervical Japanese Orthopedic Association score of the patient improved from 9/17 to 16/17. Postoperative images showed excellent spinal cord decompression, and no major or severe complications had occurred. : Basilar invagination alongside Klippel-Feil syndrome represents a relatively uncommon condition. Utilizing a posterior approach for treating reducible BI with a C-arm-free technique proved to be a safe method in addressing severe myelopathy. This novel navigation technique yields excellent outcomes for patients with BI.
Topics: Humans; Male; Adolescent; Klippel-Feil Syndrome; Decompression, Surgical; Platybasia; Treatment Outcome; Spinal Cord Compression
PubMed: 38674263
DOI: 10.3390/medicina60040616 -
World Neurosurgery Jun 2020Chiari malformation (CM) is defined as a herniation of cerebellar tonsils below the foramen magnum and is considered to be due to underdevelopment of posterior fossa... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chiari malformation (CM) is defined as a herniation of cerebellar tonsils below the foramen magnum and is considered to be due to underdevelopment of posterior fossa (PF) bone components. There is overcrowding of neural structures, and normal cerebrospinal fluid circulation is frequently blocked. Although several publications exist of measurements of dimensions and volumes from bone components of PF in CM, there is no systematic review evaluating quantitatively these dimensions. The aim of this study was to evaluate PF dimensions and volumes in a meta-analysis.
METHODS
An electronic search using PubMed and Google Scholar was done. Study eligibility criteria were defined by the PICO strategy, which selected patients and interventions. Studies comparing PF dimensions between patients with CM and normal subjects were selected. A meta-analysis of pooled data was done using statistical software.
RESULTS
Data for pooled analysis were obtained from 12 studies. Data synthesis was based on small published sample sizes in the majority of studies. Key findings included smaller measurements of clivus, supraoccipital bone, and PF area dimensions in patients with CM compared with normal subjects. Brainstem and cerebellar length was not different between groups.
CONCLUSIONS
This review provides evidence of smaller measurements of clivus, supraoccipital bone, and PF area dimensions in patients with CM compared with normal subjects. An implication of the key findings is that surgical treatment of CMs should consider the smaller dimensions of PF in planning.
Topics: Arnold-Chiari Malformation; Case-Control Studies; Cephalometry; Cranial Fossa, Posterior; Humans; Magnetic Resonance Imaging; Occipital Bone; Organ Size; Platybasia; Reference Values; Tomography, X-Ray Computed
PubMed: 32156591
DOI: 10.1016/j.wneu.2020.02.182 -
World Neurosurgery Jan 2020
Topics: Humans; Kyphosis; Platybasia
PubMed: 31881579
DOI: 10.1016/j.wneu.2019.10.119 -
Child's Nervous System : ChNS :... May 2022Osteogenesis imperfecta (OI) is a rare bone disease due to an abnormal synthesis of 1-type collagen. OI is frequently associated with basilar impression (BI), defined by...
Severe Basilar impression in osteogenesis imperfecta treated with halo gravity traction, occipitocervicothoracic fusion, foramen magnum and upper cervical decompression and expansive duroplasty: a technical note.
Osteogenesis imperfecta (OI) is a rare bone disease due to an abnormal synthesis of 1-type collagen. OI is frequently associated with basilar impression (BI), defined by the elevation of the clivus and floor of the posterior fossa with subsequent migration of the upper cervical spine and the odontoid peg into the base of the skull. Bone intrinsic fragility leading to fractures and deformity, brainstem compression and impaired CSF circulation at cranio-vertebral junction (CVJ) makes the management of these conditions particularly challenging. Different surgical strategies, including posterior fossa decompression with or without instrumentation, transoral or endonasal decompression with posterior occipito-cervical fusion, or halo gravity traction with posterior instrumentation have been reported, but evidence about best modalities treatment is still debated. In this technical note, we present a case of a 16-years-old patient, diagnosed with OI and BI, treated with halo traction, occipito-cervico-thoracic fixation, foramen magnum and upper cervical decompression, and expansive duroplasty. We focus on technical aspects, preoperative work up and postoperative follow up. We also discuss advantages and limitations of this strategy compared to other surgical techniques.
