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Neurology India 2008A novel method of treatment of basilar invagination that involves distraction of the atlantoaxial joint using specially designed spiked spacers is described. Bone graft...
OBJECTIVE
A novel method of treatment of basilar invagination that involves distraction of the atlantoaxial joint using specially designed spiked spacers is described. Bone graft that is additionally placed within the appropriately prepared atlantoaxial joint and posterior to the arch of atlas and lamina of C2 provides bony fusion.
MATERIALS AND METHODS
Between December 2002 and April 2007, 11 patients underwent the discussed method of fixation at the Department of Neurosurgery, King Edward Memorial Hospital in Mumbai, India. All 11 patients had "congenital" basilar invagination and the symptoms were progressive in nature.
RESULTS
The mean follow-up period was 21 months (range 8-40 months). Neurological improvement and successful distraction with atlantoaxial stabilization and ultimate bone fusion was achieved in all the patients and was documented with dynamic radiography. There were no neurological, vascular, or infective complications.
CONCLUSIONS
We conclude that the described method of atlantoaxial joint distraction and fixation provides an alternative treatment strategy for cases with basilar invagination. "Joint distraction" as a stand-alone method could provide reduction of basilar invagination and firm stabilization in such cases.
Topics: Adolescent; Adult; Atlanto-Axial Joint; Bone Screws; Child; Disease Progression; Female; Humans; Magnetic Resonance Imaging; Male; Platybasia; Prospective Studies; Retrospective Studies; Spinal Cord Compression; Tomography, X-Ray Computed; Young Adult
PubMed: 18688138
DOI: 10.4103/0028-3886.41991 -
Arquivos de Neuro-psiquiatria Jun 2003The present study shows the results of 53 patients who have been treated surgically for basilar impression (BI), Chiari malformation (CM), and syringomyelia (SM). The...
The present study shows the results of 53 patients who have been treated surgically for basilar impression (BI), Chiari malformation (CM), and syringomyelia (SM). The patients were divided into two groups. Group I (24 patients) underwent osteodural decompression with large inferior occipital craniectomy, laminectomy from C 1 to C 3, dural opening in Y format, dissection of arachnoid adhesion between the cerebellar tonsils, medulla oblongata and spinal cord, large opening of the fourth ventricle and dural grafting with the use of bovine pericardium. Group II patients (29 patients) underwent osteodural-neural decompression with the same procedures described above plus dissection of the arachnoid adherences of the vessels of the region of the cerebellar tonsils, and tonsillectomy (amputation) in 10 cases, and as for the remainning 19 cases, intrapial aspiration of the cerebellar tonsils was performed. The residual pial sac was sutured to the dura in craniolateral position. After completion of the suture of the dural grafting, a thread was run through the graft at the level of the created cisterna magna and fixed to the cervical aponeurosis so as to move the dural graft on a posterior- caudal direction, avoiding, in this way, its adherence to the cerebellum.
Topics: Adult; Arnold-Chiari Malformation; Decompression, Surgical; Humans; Middle Aged; Platybasia; Retrospective Studies; Syringomyelia; Treatment Outcome
PubMed: 12894269
DOI: 10.1590/s0004-282x2003000300009 -
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 -
Neurologia Medico-chirurgica Oct 2005Twelve selected patients, eight males and four females aged 14 to 50 years, with syringomyelia associated with congenital craniovertebral bony anomalies including...
Twelve selected patients, eight males and four females aged 14 to 50 years, with syringomyelia associated with congenital craniovertebral bony anomalies including basilar invagination and fixed atlantoaxial dislocation, and associated Chiari I malformation in eight, were treated by atlantoaxial joint manipulation and restoration of the craniovertebral region alignment between October 2002 and March 2004. Three patients had a history of trauma prior to the onset of symptoms. Spastic quadriparesis and ataxia were the most prominent symptoms. The mean duration of symptoms was 11 months. The atlantoaxial dislocation and basilar invagination were reduced by manual distraction of the facets of the atlas and axis, stabilization by placement of bone graft and metal spacers within the joint, and direct atlantoaxial fixation using an inter-articular plate and screw method technique. Following surgery all patients showed symptomatic improvement and restoration of craniovertebral alignment during follow up from 3 to 20 months (mean 7 months). Radiological improvement of the syrinx could not be evaluated as stainless steel metal plates, screws, and spacers were used for fixation. Manipulation of the atlantoaxial joints and restoring the anatomical craniovertebral alignments in selected cases of syringomyelia leads to remarkable and sustained clinical recovery, and is probably the optimum surgical treatment.
