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World Neurosurgery Aug 2023
Topics: Humans; Foramen Magnum; Platybasia; Arnold-Chiari Malformation
PubMed: 37550925
DOI: 10.1016/j.wneu.2023.03.124 -
Acta Neurochirurgica Oct 2022Treatments for symptomatic or unstable basilar invagination (BI) include posterior decompression, distraction/fusion, trans-nasal or trans-oral anterior decompression,...
BACKGROUND
Treatments for symptomatic or unstable basilar invagination (BI) include posterior decompression, distraction/fusion, trans-nasal or trans-oral anterior decompression, and combined techniques, with the need for occipitocervical fusion based on the degree of craniocervical instability. Variations of the far lateral transcondylar approach are described in limited case series for BI, but have not been widely applied.
METHODS
A single-institution, retrospective review of consecutive patients undergoing a far lateral transcondylar approach for odontoidectomy (± resection of the inferior clivus) followed by occipitocervical fusion over a 6-year period (1/1/2016 to 12/31/2021) is performed. Detailed technical notes are combined with images from cadaveric dissections and patient surgeries to illustrate our technique using a lateral retroauricular incision.
RESULTS
Nine patients were identified (3 males, 6 females; mean age 40.2 ± 19.6 years). All patients had congenital or acquired BI causing neurologic deficits. There were no major neurologic or wound-healing complications. 9/9 patients (100%) experienced improvement in preoperative symptoms.
CONCLUSIONS
The far lateral transcondylar approach provides a direct corridor for ventral brainstem decompression in patients with symptomatic BI. A comprehensive knowledge of craniovertebral junction anatomy is critical to the safe performance of this surgery, especially when using a lateral retroauricular incision.
Topics: Adult; Decompression, Surgical; Female; Humans; Male; Middle Aged; Nose; Platybasia; Retrospective Studies; Spinal Fusion; Young Adult
PubMed: 35867183
DOI: 10.1007/s00701-022-05312-9 -
Child's Nervous System : ChNS :... Oct 2008Osteogenesis imperfecta (OI) is an inheritable disorder of bone development caused by defective collagen synthesis. The attendant basilar impression or secondary basilar... (Review)
Review
INTRODUCTION
Osteogenesis imperfecta (OI) is an inheritable disorder of bone development caused by defective collagen synthesis. The attendant basilar impression or secondary basilar invagination is uncommon but can be devastating.
CLINICAL MATERIALS AND METHODS
Fifty-two patients with osteochondrodysplasia (28 with OI, six with Hajdu-Cheney syndrome, six with Paget's disease, and 12 with spondyloepiphyseal dysplasia) with basilar impression were evaluated between 1985 and 2005. The male/female ratio in this cohort was 1:1. The mean age at presentation was 12.2 years.
SYMPTOMS
Symptoms and signs included headache, lower cranial nerve dysfunction, dysphagia, respiratory embarrassment, weakness, and ataxia.
TREATMENT
In the earlier part of the series (1985-1995), all patients with hydrocephalus were shunted and a ventral transoral decompression made for ventral compression of the pontomedullary junction followed by a dorsal occipitocervical fusion. As a result of this evaluation, it was felt that most patients would benefit by early bracing after the hydrocephalus was shunted if it existed. However, 20% of patients still required an anterior ventral decompression and the occipitocervical fusion.
RESULTS
The results showed that the fusions were stable but over a period of time, there was progressive forward bending with osteogenesis imperfecta as well as with the Hajdu-Cheney syndrome. All patients with spondyloepiphyseal dysplasia had a good strong stable fusion which stood the test of time.
CONCLUSION
In conclusion, we feel that early intervention with occipitocervical bracing can prevent the progressive march of significant basilar impression which leads to mortality.
Topics: Child; Decompression, Surgical; Female; Humans; Hydrocephalus; Male; Osteochondrodysplasias; Osteogenesis Imperfecta; Platybasia; Spinal Fusion
PubMed: 18401562
DOI: 10.1007/s00381-008-0602-z -
World Neurosurgery Sep 2022Although posterior procedures are used for most cases of basilar invagination, transoral decompression is an important tool in complex deformities with severe...
BACKGROUND
Although posterior procedures are used for most cases of basilar invagination, transoral decompression is an important tool in complex deformities with severe degeneration and neural compression.
