scholarly journals High cervical myelopathy due to bony craniovertebral junction anomalies (atlantoaxial dislocation) in pediatric population- clinical scoring system

2016 ◽  
Vol 52 (02) ◽  
pp. 131-138
Author(s):  
Raj Kumar
Keyword(s):  
Cervical Myelopathy ◽  
Scoring System ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Atlantoaxial Dislocation ◽  
Surgical Approaches ◽  
Lower Cranial Nerve ◽  
Complex Anatomy ◽  
Clinical Scoring ◽  
High Cervical

SUMMARYBony craniovertebral junction anomalies are rare anomalies to cause high cervical myelopathy. Atlantoaxial dislocation (congenital) is one of the commonest bony anomaly in children presenting with high cervical compression. It is relatively common in India with an incidence of 5-8 / 1000. When the distance of atlas (anterior arch) is more than 3mm ( 4 mm children) from odontoid process, it is called as Atlantoaxial dislocation (AAD) resulting into bony compression of high cervical cord. The patients may present with quadriparesis, sensory impairment in all limbs along with lower cranial nerve involvement. Because of lower medullary involvement the respiratory compromises are also frequent, posing a threat to life. Complex anatomy of foramen magnum, plethora of clinical conditions and atypical surgical approaches are responsible for poor outcome in these children. A new clinical scoring system for myelopathy was evolved in order to have an objective and precise grading of these cases preoperatively and postoperatively. The need of precise scoring system was felt to have reproducibility and easy applicability in children of craniovertebral junction anomalies in order to fetch even minimal improvement or deterioration following complex surgery. Motor functions, gait, sensory, sphincteric, respiratory function & spasticity were the parameters included in study of scoring system. This study was done in 177 operated cases of AAD (67 patients, below 14 years of age included for statistical analysis). Their detailed clinical & radiological evaluation was done preoperatively & postoperatively. The Kumar & Kalra high cervical myelopathy grading system was thus, introduced in literature. System was easy to use, interpret and was more sensitive to the changes in neurological status. It helped neurosurgeons and neurologists globally to evaluate and prognosticate the cases of Atlantoaxial dislocation.

Upper cervical myelopathy due to arachnoiditis and spinal cord tethering from adjacent C-2 osteomyelitis

2007 ◽  
Vol 6 (1) ◽  
pp. 64-67 ◽  
Author(s):  
Sharad Rajpal ◽  
Krisada Chanbusarakum ◽  
Praveen R. Deshmukh
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Complete Resolution ◽  
Magnetic Resonance Image ◽  
Epidural Abscess ◽  
Odontoid Process ◽  
Surgical Decompression ◽  
Upper Cervical ◽  
High Cervical ◽  
Spinal Cord Tethering

✓Myelopathy caused by a spinal cord infection is typically related to an adjacent compressive lesion such as an epidural abscess. The authors report a case of progressive high cervical myelopathy from spinal cord tethering caused by arachnoiditis related to an adjacent C-2 osteomyelitis. This 70-year-old woman initially presented with a methicillin-sensitive Staphylococcus aureus osteomyelitis involving the C-2 odontoid process. She was treated with appropriate antibiotic therapy but, over the course of 4 weeks, she developed progressive quadriparesis. A magnetic resonance image revealed near-complete resolution of the C-2 osteomyelitis, but new ventral tethering of the cord was observed at the level of the odontoid tip. She subsequently underwent open surgical decompression and cord detethering. Postoperatively she experienced improvement in her symptoms and deficits, which continued to improve 1 year after her surgery. To the authors’ knowledge, this is the first reported case of progressive upper cervical myelopathy due to arachnoiditis and cord tethering from an adjacent methicillin-sensitive S. aureus C-2 osteomyelitis.

A CLINICAL SCORING SYSTEM FOR NEUROLOGICAL ASSESSMENT OF HIGH CERVICAL MYELOPATHY

Neurosurgery ◽  
2007 ◽  
Vol 61 (5) ◽  
pp. 987-994 ◽  
Author(s):  
Raj Kumar ◽  
Samir K. Kalra ◽  
Ashok K. Mahapatra
Keyword(s):  
Scoring System ◽  
Pediatric Patients ◽  
Cervical Vertebrae ◽  
Neurological Status ◽  
Response To Treatment ◽  
Clinical Parameters ◽  
Irreducible Variety ◽  
Clinical Scoring ◽  
High Cervical

