The High Cervical Anterolateral Retropharyngeal Approach

OBJECTIVEThe surgical treatment of an upper cervical spinal tumor (UCST) at C1–2/C1–3 is challenging due to anterior exposure and reconstruction. Limited information has been published concerning the effective approach and reconstruction for an anterior procedure after C1–2/C1–3 UCST resection. The authors attempted to introduce a novel, customized, anterior craniocervical reconstruction between the occipital condyles and inferior vertebrae through a modified high-cervical retropharyngeal approach (mHCRA) in addressing C1–2/C1–3 spinal tumors.METHODSSeven consecutive patients underwent 2-stage UCST resection with circumferential reconstruction. Posterior decompression and occiput-cervical instrumentation was conducted at the stage 1 operation, and anterior craniocervical reconstruction using a 3D-printed implant was performed between the occipital condyles and inferior vertebrae via an mHCRA. The clinical characteristics, perioperative complications, and radiological outcomes were reviewed, and the rationale for anterior craniocervical reconstruction was also clarified.RESULTSThe mean age of the 7 patients in the study was 47.6 ± 19.0 years (range 12–72 years) when referred to the authors’ center. Six patients (85.7%) had recurrent tumor status, and the interval from primary to recurrence status was 53.0 ± 33.7 months (range 24–105 months). Four patients (57.1%) were diagnosed with a spinal tumor involving C1–3, and 3 patients (42.9%) with a C1–2 tumor. For the anterior procedure, the mean surgical duration and average blood loss were 4.1 ± 0.9 hours (range 3.0–6.0 hours) and 558.3 ± 400.5 ml (range 100–1300 ml), respectively. No severe perioperative complications occurred, except 1 patient with transient dysphagia. The mean pre- and postoperative visual analog scale scores were 8.0 ± 0.8 (range 7–9) and 2.4 ± 0.5 (range 2.0–3.0; p < 0.001), respectively, and the mean improvement rate of cervical spinal cord function was 54.7% ± 13.8% (range 42.9%–83.3%) based on the modified Japanese Orthopaedic Association scale score (p < 0.001). Circumferential instrumentation was in good position and no evidence of disease was found at the mean follow-up of 14.8 months (range 7.3–24.2 months).CONCLUSIONSThe mHCRA provides optimal access to the surgical field at the C0–3 level. Customized anterior craniocervical fixation between the occipital condyles and inferior vertebrae can be feasible and effective in managing anterior reconstruction after UCST resection.

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Prediction of Spontaneous Preterm Delivery in Twin Pregnancies By Cervical Length at Mid-Gestation

Twin Research and Human Genetics ◽

10.1375/twin.11.5.552 ◽

2008 ◽

Vol 11 (5) ◽

pp. 552-557 ◽

Cited By ~ 20

Author(s):

Katharina Klein ◽

Hubertus Gregor ◽

Kora Hirtenlehner-Ferber ◽

Maria Stammler-Safar ◽

Armin Witt ◽

...

Keyword(s):

Preterm Delivery ◽

Smoking Habit ◽

Cervical Length ◽

Spontaneous Preterm Delivery ◽

Spontaneous Labour ◽

High Incidence ◽

High Cervical ◽

Twin Pregnancies ◽

Preterm Rupture Of Membranes ◽

Spontaneous Delivery

AbstractThe objective of our study was to evaluate the correlation of the cervical length at 20–25 weeks of gestation with the incidence of spontaneous preterm delivery in twins in a country with a high incidence of preterm delivery compared to other European countries. Cervical length was measured in 262 consecutive patients. Previous preterm delivery before 34 weeks of gestation, chorionicity, maternal age, body-mass-index, smoking habit and parity were recorded as risk factors for preterm delivery. Women who were symptomatic at 20–25 weeks and who delivered because of other reasons than spontaneous labour and preterm rupture of membranes or at term were excluded. The primary outcome was incidence of preterm birth before 34 weeks. Two hundred and twenty-three patients were analyzed. Thirty-two (14%) delivered before 34 weeks. There was a significant correlation between cervical length of less than 25 mm and spontaneous delivery before 34 weeks (50% vs. 13%,p= .007). In addition, logistic regression analysis found cervical length to be the only significant predictor of spontaneous delivery before 34 weeks (OR 1.084; 95% CI 1.015; 1.159;p= .017). We conclude that the risk of severe preterm delivery in twins is high. Cervical length at mid-gestation was the only predictor of delivery before 34 weeks.

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Epidural Contrast Staining in High Cervical Micro-Arteriovenous Fistulae

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.51 ◽

2021 ◽

pp. 1-9

Author(s):

Marlise P. dos Santos ◽

Charles Haw ◽

Fabio Settecase ◽

Jason Chew

Keyword(s):

Arteriovenous Fistulae ◽

High Cervical

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Retromandibular Fossa Approach to the High Cervical Internal Carotid Artery: An Anatomic Study

Operative Neurosurgery ◽

10.1227/01.neu.0000326020.07187.6b ◽

2008 ◽

Vol 62 (suppl_5) ◽

pp. ONS363-ONS370 ◽

Cited By ~ 2

Author(s):