Topics: Adolescent; Cervical Vertebrae; Decompression; Foramen Magnum; Humans; Osteogenesis Imperfecta; Platybasia; Traction
PubMed: 35296931
DOI: 10.1007/s00381-022-05495-7 -
Clinical Radiology Jun 2020To describe the magnetic resonance imaging (MRI) findings of the cervical spine of patients with mucopolysaccharidosis type VI (MPS VI) and correlate them with clinical...
AIM
To describe the magnetic resonance imaging (MRI) findings of the cervical spine of patients with mucopolysaccharidosis type VI (MPS VI) and correlate them with clinical manifestations.
MATERIALS AND METHODS
This is a cross-sectional study involving 12 patients with MPS VI. A limited neurological examination was undertaken in each patient including Tinel's test, assessment of muscle tone, and the evaluation of deep tendon reflexes. Additionally, each patient underwent cervical spine MRI to evaluate platybasia, odontoid dysplasia, periodontoid soft-tissue thickening, spinal canal stenosis, myelopathy, basilar invagination, platyspondyly, and reduction of nasopharyngeal airway.
RESULTS
Nine patients were male (75%). The average age was 12.5 (±3.5 years). Tinel's test was negative in all patients. No muscle tone abnormalities were observed. Approximately 48% of the tested reflexes were considered abnormal, 10 of which (8.3%) were pathological occurring in five different patients (41.6%). At MRI, all patients showed periodontoid soft-tissue thickening and cervical spinal stenosis; six showed spinal cord compression and two showed myelopathy. Odontoid hypoplasia and basilar invagination were observed in nine patients. All patients with cervical stenosis on MRI had abnormal reflexes; however, only two of the six patients with evidence of cord compression on MRI had abnormal reflexes on clinical examination.
CONCLUSIONS
The present study of 12 patients with MPS VI demonstrated that a normal neurological examination cannot confidently exclude potential cord compression in patients with this condition. MRI may aid in the timely identification of cervical spine abnormalities, and potentially play a role in lessening morbidity and mortality in patients with MPS.
Topics: Cervical Vertebrae; Child; Cross-Sectional Studies; Female; Humans; Magnetic Resonance Imaging; Male; Mucopolysaccharidosis VI; Neurologic Examination; Spinal Cord Compression
PubMed: 32061396
DOI: 10.1016/j.crad.2020.01.007 -
Neurosurgical Focus Mar 2024
Topics: Humans; Spinal Diseases; Joint Instability; Atlanto-Axial Joint; Decompression, Surgical; Platybasia; Joint Dislocations
PubMed: 38428006
DOI: 10.3171/2023.11.FOCUS23789 -
Operative Neurosurgery (Hagerstown, Md.) Dec 2019Patients with basilar invagination and atlas occipitalization usually present abnormal anatomy of the vertebral arteries (VAs) at the craniovertebral junction (CVJ).
Three-Dimensional Evaluation and Classification of the Anatomy Variations of Vertebral Artery at the Craniovertebral Junction in 120 Patients of Basilar Invagination and Atlas Occipitalization.
BACKGROUND
Patients with basilar invagination and atlas occipitalization usually present abnormal anatomy of the vertebral arteries (VAs) at the craniovertebral junction (CVJ).
OBJECTIVE
To describe and further classify different types of VA variations at the CVJ with 3D visualization technology.
METHODS
One hundred twenty patients with basilar invagination and atlas occipitalization who had undergone 3-dimensional computed tomographic angiography (3D-CTA) were retrospectively studied. Imaging data were processed via the separating, fusing, opacifying, and false-coloring-volume rendering technique. Abnormal anatomy of the VA at the CVJ was categorized and related anatomic parameters were measured.
RESULTS
Seven different types were classified. Type I, VAs enter the cranium after leaving VA groove on the posterior arch of atlas (26.7% of 240 sides); Type II, VAs enter an extraosseous canal created in the assimilated atlas lateral mass-occipital condyle complex before reaching the cranium (53.3%); Type III, VA courses above the axis facet or curves below the atlas lateral mass then enter the cranium (11.7%); Type IV, VAs enter the spinal canal under the axis lamina (1.3%); Type V, high-riding VA (31.3%); Type VI, fenestrated VA (2.9%); Type VII, absent VA (4.2%). Distance from the canal of Type II VA to the posterior facet surface of atlas lateral mass (5.51 ± 2.17 mm) means a 3.5-mm screw can be safely inserted usually. Shorter distance from the midline (13.50 ± 4.35) illustrates potential Type III VA injury during exposure. Decreased height and width of axis isthmus in Type V indicate increased VA injury risks.
