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European Spine Journal : Official... Sep 2008Chiari I malformations are often associated with congenital craniocervical anomalies such as platybasia, basilar invagination, and retroflexion of the odontoid process....
Chiari I malformations are often associated with congenital craniocervical anomalies such as platybasia, basilar invagination, and retroflexion of the odontoid process. Management of ventral brain stem compression associated with Chiari I malformations remains controversial, but several authors report a significant rate of failure with suboccipital decompression alone in the presence of pronounced ventral brain stem compression (VBSC). Treatment options described in the literature for these patients involve anterior, posterior, or combined decompressions with or without concurrent arthrodesis. A combined anterior and posterior approach provides a definitive circumferential decompression but also significantly disrupts the stability of the occipitocervical junction usually necessitating occipitocervical fixation. We describe an alternative surgical treatment for Chiari I patients with significant ventral brain stem compression where a combined anterior and posterior decompression was considered necessary. We report two patients who underwent transoral odontoidectomy with preservation of the anterior arch of the atlas and suboccipital craniectomy with C1 laminectomy followed by C1-C2 arthrodesis. Preservation of the anterior arch of the atlas in conjunction with C1-C2 arthrodesis stabilizes the occipito-atlanto-axial segments while conserving more cervical mobility as compared to an occipitocervical fusion.
Topics: Adolescent; Adult; Arnold-Chiari Malformation; Atlanto-Axial Joint; Atlanto-Occipital Joint; Brain Stem; Cervical Vertebrae; Female; Humans; Laminectomy; Odontoid Process; Radiography; Skull; Spinal Cord Compression; Spinal Fusion
PubMed: 18629549
DOI: 10.1007/s00586-008-0706-x -
Arquivos de Neuro-psiquiatria Jun 2008The Chiari malformation (CM) is characterized by variable herniation of one or both cerebellar tonsils, associated or not with displacement of the hindbrain structures...
The Chiari malformation (CM) is characterized by variable herniation of one or both cerebellar tonsils, associated or not with displacement of the hindbrain structures into the vertebral canal. This is a retrospective study of 29 patients with CM submitted to surgical procedure between 1990 and 2003. There were 14 females and 15 males whose ages ranged from 16 to 65 years. There were seven patients with isolated CM, 12 associated with syringomyelia (SM), three associated with basilar impression (BI) and seven associated with SM and BI. The surgery was based on posterior fossa decompression. In seven patients a catheter was introduced from the subarachnoid space into the III ventricle and five were submitted to tonsillectomy. Twenty-one patients improved, one worsened, one remained unchanged, four missed follow up and two died. We conclude that the best results with CM surgery are obtained by an effective posterior fossa decompression. Those CM cases associated with other abnormalities, such as SM and BI, probably need complementary techniques which will be the theme for new prospective studies.
Topics: Adolescent; Adult; Aged; Arnold-Chiari Malformation; Craniotomy; Decompression, Surgical; Female; Humans; Male; Middle Aged; Platybasia; Retrospective Studies; Syringomyelia; Tonsillectomy; Treatment Outcome
PubMed: 18545779
DOI: 10.1590/s0004-282x2008000200008 -
American Journal of Medical Genetics.... May 2008
Topics: Adolescent; Brain; Codon, Nonsense; Contractile Proteins; Female; Filamins; Human Growth Hormone; Humans; Microfilament Proteins; Platybasia; Spine; Syndrome; Synostosis
PubMed: 18386804
DOI: 10.1002/ajmg.a.32303 -
Arquivos de Neuro-psiquiatria Dec 2007The transoral approach provides a safe exposure to lesions in the midline and the ventral side of the craniovertebral junction. The advantages of the transoral approach...
The transoral approach provides a safe exposure to lesions in the midline and the ventral side of the craniovertebral junction. The advantages of the transoral approach are 1) the impinging bony pathology and granulation tissue are accessible only via the ventral route; 2) the head is placed in the extended position, thus decreasing the angulation of the brainstem during the surgery; and 3) surgery is done through the avascular median pharyngeal raphe and clivus. We analyzed the clinical effects of odontoidectomy after treating 38 patients with basilar invagination. The anterior transoral operation to treat irreducible ventral compression in patients with basilar invagination was performed in 38 patients. The patients ages ranged from 34 to 67 years. Fourteen patients had associated Chiari malformation and eight had previously undergone posterior decompressive surgery. The main indication for surgery was significant neurological deterioration. Symptoms and signs included neck pain, myelopathy, lower cranial nerve dysfunction, nystagmus and gait disturbance. Extended exposure was performed in 24 patients. The surgery was beneficial to the majority of patients. There was one death within 10 days of surgery, due to pulmonary embolism. Postoperative complications included two cases of pneumonia, three cases of oronasal fistula with regurgitation and one cerebrospinal fluid leak. In patients with marked ventral compression, the transoral approach provides direct access to the anterior face of the craniovertebral junction and effective means for odontoidectomy.
Topics: Adult; Aged; Arnold-Chiari Malformation; Decompression, Surgical; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mouth; Odontoid Process; Platybasia; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 18345423
DOI: 10.1590/s0004-282x2007000700014 -
Neurology India 2008A 20-year-old male had torticollis and short neck since birth. He presented with symptom of progressive quadriparesis over a two-year period. Investigations revealed...