Yusuf Izci ◽

Roham Moftakhar ◽

Mark Pyle ◽

Mustafa K. Basşkaya

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Average Length ◽

Cranial Nerves ◽

External Carotid Artery ◽

External Carotid ◽

Digastric Muscle ◽

High Cervical ◽

Cervical Internal Carotid Artery

Abstract Objective: Access to the high cervical internal carotid artery (ICA) is technically challenging for the treatment of lesions in and around this region. The aims of this study were to analyze the efficacy of approaching the high cervical ICA through the retromandibular fossa and to compare preauricular and postauricular incisions. In addition, the relevant neural and vascular structures of this region are demonstrated in cadaveric dissections. Methods: The retromandibular fossa approach was performed in four arterial and venous latex-injected cadaveric heads and necks (eight sides) via preauricular and postauricular incisions. This approach included three steps: 1) sternocleidomastoid muscle dissection; 2) transparotid dissection; and 3) removal of the styloid apparatus and opening of the retromandibular fossa to expose the cervical ICA with the internal jugular vein along with Cranial Nerves X, XI, and XII. Results: The posterior belly of the digastric muscle and the styloid muscles were the main obstacles to reaching the high cervical ICA. The high cervical ICA was successfully exposed through the retromandibular fossa in all specimens. In all specimens, the cervical ICA exhibited an S-shaped curve in the retromandibular fossa. The external carotid artery was located more superficially than the ICA in all specimens. The average length of the ICA in the retromandibular fossa was 6.8 cm. Conclusion: The entire cervical ICA can be exposed via the retromandibular fossa approach without neural and vascular injury by use of meticulous dissection and good anatomic knowledge. Mandibulotomy is not necessary for adequate visualization of the high cervical ICA.

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Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011653 ◽

2015 ◽

Vol 8 (7) ◽

pp. 722-728 ◽

Cited By ~ 22

Author(s):

Grzegorz Brzezicki ◽

Dennis J Rivet ◽

John Reavey-Cantwell

Keyword(s):

Skull Base ◽

Treatment Option ◽

Case Series ◽

Endovascular Intervention ◽

Long Term Results ◽

Complete Revascularization ◽

Intraoperative Complication ◽

Pipeline Embolization Device ◽

High Cervical

BackgroundMost cervical dissections are treated with anticoagulation or antiplatelet agents with very good results; however, some patients may benefit from endovascular intervention. High cervical and skull base dissections are often more challenging to treat because of the distal location and tortuous anatomy. The Pipeline Embolization Device (PED) may be a reasonable treatment option for this indication.ObjectivesTo report a case series of patients treated with the PED for high cervical and skull base dissections, focusing on their presentation, indications for treatment, dissection revascularization success, and pseudoaneurysm obliteration evaluated by imaging, and to review available pertinent literature.MethodsWe retrospectively reviewed all cases of high cervical and skull base dissections treated with a PED at our institution. Patient clinical characteristics, presentation, procedural and follow-up imaging, and clinical course were analyzed to evaluate for procedure complications, dissection revascularization success, pseudoaneurysm obliteration, and clinical outcome.ResultsThis is a retrospective case series including 11 patients with 13 carotid dissections treated in our center. There were nine traumatic and four spontaneous dissections. The most common presentation was cerebrovascular accident/transient ischemic attack (CVA/TIA; 5 patients) and headache/face pain (4 patients). Eleven dissections were associated with pseudoaneurysms. Three patients failed medical management with anticoagulation, although flow-limiting stenosis was the main indication for endovascular intervention. Up to three PEDs per vessel were deployed. Angioplasty was used in 10 cases. Complete revascularization (<10% residual stenosis) was achieved in 91% of vessels and 50% of pseudoaneurysms were completely or near completely obliterated immediately after PED(s) deployment. Proximal iatrogenic dissection was the only intraoperative complication. Follow-up imaging was available for nine treated vessels and demonstrated patent PEDs without significant in-stent stenosis up to 9 months after intervention. 75% of pseudoaneurysms were completely obliterated at follow-up. One PED partially collapsed but had no neurological consequences. There were no new CVA/TIAs.ConclusionsOur initial experience with treatment of high cervical and skull base dissections with the PED appears to show that this technique may be a safe and viable treatment option. However, long-term results are needed to fully evaluate the efficacy of such treatment.

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Magnetic resonance imaging—guided percutaneous fenestration of a cervical intradural cyst

Journal of Neurosurgery Spine ◽

10.3171/spi.2003.99.3.0313 ◽

2003 ◽

Vol 99 (3) ◽

pp. 313-315 ◽

Cited By ~ 12

Author(s):

Shinobu Takahashi ◽

Shigehiro Morikawa ◽

Masaaki Egawa ◽

Yasuo Saruhashi ◽

Yoshitaka Matsusue

Keyword(s):

Magnetic Resonance ◽

Mr Imaging ◽

Complete Disappearance ◽

Resonance Imaging ◽

Content Type ◽

Local Anesthetic Agent ◽

Intradural Extramedullary ◽

Severe Exercise ◽

Exercise Induced ◽

High Cervical

✓ The authors describe the case of a high cervical, intradural extramedullary cyst located anterior to the spinal cord in a 13-year-old boy. The lesion was fenestrated percutaneously by using real-time magnetic resonance (MR) imaging guidance and a local anesthetic agent. The patient's symptom, severe exercise-induced headache, immediately resolved after treatment. Nine months later, complete disappearance of the cyst was confirmed on MR imaging and computerized tomography myelography. Magnetic resonance imageing—guided fenestration can be considered a minimally invasive option for intradural cystic lesions.

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