CONCLUSION
Seven types of VA variations were described, together with valuable information helpful to minimize VA injury risk intraoperatively.
Topics: Adolescent; Adult; Central Nervous System Vascular Malformations; Cerebral Angiography; Cervical Atlas; Child; Computed Tomography Angiography; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Musculoskeletal Abnormalities; Occipital Bone; Platybasia; Retrospective Studies; Vertebral Artery; Young Adult
PubMed: 31127851
DOI: 10.1093/ons/opz076 -
Zhonghua Wai Ke Za Zhi [Chinese Journal... Oct 2019To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in...
[Reduction of the atlantoaxial dislocation associated with basilar invagination through single-stage posterior approach: using Xuanwu occipital-cervical reduction surgical suite].
To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in single stage. Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed. There were 15 males and 22 females with age of (42.3±12.3)years (range: 18-69 yars). All the cases had congenital osseous abnormalities, such as assimilation of atlas and abnormal cervical fusion. Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including anterior atlantodental interval (ADI),the distance of odontoid tip above Chamberlain line,clivus-canal angle (CCA) and the length of syrinx were collected.The preoperative and postoperative JOA score and radiological measurements were compared by paired -test. The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(14.3,0.00).Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from 118.0 degrees preoperative to 143.7 degrees postoperative(6.2,0.00). Shrinkage of the syrinx was observed 1 week after surgery in 24 patients, and 6 months in 31 patients. Twenty-eight patients achieved bone fusion 6 months after surgery. All the patients achieved bone fusion 12 months after surgery. One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness, and relieved in 2 weeks. Two patients developed moderate neck pain after surgery, and relieved in 1 month. No implant failure, spacer subsidence or infection was observed. The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe. Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.
Topics: Adolescent; Adult; Aged; Atlanto-Axial Joint; Cervical Vertebrae; Decompression, Surgical; Female; Humans; Joint Dislocations; Male; Middle Aged; Occipital Bone; Platybasia; Retrospective Studies; Spinal Fusion; Young Adult
PubMed: 31510735
DOI: 10.3760/cma.j.issn.0529-5815.2019.10.012 -
Operative Neurosurgery (Hagerstown, Md.) Jun 2020For patients with odontoid process protrusion and basilar invagination, posterior screw-rod fixation can usually achieve satisfactory horizontal reduction, but in some...
BACKGROUND
For patients with odontoid process protrusion and basilar invagination, posterior screw-rod fixation can usually achieve satisfactory horizontal reduction, but in some cases satisfactory reduction in the vertical direction cannot be achieved at the same time.
OBJECTIVE
To propose a method for calculation of the theoretical maximum vertical reduction possible in individual patients.
METHODS
The computed tomography imaging data of patients with occipitalization and basilar invagination who were treated at our institute between January 2013 and June 2016 were retrospectively analyzed. The direction of odontoid reduction was decided by the inclination of the lateral joint. The atlanto-dental distance was assumed to be the maximum possible reduction in the horizontal direction. The maximum vertical reduction possible was calculated based on these values.
RESULTS
A total of 82 patients (34 males and 48 females) were included. The theoretical vertical reduction value was 4.2 ± 3.0 mm, which was significantly smaller than that of the dental protrusion (14.5 ± 3.8 mm, P = .000). Analysis of follow-up data (29 cases) showed that, the difference between the theoretical vertical reduction value H (4.7 ± 3.5 mm) and the actual vertical reduction value Ha (5.6 ± 3.5 mm) was not significant (P = .139).
CONCLUSION
The theoretical calculation method we proposed can well predict the actual degree of vertical reduction. The theoretical vertical reduction value is significantly lower than the odontoid protrusion value, indicating that satisfactory reduction in the vertical direction is difficult with a posterior approach alone.
Topics: Atlanto-Axial Joint; Female; Humans; Joint Dislocations; Male; Platybasia; Retrospective Studies; Spinal Fusion
PubMed: 31584103
DOI: 10.1093/ons/opz287