Topics: Adolescent; Adult; Arnold-Chiari Malformation; Atlanto-Axial Joint; Bone Plates; Bone Screws; Female; Humans; Joint Dislocations; Male; Middle Aged; Platybasia; Spinal Fusion; Syringomyelia; Treatment Outcome
PubMed: 16247236
DOI: 10.2176/nmc.45.512 -
Acta Neurochirurgica Nov 2020
Topics: Arnold-Chiari Malformation; Humans; Joint Instability; Platybasia
PubMed: 32895771
DOI: 10.1007/s00701-020-04557-6 -
European Spine Journal : Official... May 2013Transoral resection of the odontoid has been accepted as a standard procedure to decompress the cervicomedullary junction during the past several decades. The endoscopic...
PURPOSE
Transoral resection of the odontoid has been accepted as a standard procedure to decompress the cervicomedullary junction during the past several decades. The endoscopic transnasal odontoidectomy is emerging as a feasible surgical alternative to conventional microscopic transoral approach. In this article, we describe several operative nuances and pearls from our experience about this approach, which provided successful decompression.
METHODS
From September 2009 to April 2010, three consecutive patients with basilar invagination, of which the etiology was congenital osseous malformations, underwent endoscopic transnasal odontoidectomy. All patients presented with myelopathy. The last two cases also received occipitocervical fixation and bone fusion during the same surgical episode to ensure stability.
RESULTS
All the patients were extubated after recovery from anesthesia and allowed oral food intake the next day. Cerebrospinal fluid rhinorrhea was found in the second case and cured by continuous lumber drainage of cerebrospinal fluid. No infection was noted. The average follow-up time was more than 24 months. Remarkable neurological recovery was observed postoperative in all patients.
CONCLUSION
The endoscopic transnasal odontoidectomy is a feasible approach for anterior decompression of pathology at the cervicomedullary junction. The advantages over the standard transoral odontoidectomy include elimination of risk of tongue swelling and teeth damaging, improvement of visualization, alleviation of prolonged intubation, reduction of need for enteral tube feeding and less risk of affecting phonation. The minimally invasive access and faster recovery associated with this technique make it a valid alternative for decompression of the ventral side of the cervicomedullary junction.
Topics: Adult; Decompression, Surgical; Female; Humans; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Odontoid Process; Platybasia; Radiography; Treatment Outcome
PubMed: 23224062
DOI: 10.1007/s00586-012-2605-4 -
Neurology India 2021Vertebral artery (VA) may run an anomalous course in congenital craniovertebral junction anomalies. Anomalous VA, though rare, is challenging to handle. An anomalous VA...
INTRODUCTION
Vertebral artery (VA) may run an anomalous course in congenital craniovertebral junction anomalies. Anomalous VA, though rare, is challenging to handle. An anomalous VA can get injured during exposure of craniovertebral junction, even in the experienced hands.
OBJECTIVE
The objective of this article was to describe the technique of repairing the VA in case of its damage during exposure in the craniovertebral junction (atlantoaxial dislocation [AAD] with basilar invagination [BI]).
PROCEDURE
The authors describe a case of VA artery injury in a case of severe BI & AAD, which was anomalous and coursing over the joints. Following the repair of injured VA, we proceeded with the surgery (distraction, compression, extension, and reduction [DCER]).
CONCLUSION
To avoid injury, it is important to always perform a CT 3-D angiogram, perform meticulous dissection under the microscope while exposing the joints, use variable impedance bipolar to control venous bleeding and always expose the side with non-dominant VA first.
Topics: Atlanto-Axial Joint; Cervical Vertebrae; Humans; Joint Dislocations; Platybasia; Spinal Fusion; Vertebral Artery
PubMed: 33904442
DOI: 10.4103/0028-3886.314543 -
Journal of Bone and Mineral Research :... Feb 2011Cranial base abnormalities are an important complication of osteogenesis imperfecta (OI), a hereditary bone fragility disorder that in most patients is caused by...
