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Journal of Neurosurgery. Pediatrics Jun 2024The purpose of this study was to identify factors associated with fusion success among pediatric patients undergoing occiput-C2 rigid instrumentation and fusion.
OBJECTIVE
The purpose of this study was to identify factors associated with fusion success among pediatric patients undergoing occiput-C2 rigid instrumentation and fusion.
METHODS
The Pediatric Spine Study Group registry was queried to identify patients ≤ 21 years of age who underwent occiput-C2 posterior spinal rigid instrumentation and fusion and had a 2-year minimum clinical and radiographic (postoperative lateral cervical radiograph or CT scan) follow-up. Fusion failure was defined clinically if a patient underwent hardware revision surgery > 30 days after the index procedure or radiographically by the presence of hardware failure or screw haloing on the most recent follow-up imaging study. Univariate comparisons and multivariable logistic regression analyses were subsequently performed.
RESULTS
Seventy-six patients met inclusion criteria. The median age at surgery was 9 years (range 1.5-17.2 years), and 51% of the cohort was male. Overall, 75% of patients had syndromic (n = 41) or congenital (n = 15) etiologies, with the most frequent diagnoses of Down syndrome (28%), Chiari malformation (13%), and Klippel-Feil syndrome (12%). Data were available to determine if there was a fusion failure in 97% (74/76) of patients. Overall, 38% (28/74) of patients had fusion failure (95% CI 27%-50%). Univariate analysis demonstrated that use of a rigid cervical collar postoperatively (p = 0.04) and structural rib autograft (p = 0.02) were associated with successful fusion. Multivariable logistic regression analysis determined that patients who had rib autograft used in surgery had a 73% decrease in the odds of fusion failure (OR 0.27, 95% CI 0.09-0.82; p = 0.02). Age, etiology including Down syndrome, instrumentation type, unilateral instrumentation, use of recombinant human bone morphogenetic protein, and other variables did not influence the risk for fusion failure.
CONCLUSIONS
In this multicenter, multidisciplinary, international registry of children undergoing occiput-C2 instrumentation and fusion, fusion failure was seen in 38% of patients, a higher rate than previously reported in the literature. The authors' data suggest that postoperative immobilization in a rigid cervical collar may be beneficial, and the use of structural rib autograft should be considered, as rib autograft was associated with a 75% higher chance of successful fusion.
Topics: Humans; Male; Child; Spinal Fusion; Female; Adolescent; Child, Preschool; Infant; Ribs; Cervical Vertebrae; Treatment Outcome; Autografts; Occipital Bone; Retrospective Studies; Bone Transplantation; Registries; Follow-Up Studies
PubMed: 38518281
DOI: 10.3171/2024.1.PEDS23419 -
No Shinkei Geka. Neurological Surgery Mar 2024The craniovertebral junction not only contains anatomically important structures such as the medulla oblongata, upper cervical spinal cord, and vertebral artery, but...
The craniovertebral junction not only contains anatomically important structures such as the medulla oblongata, upper cervical spinal cord, and vertebral artery, but also controls the dynamic movements of flexion, extension, and rotation of the head and neck. Consequently, instability and spinal deformities can easily occur in the craniovertebral region, and appropriate treatment should be selected based on the specificity of the lesion. Basilar invagination often involves bone and vascular anomalies and fusion surgery is often required. Therefore, careful pre-operative simulations are necessary. The creation and use of three-dimensional bone models, including image navigation, are useful for surgical simulation.
Topics: Humans; Atlanto-Occipital Joint; Spinal Fusion; Neurosurgical Procedures; Vertebral Artery; Decompression, Surgical; Cervical Vertebrae
PubMed: 38514132
DOI: 10.11477/mf.1436204927 -
World Neurosurgery May 2024This study aimed to examine the mechanism of occipital condyle fractures (OCFs), their clinical symptoms, computer tomography (CT) scan findings, treatment options, and...
OBJECTIVE
This study aimed to examine the mechanism of occipital condyle fractures (OCFs), their clinical symptoms, computer tomography (CT) scan findings, treatment options, and classification.
METHODS
A retrospective analysis was conducted on 43 patients with OCFs who were admitted to our neurosurgery center between 2017 and 2023.