A 20-year-old male had torticollis and short neck since birth. He presented with symptom of progressive quadriparesis over a two-year period. Investigations revealed basilar invagination with marked rotation in the craniovertebral region and relatively large C3-4 region osteophytes. Serial MRI over two years showed persistent signal opposite C3-4 disc space suggestive of cord compression. Although the cord was humped over the odontoid process, there was no clear radiological evidence that the cord was compromised at this level. During surgery, instability was identified only at the craniovertebral region and not at the level of C3-4. Distraction of the lateral masses of atlas and axis and fixation using interarticular spacers and bone graft and direct screw implantation in the lateral mass of the atlas and pars of the axis resulted in reduction of the basilar invagination and of atlantoaxial dislocation. The patient had marked clinical recovery, despite the fact that no direct procedure was done for C3-4 disc decompression. The case suggests that C3-4 disc changes could be secondary to primary instability at the craniovertebral junction.
Topics: Atlanto-Axial Joint; Bone Screws; Cervical Vertebrae; Decompression, Surgical; Humans; Intervertebral Disc Displacement; Magnetic Resonance Imaging; Male; Odontoid Process; Platybasia; Tomography, X-Ray Computed; Young Adult
PubMed: 18310842
DOI: 10.4103/0028-3886.39317 -
The Angle Orthodontist Jan 2008Three cases of abnormal incidental findings on lateral cephalogram are presented. These patients reported for orthodontic consultation in their adolescence. While...
Three cases of abnormal incidental findings on lateral cephalogram are presented. These patients reported for orthodontic consultation in their adolescence. While studying the patients' cephalograms, abnormal radiographic findings were discovered in their cervical vertebrae. Because the patients were asymptomatic, early diagnosis based on these radiographic findings made the patients aware of the situations. Lifestyle changes were instituted with specialist consultation in two patients to prevent or delay the onset of symptoms of an underlying pathology. Patients were educated about the likely future course of these findings. Specialist follow-up was advised to all the patients.
Topics: Adolescent; Atlanto-Occipital Joint; Axis, Cervical Vertebra; Cephalometry; Cervical Atlas; Cervical Vertebrae; Female; Humans; Incidental Findings; Malocclusion; Odontoid Process; Platybasia; Radiography; Synostosis
PubMed: 18193959
DOI: 10.2319/091306-370.1 -
European Neurology 2007Descriptions of the flattening (platybasia) of the skull base and the upward displacement(impression) of the basilar and condylar portions of the occipitalbone by the...
Descriptions of the flattening (platybasia) of the skull base and the upward displacement(impression) of the basilar and condylar portions of the occipitalbone by the upper cervical spine date to the late 18th and early 19th centuries. Anatomical measurements to display these abnormalities were begun in 1865, but the full clinical significance was not appreciated until Homen's work in 1901. Subsequent refinement of radiology facilitated diagnosis and the later advent of surgical treatment.
Topics: History, 18th Century; History, 19th Century; History, 20th Century; Humans; Middle Aged; Neurology; Odontoid Process; Platybasia; Skull
PubMed: 17483591
DOI: 10.1159/000102172 -
Arquivos de Neuro-psiquiatria Dec 2006
Topics: Cisterna Magna; Humans; Paraparesis, Spastic; Platybasia; Terminology as Topic
PubMed: 17221026
DOI: 10.1590/s0004-282x2006000600040 -
Arquivos de Neuro-psiquiatria Sep 2006We report on a 48 years-old man with basilar impression without syringohydromyelia, in which the cisterna magna was impacted by the cerebellar tonsils. Six months after...
We report on a 48 years-old man with basilar impression without syringohydromyelia, in which the cisterna magna was impacted by the cerebellar tonsils. Six months after posterior fossa decompression there was the disappearance of nuchal rigidity, vertigo, spastic paraparesis and improvement of balance. Nevertheless hyperreflexia and diminished pallesthesia of the lower limbs persisted.
Topics: Arnold-Chiari Malformation; Cisterna Magna; Decompression, Surgical; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paraparesis, Spastic; Platybasia
PubMed: 17119816
DOI: 10.1590/s0004-282x2006000400029 -
Neurologia Medico-chirurgica Jun 2006Two patients presented with congenital basilar invagination manifesting as progressive myelopathy. Both patients underwent surgery using a neuronavigation-assisted...
Two patients presented with congenital basilar invagination manifesting as progressive myelopathy. Both patients underwent surgery using a neuronavigation-assisted transoral-transpharyngeal approach. The Brain-LAB Vector Vision navigation system was used for image guidance. The registration accuracies were 0.9 and 1.3 mm. After decompression, posterior stabilization was performed. Both patients had an uneventful postoperative course. The transoral-transpharyngeal approach with the neuronavigation system provides safe exposure and decompression for basilar invagination.
Topics: Adult; Cervical Vertebrae; Decompression, Surgical; Female; Humans; Magnetic Resonance Imaging; Male; Neuronavigation; Odontoid Process; Palate, Soft; Pharynx; Platybasia; Spinal Cord Compression; Tomography, X-Ray Computed
PubMed: 16794353
DOI: 10.2176/nmc.46.306