METHODS
Consecutive patients who underwent transoral odontoidectomy for basilar invagination and atlantoaxial dislocation at the neurosurgical unit of Lady Reading Hospital Peshawar between June 2016 and January 2022 were retrospectively included. Preoperative and postoperative neurological, clinical, and radiological parameters were recorded and compared.
RESULTS
Of the 33 patients included in this study, 22 were men and 11 were women. The mean age was 23.4 years ±8.4 years (mean ± standard deviation). The most common presenting symptoms were gait abnormalities and neck pain. A total of 28 patients were treated for the first time, while 5 patients had prior posterior fusion. The mean distance of the tip of the dens above the chamberlain line was 8.9 ± 4.2 mm, while the mean anterior atlantodental interval was 6.5 ± 2.1 mm. Seven patients had an anomalous course of vertebral artery on at least one side. A total of 28 patients improved significantly, while 5 patients did not improve at the follow-up. The mean follow-up was 8.5 months ±6.3 (mean ± standard deviation). The mean Nurick and Modified Japanese Orthopedic Association scores improved postoperatively (P < 0.05). Three patients underwent reoperation including one with vertebral artery injury. Three patients underwent tracheostomy.
CONCLUSIONS
With proper patient selection, transoral odontoidectomy can be safely performed in a limited-resource setting.
Topics: Adult; Atlanto-Axial Joint; Decompression, Surgical; Female; Humans; Joint Dislocations; Male; Platybasia; Retrospective Studies; Spinal Fusion; Young Adult
PubMed: 35700863
DOI: 10.1016/j.wneu.2022.06.024 -
Spine May 2014This study evaluates a series of consecutive endoscopic endonasal odontoidectomies performed since 2008 in our center.
STUDY DESIGN
This study evaluates a series of consecutive endoscopic endonasal odontoidectomies performed since 2008 in our center.
OBJECTIVE
The aim of the study was to analyze the outcome and the surgical technique to enlighten advantages and limitations of this procedure.
SUMMARY OF BACKGROUND DATA
Odontoidectomy represents the treatment of choice in selected cases of basilar invagination. Transoral-transpharyngeal odontoidectomy is the "gold standard" and more experienced technique. Recently, the endoscopic endonasal approach has been proposed as an alternative route.
METHODS
All patients underwent a pre- and postoperative evaluation of neurological status using physical neurological examination, assessment of American Spinal Injury Association impairment scale score, and neurophysiological investigations. Pre- and postoperative neuroradiological examinations consisted of magnetic resonance imaging, computed tomography, and radiography in flexion and extension. Surgical complications, time of orotracheal extubation and of resumption of oral feeding after surgery were considered, basing on medical records.
RESULTS
The series is composed of 5 cases. All cases presented a progressive tetraparesis despite a posterior occipitocervical arthrodesis. Two patients presented with irreducible atlantoaxial subluxation in Down syndrome, whereas the others presented with an atlanto-occipital malformation with platybasia and basilar invagination. No complications were observed. In all except one case, orotracheal intubation was removed immediately at the end of surgery. Oral feeding was resumed 1 day after surgery in all but one case that initially required an orogastric tube. At follow-up (mean: 34.2 mo; range: 3-57 mo), neurological symptoms have been shown to improve in 2 cases and stabilization, arresting the neurological worsening, in 3 cases.
CONCLUSION
Endoscopic endonasal odontoidectomy resulted in a safe, effective, and well-tolerated procedure. From our experience, we conclude that the different approaches for odontoidectomy should be considered to be complementary rather than alternative: the endonasal endoscopic can be advantageous in selected cases presenting some anatomical conditions related (micrognathia and macroglossia) to the oral cavity and to high position of the odontoid.
Topics: Adult; Child; Decompression, Surgical; Endoscopy; Female; Humans; Male; Middle Aged; Odontoid Process; Platybasia; Retrospective Studies; Treatment Outcome
PubMed: 24525988
DOI: 10.1097/BRS.0000000000000271 -
Anales de La Facultad de Medicina,... Sep 1950
Topics: Humans; Nervous System Diseases; Occipital Bone; Platybasia; Syringomyelia
PubMed: 14829836
DOI: No ID Found -
Neurology India 2022
Topics: Atlanto-Axial Joint; Humans; Platybasia
PubMed: 36076712
DOI: 10.4103/0028-3886.355162 -
Journal of Neuroradiology = Journal de... Jan 2022This study aims to determine the reliability of the radiological tests used in the diagnosis of basilar invagination (BI).
