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World Neurosurgery Feb 2021Malformations in the craniocervical junction (CCJ) are rare in the pediatric population but often need surgical treatment. We present a pediatric case series of patients... (Review)
Review
Two-Stage Approach for Unstable Pediatric Craniocervical Junction Anomalies with a Halo Vest and Delayed Occipitocervical Fusion: Technical Note, Case Series, and Literature Review.
OBJECTIVE
Malformations in the craniocervical junction (CCJ) are rare in the pediatric population but often need surgical treatment. We present a pediatric case series of patients treated with a 2-stage surgical approach with a halo vest and occipitocervical fusion and review complications and outcomes.
METHODS
A retrospective analysis of a single-center case series was performed. Pediatric patients affected by congenital craniocervical junction anomalies and treated with a 2-stage approach were included. A halo vest was implanted in the first surgery, and ambulatory progressive reduction was performed. When a favorable anatomic situation was observed, arthrodesis was performed. Safety analysis was undertaken by analyzing the incidence of complications in both procedures. Effectivity analysis was carried out analyzing radiologic and clinical outcome (Goel grade and modified Japanese Orthopaedic Association score). Student t test was used for statistical analysis.
RESULTS
Sixteen cases were included. Mean age of patients was 9.38 years. Safety analysis showed 2 halo loosenings, 1 pin infection, 2 wound infections, 1 cerebrospinal fluid leak, and 2 delayed broken rods. No major complications were observed. Radiologic analysis showed an improvement in the tip of the odontoid process to the McRae line distance (from -3.26 mm to -6.16 mm), atlantodental interval (from 3.05 mm to 1.88 mm), clival-canal angle (from 134.61° to 144.38°), and cervical kyphosis (from 6.39° to 1.54°). Clinical analysis also showed improvement in mean Goel grade (from 1.75 to 1.44) and modified Japanese Orthopaedic Association score (from 15.12 to 16.41).
CONCLUSIONS
The 2-stage approach was a suitable and effective treatment for craniocervical junction anomalies in pediatric patients.
Topics: Adolescent; Arthrodesis; Atlanto-Axial Joint; Atlanto-Occipital Joint; Child; Child, Preschool; Craniofacial Abnormalities; External Fixators; Female; Humans; Joint Instability; Male; Neck Pain; Occipital Bone; Odontoid Process; Platybasia; Postoperative Complications; Traction; Treatment Outcome
PubMed: 33227530
DOI: 10.1016/j.wneu.2020.11.079 -
BMC Musculoskeletal Disorders Nov 2020The revision surgery of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) after a previous occipitocervical fusion (OCF) is challenging....
BACKGROUND
The revision surgery of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) after a previous occipitocervical fusion (OCF) is challenging. Transoral revision surgery has more advantages than a combined anterior and posterior approach in addressing this pathology. The C-JAWS is a cervical compressive staple that has been used in the lower cervical spine with many advantages. Up to now, there is no report on the application of C-JAWS in the atlantoaxial joint. We therefore present this report to investigate the clinical outcomes of transoral intraarticular cage distraction and C-JAWS fixation for revision of BI with IAAD.
METHODS
From June 2011 to June 2015, 9 patients with BI and IAAD were revised by this technique after previous posterior OCF in our department. Plain cervical radiographs, computed tomographic scans and magnetic resonance imaging were obtained pre- and postoperatively to assess the degree of atlantoaxial dislocation and compression of the cervical cord. The Japanese Orthopedic Association (JOA) score was used to evaluate the neurological function.
RESULTS
The revision surgeries were successfully performed in all patients. The average follow-up duration was 18.9 ± 7.3 months (range 9-30 months). The postoperative atlas-dens interval (ADI), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and JOA score were significantly improved in all patients (P < 0.05). Bony fusion was achieved after 3-9 months in all cases. No patients developed recurrent atlantoaxial instability.
CONCLUSIONS
Transoral revision surgery by intraarticular cage distraction and C-JAWS fixation could provide a satisfactory outcome for BI with IAAD after a previous unsuccessful posterior operation.
Topics: Atlanto-Axial Joint; Decompression, Surgical; Humans; Jaw; Joint Dislocations; Platybasia; Spinal Fusion; Treatment Outcome
PubMed: 33218335
DOI: 10.1186/s12891-020-03792-3 -
Surgical Neurology International 2020Atlanto-occipital dislocation (AOD) is a rare, highly morbid, and highly lethal injury that results from high-energy trauma and almost universally requires operative...