RESULTS
The investigation covered their clinical symptoms, CT scan results, and treatment outcomes. It was found that 25.6% of the patients suffered from severe craniocerebral injuries with Glasgow Coma Scale (GCS) scores of 3-8 points, 9.3% had moderate injuries with GCS scores of 9-12 points, and 65.1% exhibited mild injuries with GCS scores of 13-15 points. Of these patients, 90.7% showed improvement upon discharge, 4.7% succumbed to their injuries, and another 4.7% developed paraplegia. Symptoms indicative of OCF in individuals with CCJ injuries included neck pain, swelling, cranial nerve palsy, and posterior pharyngeal wall swelling. Frequently observed complications in OCF patients included cerebral contusion, occipital bone fractures, and skull base fractures. Employing thin-layer CT scans of the CCJ area, along with sagittal and coronal CT reconstructions, is essential for identifying OCFs. The fractures were classified into 3 types based on the Anderson-Montesano classification, which, when modified, provides enhanced treatment guidance.
CONCLUSIONS
OCFs are predominantly present in cases of high-energy trauma, with high-resolution thin-layer CT scans serving as the preferred diagnostic method. The application of the modified Anderson-Montesano classification, distinguishing between stable and unstable fractures, facilitates the determination of suitable treatment strategies. Stable OCFs can be managed using a rigid neck brace, while unstable OCFs may require Halo-vest frame fixation or surgical intervention.
Topics: Humans; Retrospective Studies; Male; Female; Adult; Middle Aged; Occipital Bone; Young Adult; Adolescent; Aged; Tomography, X-Ray Computed; Skull Fractures; Glasgow Coma Scale; Treatment Outcome
PubMed: 38490441
DOI: 10.1016/j.wneu.2024.03.027 -
Healthcare (Basel, Switzerland) Feb 2024Injuries to humans caused by wild animals, particularly bears, are rarely mentioned in the literature. Such injuries are frequent in Siberia, which is a territory...
Injuries to humans caused by wild animals, particularly bears, are rarely mentioned in the literature. Such injuries are frequent in Siberia, which is a territory surrounded by dense forests inhabited by brown bears. In the last 4 months alone (September-December 2023), four bear attacks on humans were registered in Khakassia, Russia. This article presents a clinical case of rehabilitating a patient after a bear attack, who suffered multiple fragmentary fractures of the facial skeleton with displaced bone fragments, subcutaneous emphysema of the soft tissues of the face, damage to the parietal and right occipital regions and paranasal sinus hemorrhage on the left side. The nature of the injuries was enhanced by trauma to the upper extremity caused by the patient defending himself against the animal. In addition to the damage to his face, the bear tried to open his cranium, as evidenced by four furrows caused by its canines, including two each on the frontal and occipital bones of the skull. The patient's complex treatment included both maxillofacial and reconstructive surgeries, and outpatient treatment involved the formation of normotrophic scars using a neodymium laser and injections of a heterogeneous composition consisting of microparticles of "crosslinked" collagen of animal origin placed in a gel identical to the natural extracellular matrix.
PubMed: 38470653
DOI: 10.3390/healthcare12050542 -
Journal of Neurosurgery. Case Lessons Mar 2024Iniencephaly is a rare neural tube defect (NTD) characterized by deformities in the occiput and inion, along with rachischisis in the cervical and thoracic spine,...
BACKGROUND
Iniencephaly is a rare neural tube defect (NTD) characterized by deformities in the occiput and inion, along with rachischisis in the cervical and thoracic spine, resulting in the head appearing in retroflexion.
OBSERVATIONS
This report details the case of a female newborn who underwent surgery for an encephalocele. She survived up to 6 months, exhibiting good overall health, although she displayed physical abnormalities, including facial deformity, a short neck, and minor spasms in all limbs. Both cardiovascular and abdominal assessments remained stable, and imaging revealed defects in the occipital bone, a large cephalocele, and spinal dysraphism.
LESSONS
Although iniencephaly is generally incompatible with life, a few cases have been reported otherwise. Our patient, one of these notable exceptions, remains alive at 6 months old, possibly due to the lack of major vascular deformities. However, she does exhibit significant psychomotor retardation.
PubMed: 38467043
DOI: 10.3171/CASE2414 -
Scientific Reports Mar 2024The lesser occipital nerve (LON) has one of the most variations among occipital nerves. We aimed to investigate morphological and morphometric features of LON. A total...