OBJECTIVES
This study aims to determine the reliability of the radiological tests used in the diagnosis of basilar invagination (BI).
METHODS
Patients diagnosed with type B basilar invagination, who had both magnetic resonance (MR) and computed tomography (CT) imaging between January 2014 and November 2019 were included in this retrospective reliability study. In this study, distance from odontoid apex to Chamberlain's line (OA-CL) was accepted as a reference method for the diagnosis. Forty-two BI cases and 79 controls were included. Three radiologists with different levels of experience individually evaluated OA-CL, Boogard's angle (BoA), clivo-axial angle (CXA), clivo-dens angle (CDA), and clivo-palate angle (CPA) on midsagittal CT and MR images. Statistical analysis was made with the intraclass correlation coefficient (ICC), t-test, and receiver operating characteristic (ROC) curve.
RESULTS
The ICC for CT and MR were; 0.977-0.973 (OA-CL), 0.912-0.882 (BoA), 0.845-0.846 (CXA), 0.862-0.864 (CDA), and 0.762-0.747 (CPA) respectively (P < 0.001). The areas under the ROC curve were 0.977 (BoA), 0.832 (CXA), 0.852 (CDA), and 0.719 (CPA) (P < 0.001). The cut-off measures were ≥137.84° (BoA), ≤149.25° (CXA), ≤129.58° (CDA), and ≤61.83° (CPA). The diagnostic accuracies were 0.954 (BoA), 0.664 (CXA), 0.704 (CDA), 0.438 (CPA) (P < 0.001).
CONCLUSIONS
OA-CL and BoA express excellent inter-rater agreement than CXA, CDA, and CPA, which are limited due to morphological variations and head spatial position. BoA is the second most reliable diagnostic test. CXA, CDA, should only be used for complementary information. CPA was found inadequate for the diagnosis of BI..
Topics: Humans; Magnetic Resonance Imaging; Platybasia; Radiography; Reproducibility of Results; Retrospective Studies
PubMed: 32926897
DOI: 10.1016/j.neurad.2020.08.005 -
British Journal of Neurosurgery Dec 2023Sleep apnoea is common in patients with Basilar Invagination with Arnorld Chiari Malformation (ACM). Various studies have shown its incidence in the range of 60-70%... (Review)
Review
Sleep apnoea is common in patients with Basilar Invagination with Arnorld Chiari Malformation (ACM). Various studies have shown its incidence in the range of 60-70% among such patients. Most of the studies have shown improvement in sleep disturbances after decompressive surgeries for Chiari Malformations. There is no report of postoperative deterioration due to sleep apnoea in these patients. Authors report two cases of basilar invagination associated with ACM and Platybasia, who deteriorated probably due to worsening of pre-existing sleep disorders on 3rd and 7th postoperative days after their surgeries, despite clinico-radiological improvements during their early post-operative courses. Authors discuss literature related to sleep apnoea in basilar invagination associated with Chiari Malformations and share precautions, which are relevant and should be undertaken in such patients especially during early post-operative periods to avoid alarming complication which may occur even in experienced hands.
Topics: Humans; Platybasia; Arnold-Chiari Malformation; Sleep Apnea Syndromes; Decompression, Surgical; Sleep
PubMed: 34251945
DOI: 10.1080/02688697.2021.1947981 -
World Neurosurgery Jul 2023In this third article in a 3-article series on the craniocervical junction, we define the terms "basilar impression," "cranial settling," "basilar invagination," and...
In this third article in a 3-article series on the craniocervical junction, we define the terms "basilar impression," "cranial settling," "basilar invagination," and "platybasia," noting that these terms are often used interchangeably but represent distinct entities. We then provide examples that represent these pathologies and treatment paradigms. Finally, we discuss the challenges and future direction in the craniovertebral junction surgery space.
Topics: Humans; Platybasia; Skull; Decompression, Surgical
PubMed: 36990348
DOI: 10.1016/j.wneu.2023.03.098