Successful non-operative management for atlanto-occipital dislocation resulting in spinal cord contusion in a patient with atlanto-occipital assimilation and severe Chiari I malformation.
BACKGROUND
Atlanto-occipital dislocation (AOD) is a rare, highly morbid, and highly lethal injury that results from high-energy trauma and almost universally requires operative management for satisfactory outcomes. It can be difficult to identify the severity of injury at the time of presentation, and when diagnosis is delayed outcomes worsen significantly. Anatomic anomalies of the craniovertebral junction may further complicate its detection. When such anomalies are present either singly or in combination, they are known to cause space constraints which may increase the likelihood of spinal cord injury. Given that such anomalies and AOD are rare, few examples of patients with both are reported in the literature. Furthermore, it is not clear in what way patient management may be impacted in this context.
CASE DESCRIPTION
We will present a unique case of an 18-year-old patient with traumatic AOD and an intact neurologic examination who was found to have atlanto-occipital assimilation (AOA), platybasia, basilar invagination, and severe Chiari I malformation, who was treated effectively with non-operative management.
CONCLUSION
Our case demonstrates the successful application of a non-operative treatment strategy in a carefully selected patient with AOD in the context of AOA.
PubMed: 33194272
DOI: 10.25259/SNI_419_2020 -
Neurosciences (Riyadh, Saudi Arabia) Aug 2020To assess the correlation between craniovertebral junction (CVJ) abnormalities and syringomyelia in patients with Chiari malformation type-1 (CM1).
OBJECTIVE
To assess the correlation between craniovertebral junction (CVJ) abnormalities and syringomyelia in patients with Chiari malformation type-1 (CM1).
METHODS
This was a retrospective study including patients with CM1. Identification of cases was done by searching a radiology database at a university hospital from 2012 to 2017. Patients were divided into 2 groups based on whether CVJ abnormalities were present (CVJ+) or absent (CVJ-). The patients` demographic and clinical data were reviewed. All magnetic resonance imaging studies were examined by a certified neuroradiologist.
RESULTS
Sixty-four consecutive patients with CM1 were included. The mean age was 24+/-17 years; 59% were females. The CVJ+ group had more female patients (p=0.012). The most frequent CVJ abnormality was platybasia (71%), followed by short clivus (44%) and cervical kyphosis (33%). The CVJ abnormalities were more in Syringomyelia cases (p=0.045). However, the results were not significant when hydrocephalus cases were excluded.
CONCLUSION
Among CM1 patients, CVJ abnormalities were found more in patients with syringomyelia. Future studies with larger sample size are required to further study the correlation between CVJ abnormalities and both syringomyelia and hydrocephalus in CM1 patients.
Topics: Adult; Arnold-Chiari Malformation; Atlanto-Occipital Joint; Female; Humans; Male; Retrospective Studies; Syringomyelia; Young Adult
PubMed: 33130812
DOI: 10.17712/nsj.2020.4.20200008 -
World Neurosurgery Feb 2021To evaluate the results of surgery for congenital craniovertebral junction (CVJ) anomalies with atlantoaxial dislocation (AAD)/basilar invagination (BI) and compare the...
OBJECTIVE
To evaluate the results of surgery for congenital craniovertebral junction (CVJ) anomalies with atlantoaxial dislocation (AAD)/basilar invagination (BI) and compare the results of transoral odontoidectomy and posterior fusion (TOO+PF) with only posterior fusion (PF) in patients with irreducible AAD/BI.
METHODS AND RESULTS
All 94 patients with congenital CVJ anomalies with AAD/BI operated on during the 3-year study period (June 2013-May 2016) were included. Of these patients, 55 had irreducible AAD/BI and the remaining 39 had reducible AAD/BI. TOO+PF was restricted to patients (34/94; 36.2%) with irreducible AAD/BI when reduction and realignment by intraoperative C1-C2 facet joint manipulation were considered technically difficult and risky. The remaining patients with irreducible AAD/BI and all the patients with reducible AAD/BI (60/94; 63.8%) were managed with only posterior fusion. Poor preoperative Nurick grade, preoperative dyspnea/lower cranial nerve deficits, and syringomyelia were associated with significantly higher incidence of postoperative pulmonary complications. Follow-up ≥3 months (final follow-up) was available for 87 patients. Good outcome (Nurick grade 0-3) at final follow-up was noted in 90% (45/50) of the patients with irreducible AAD/BI and 91.9% (34/37) of the patients with reducible AAD/BI. Preoperative poor Nurick grade (4-5) was the only factor associated with poor outcome. No significant difference in perioperative complications, outcome, and fusion was noted between patients who underwent TOO+PF or only PF for irreducible AAD/BI.