The lesser occipital nerve (LON) has one of the most variations among occipital nerves. We aimed to investigate morphological and morphometric features of LON. A total of 24 cadavers, 14 males (58%) and 10 females (42%), were dissected bilaterally. LON was classified into 3 types. The number of branches and the perpendicular distances of the point where LON emerged from the posterior border of sternocleidomastoid muscle to vertical and transverse lines passing through external occipital protuberance were determined. The shortest distance between LON and great auricular nerve (GAN), and linear distance of LON to its branching point were measured. The most common variant was Type 1 (30 sides, 62.5%), followed by Type 2 (12 sides, 25%) and Type 3 (6 sides, 12.5%), respectively. In males, Type 1 (22 sides, 78.6%) was the most common, while Type 1 (8 sides, 40%) and Type 2 (8 sides, 40%) were equally common and the most common in females. On 48 sides, 2-9 branches of LON were observed. The perpendicular distance of said point to vertical and transverse lines was meanly 63.69 ± 11.28 mm and 78.83 ± 17.21 mm, respectively. The shortest distance between LON and GAN was meanly 16.62 ± 10.59 mm. The linear distance of LON to its branching point was meanly 31.24 ± 15.95 mm. The findings reported in this paper may help clinicians in estimating the location of the nerve and/or its branches for block or decompression surgery as well as preservation of LON during related procedures.
Topics: Male; Female; Humans; Clinical Relevance; Peripheral Nerves; Occipital Bone; Neck Muscles; Cadaver
PubMed: 38462647
DOI: 10.1038/s41598-024-55648-8 -
Journal of Zoo and Wildlife Medicine :... Mar 2024Two female (FL 1, FL 2) and one male (ML) 11-wk-old, intact, captive African lion cubs () were presented with a history of mild vestibular signs. Initial serum vitamin A...
Two female (FL 1, FL 2) and one male (ML) 11-wk-old, intact, captive African lion cubs () were presented with a history of mild vestibular signs. Initial serum vitamin A concentrations were low (140 nmol/L) for ML. Calvarial hyperostosis was confirmed using computed tomography (CT) of the head and cervical vertebrae in each cub. CT measurements were adapted in relation to the skull width. ML showed the most pronounced thickening of the tentorium cerebelli and occipital bone, represented by a tentorium cerebelli to skull width ratio (TCR) of 0.08 (FL 1: 0.06, FL 2: 0.05) and a basisphenoid to skull width ratio (BBR) of 0.07 (FL 1: 0.06, FL 2: 0.04). Magnetic resonance imaging (MRI) revealed cerebellar herniation and cervical intramedullary T2-weighted hyperintensity from C1, extending caudally for at least two cervical vertebrae in all cubs. Treatment was initiated with subcutaneous vitamin A supplementation and feeding of whole carcasses. Improvement in ataxia was noticed 3 wk later. Follow-up CT and MRI examinations were performed in ML after 3 and 8 mon. The affected bones appeared slightly less thickened and TCR and BBR had decreased to 0.05 after 3 mon. The cerebellum remained mildly herniated, accompanied by amelioration of cervical T2w hyperintensities. After 8 mon, evaluation and diagnostic imaging revealed further improvement regarding the neurologic status and measurements (TCR 0.05, BBR 0.04) despite persistence of a subtle cerebellar herniation. In conclusion, bone remodeling and improvement in clinical signs may be achievable in young lion cubs presented with calvarial hyperostosis and may be attributable to high-dose vitamin A supplementation.
Topics: Male; Female; Animals; Vitamin A; Lions; Vitamin A Deficiency; Encephalocele; Dietary Supplements; Receptors, Antigen, T-Cell; Hyperostosis; Craniofacial Abnormalities
PubMed: 38453512
DOI: 10.1638/2021-0107 -
Veterinary Medicine and Science Mar 2024An 11-year-old, female-neutered beagle was presented with a growing soft tissue mass arising within the deep tissues of the left cranial cervical region. At... (Review)
Review
An 11-year-old, female-neutered beagle was presented with a growing soft tissue mass arising within the deep tissues of the left cranial cervical region. At presentation, facial asymmetry was evident along with palpable lymphadenomegaly. Magnetic resonance imaging demonstrated a locally invasive cervical mass with intracranial invasion through focal osteolysis of the occipital bone. After antihistamine administration, cytology confirmed mast cell tumour (MCT) with metastasis to local lymph nodes and liver. The owner chose to pursue lomustine and prednisolone, which were dispensed, but, before home administration, prolonged seizures/status epilepticus occurred prompting euthanasia. Postmortem examination confirmed a high-grade MCT associated with, and infiltrating through, muscle, calvarium, dura mata, leptomeninges and the underlying brain. We present the clinical, imaging, and pathological findings of an unprecedented case of extracranial MCT tumour causing osteolysis of an imperforate flat bone (occipital bone) and intracranial invasion.
Topics: Female; Animals; Dogs; Mast Cells; Osteolysis; Brain; Liver; Neoplasms; Dog Diseases
PubMed: 38450948
DOI: 10.1002/vms3.1402