Cranial base abnormalities are an important complication of osteogenesis imperfecta (OI), a hereditary bone fragility disorder that in most patients is caused by mutations affecting collagen type I. To elucidate which clinical characteristics are associated with the occurrence of cranial base abnormalities in OI, we compared cephalometric results of 187 OI patients (median age 12.0 years, range 3.4 to 47 years; 96 female) with those of 191 healthy subjects and related findings to clinical descriptors of the disease. Overall, 41 patients (22%) had at least one unambiguously abnormal skull base measure. Multivariate logistic regression analysis in patients with OI types I, III, and IV (n = 169) revealed that height Z-score [odds ratio (OR) = 0.53, 95% confidence interval (CI) 0.43-0.66, p < .001]--but not age, gender, scleral hue, lumbar spine areal bone mineral density, or a history of bisphosphonate treatment--was a significant independent determinant of skull base abnormalities. Among patients with a height Z-score below -3, 48% had a skull base abnormality regardless of whether they had received bisphosphonate treatment in the first year of life or not. Genotype-phenotype correlations were evaluated in patients with detectable mutations in COL1A1 or COL1A2, the genes coding for collagen type I (n = 140). Skull base abnormalities were present in 6% of patients with haploinsufficiency (frameshift or nonsense) mutations, in 43% of patients with helical glycine substitutions caused by COL1A1 mutations, in 32% of patients with helical glycine substitutions owing to COL1A2 mutations, and in 17% of patients with splice-site mutations affecting either COL1A1 or COL1A2. However, multivariate logistic regression analysis showed that height Z-score but not the type of collagen type I mutation was independently associated with the prevalence of skull base abnormalities. In conclusion, this study shows that clinical severity of OI, as expressed by the height Z-score, was the strongest predictor of skull base abnormalities. We did not find evidence for the hypothesis that bisphosphonate treatment protects against skull base abnormalities.
Topics: Adolescent; Bone and Bones; Child; Collagen; Collagen Type I; Collagen Type I, alpha 1 Chain; Densitometry; Female; Genotype; Humans; Male; Mutation; Osteogenesis Imperfecta; Phenotype; Platybasia; Regression Analysis; Skull
PubMed: 20721936
DOI: 10.1002/jbmr.220 -
Psychiatry and Clinical Neurosciences Apr 1998A 43-year-old woman presented with dull headache, left tinnitus and dizziness. Neurological examination revealed down-beat gaze nystagmus, left tinnitus, positive...
A 43-year-old woman presented with dull headache, left tinnitus and dizziness. Neurological examination revealed down-beat gaze nystagmus, left tinnitus, positive Romberg sign, poor standing on the left foot, poor tandem gait, left spastic gait and positive pathological reflexes in the bilateral upper and lower extremities. Plain X-ray of the skull and cervical vertebrae demonstrated basilar impression and atlantoaxial fusion. Magnetic resonance imaging of the brain and cervical spine showed cerebellar tonsil descent and syringomyelia located in the left side of the spine at the II-III vertebral level which communicated with the fourth ventricle. The patient was diagnosed as having cervical syringomyelia. Arnold-Chiari type I malformation and basilar impression. Preoperative polysomnography showed dysrhythmic breathing and bradypnea during sleep. Abnormal breathing improved after suboccipital decompression craniotomy and upper cervical laminectomy. It was suggested that dysrhythmic breathing was caused by a disorder of the medullary respiratory center. Herniation of the cerebellar tonsil and syringomyelia might have compressed the medulla.
Topics: Adult; Arnold-Chiari Malformation; Cerebellum; Cervical Vertebrae; Encephalocele; Female; Humans; Magnetic Resonance Imaging; Medulla Oblongata; Platybasia; Polysomnography; Sleep Apnea Syndromes; Syringomyelia
PubMed: 9628158
DOI: 10.1111/j.1440-1819.1998.tb01037.x -
Surgical Neurology International 2015Craniometric studies have shown that both Chiari malformation (CM) and basilar invagination (BI) belong to a spectrum of malformations. A more precise method to...
BACKGROUND
Craniometric studies have shown that both Chiari malformation (CM) and basilar invagination (BI) belong to a spectrum of malformations. A more precise method to differentiate between these types of CVJM is desirable. The Chamberlain's line violation (CLV) is the most common method to identify BI. The authors sought to clarify the real importance of CLV in the spectrum of craniovertebral junction malformations (CVJM) and to identify possible pathophysiological relationships.
METHODS
We evaluated the CLV in a sample of CVJM, BI, CM patients and a control group of normal subjects and correlated their data with craniocervical angular craniometry.
RESULTS
A total of 97 subjects were studied: 32 normal subjects, 41 CM patients, 9 basilar invagination type 1 (BI1) patients, and 15 basilar invagination type 2 (BI2) patients. The mean CLV violation in the groups were: The control group, 0.16 ± 0.45 cm; the CM group, 0.32 ± 0.48 cm; the BI1 group, 1.35 ± 0.5 cm; and the BI2 group, 1.98 ± 0.18 cm. There was strong correlation between CLV and Boogard's angle (R = 0.82, P = 0.000) and the clivus canal angle (R = 0.7, P = 0.000).
CONCLUSIONS
CM's CLV is discrete and similar to the normal subjects. BI1 and BI2 presented with at least of 0.95 cm CLV and these violations were strongly correlated with a primary cranial angulation (clivus horizontalization) and an acute clivus canal angle (a secondary craniocervical angle).
PubMed: 26229733
DOI: 10.4103/2152-7806.160322