CONCLUSIONS
Many of the patients with congenital AAD/BI showed remarkable recovery after surgery. Preoperative poor Nurick grade (4-5) is associated with poor outcome. TOO+PF is a safe alternative treatment option for irreducible AAD/BI when only PF techniques are technically difficult/risky.
Topics: Adolescent; Adult; Aged; Atlanto-Axial Joint; Cervical Vertebrae; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Joint Dislocations; Male; Middle Aged; Odontoid Process; Platybasia; Preoperative Care; Retrospective Studies; Spinal Fusion; Treatment Outcome; Young Adult
PubMed: 33096283
DOI: 10.1016/j.wneu.2020.10.082 -
European Spine Journal : Official... Feb 2021To compare clinical effect and safety between posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To compare clinical effect and safety between posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) in treatment of Chiari type I malformation and basilar impression.
METHODS
A comprehensive computer search was conducted from 2000 to 2019. The quality assessment was performed by the QUADAS-2 tool. The clinical value of comparison between PFDD and PFD was evaluated by using the pooled estimate of sensitivity and specificity. In addition, sensitivity analysis and bias analysis were applied to ensure the accuracy of the results.
RESULTS
Finally, 468 patients were enrolled in 6 studies and ultimately met the eligibility criteria. The PFDD and PFD groups were 282 and 186, respectively. The meta-analysis showed no significant difference in the Chicago Chiari Outcome Scale (COSS score) (MD = 0.14, 95% CI [-0.23, 0.50], P = 0.47; P = heterogeneity = 0.86, I = 0%). Meanwhile, Significant difference existed in length of stay (MD = -1.08, 95% CI [-1.32, -0.84], P = 0.001; heterogeneity P < 0.000001, I = 85%) and complications (OR = 0.35, 95%CI [0.20, 0.62], P = 0.0003; P for Heterogeneity = 0.04, I = 56%).
CONCLUSION
PFD is a more efficient and safer therapy than PFDD in the treatment of Chiari type I malformation with basilar impression.
Topics: Arnold-Chiari Malformation; Cranial Fossa, Posterior; Decompression, Surgical; Dura Mater; Humans; Platybasia; Retrospective Studies; Treatment Outcome
PubMed: 33091143
DOI: 10.1007/s00586-020-06643-w -
Radiologia Brasileira 2020The present study aims to perform a reproducibility study of the clivus-canal angle (CCA), Welcker's basal angle (WBA), and the distance from the odontoid process to...
OBJECTIVE
The present study aims to perform a reproducibility study of the clivus-canal angle (CCA), Welcker's basal angle (WBA), and the distance from the odontoid process to Chamberlain's line (DOCL) on magnetic resonance imaging (MRI).
MATERIALS AND METHODS
Two medical students and two radiologists respectively evaluated 100 and 50 consecutive MRI scans of adult skulls, selected randomly. Each examiner, working independently and blinded to the previous results, performed readings for each patient on two different occasions. Measurements were performed in T1-weighted sequences acquired in the midsagittal plane. The levels of intraobserver reproducibility and interobserver agreement were evaluated by calculating the intraclass correlation coefficients (ICCs) and the corresponding 95% confidence intervals.
RESULTS
The mean values obtained by the examiners were 150º for the CCA, 130º for the WBA, and 2.5 mm for the DOCL. The ICC for interobserver agreement was 0.980, 0.935, and 0.967, for the CCA, WBA, and DOCL, respectively, for the students, compared with 0.977, 0.941, and 0.982, respectively, for the radiologists, and 0.980, 0.992, and 0.990, respectively, for all of the examiners together. In the analysis of intraobserver agreement, the ICC ranged from 0.929 to 0.959 for the CCA, from 0.918 to 0.964 for the WBA, and from 0.918 to 0.981 for the DOCL.
CONCLUSION
The measurement of the CCA, WBA, and DOCL appears to show excellent intraobserver reproducibility and interobserver agreement on MRI.
PubMed: 33071375
DOI: 10.1590/0100-3984.2019.0068 -
European Journal of Radiology Nov 2020
Topics: Humans; Magnetic Resonance Imaging; Platybasia; Radiography; Radiology
PubMed: 32950798
DOI: 10.1016/j.ejrad.2020.109280 -
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 -
Acta Neurochirurgica Nov 2020
Topics: Arnold-Chiari Malformation; Humans; Joint Instability; Platybasia
PubMed: 32895771
DOI: 10.1007/s00701-020-04557-6