Abstract OBJECTIVE The assessment of response to treatment in pediatric patients with congenital atlantoaxial dislocation (AAD) is performed using a disability grading system but may be better determined by a score based on clinical parameters. This study proposes a scoring system based on a comprehensive neurological examination to assess surgical outcome in these patients. METHODS Sixty-seven patients with congenital AAD aged 14 years or younger were included and analyzed prospectively. A scoring system based on six factors (motor power, gait, sensory involvement, sphincteric involvement, spasticity, and respiratory difficulty) was designed at the beginning of the study and all patients were assessed using this score as well as the Di Lorenzo's grade preoperatively, postoperatively, and at the time of each follow-up visit. RESULTS There was a very high incidence of occipitalized arch of atlas and fusion of the second and third cervical vertebrae in the irreducible variety. Most patients were classified in poor grades preoperatively; however, the changes in score were seen more often when using the scoring system we developed compared with the Di Lorenzo's grade. Our score also corroborated better with the clinical improvement. CONCLUSION The clinical profiles of pediatric patients with AAD are similar with a higher incidence of atlas arch anomalies in patients with irreducible AAD. A scoring system based on clinical parameters is proposed for clinical evaluation of such patients. This system is easy to use and interpret and is more sensitive to the changes in the neurological status of patients.

Pyogenic Osteomyelitis of an Invaginated Odontoid Process with Rapid Deterioration of High Cervical Myelopathy: A Case Report

1998 ◽  
Vol 140 (10) ◽  
pp. 1093-1094 ◽  
Author(s):  
M. Kurimoto ◽  
S. Endo ◽  
M. Ohi ◽  
Y. Hirashima ◽  
N. Matsumura ◽  
...  
Keyword(s):  
Case Report ◽  
Cervical Myelopathy ◽  
Odontoid Process ◽  
Rapid Deterioration ◽  
Pyogenic Osteomyelitis ◽  
High Cervical

scholarly journals Resection of a Lower Clival Meningioma via Posterolateral Approach: Two-Dimensional Operative Video

2020 ◽  
Author(s):  
Pinar E. Ocak ◽  
Selcuk Yilmazlar
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerves ◽  
Posterolateral Approach ◽  
Left Vertebral Artery ◽  
Posterior Arch ◽  
Upper Cervical Spine ◽  
Two Dimensional ◽  
Lower Cranial Nerve ◽  
Complex Anatomy ◽  
Microsurgical Resection

Abstract Objectives This study aimed to demonstrate resection of a craniovertebral junction (CVJ) meningioma via the posterolateral approach. Design The study is designed with a two-dimensional operative video. Setting This study is conducted at department of neurosurgery in a university hospital. Participants A 50-year-old woman who presented with lower cranial nerve findings due to a left-sided lower clival meningioma (Fig. 1). Main Outcome Measures Microsurgical resection of the meningioma and preservation of the neurovascular structures. Results The patient was placed in park-bench position and a left-sided retrosigmoid suboccipital craniotomy, followed by C1 hemilaminectomy and unroofing the lip of the foramen magnum, was performed. The dural incision extended from the suboccipital region down to the posterior arch of C2 (Fig. 2). The arachnoid overlying the tumor was incised, revealing the course of the cranial nerve (CN) XI on the dorsolateral aspect of the tumor. The left vertebral artery (VA) was encased by the tumor which was originating from the dura below the jugular foramen. The mass was resected in a piecemeal fashion eventually. At the end of the procedure, all relevant cranial nerves and adjacent vascular structures were intact. Postoperative magnetic resonance imaging (MRI) confirmed total resection and the patient was discharged home on postoperative day 3 safely. Conclusions Microsurgical resection of the lesions of the CVJ are challenging as this transition zone between the cranium and upper cervical spine has a complex anatomy. Since adequate exposure of the extradural and intradural segments of the VA can be obtained by the posterolateral approach, this approach can be preferred in cases with tumors anterior to the VA or when the artery is encased by the tumor.The link to the video can be found at: https://youtu.be/d3u5Qrc-zlM.

Immediate postoperative regression of retroodontoid pannus after lateral mass reconstruction in a patient with rheumatoid disease of the craniovertebral junction

2008 ◽  
Vol 9 (3) ◽  
pp. 273-276 ◽  
Author(s):  
Atul Goel ◽  
Nitin Dange
Keyword(s):  
Bone Graft ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Postoperative Phase ◽  
Complete Disappearance ◽  
Lateral Mass ◽  
Rheumatoid Disease ◽  
Mass Reconstruction

The authors report the case of a 35-year-old man who had polyarthritic affliction with rheumatoid disease. He presented with complaints of quadriparesis that had progressed over the course of 2 years. Investigations revealed telltale evidence of rheumatoid disease of the craniovertebral junction with retroodontoid pannus, basilar invagination, and “fixed” atlantoaxial dislocation. The patient underwent lateral mass reconstruction with distraction of the facets and impaction of a spiked metal spacer and bone graft within the joint. Investigations done in the immediate postoperative phase showed complete disappearance of retroodontoid pannus in addition to reduction of basilar invagination and atlantoaxial dislocation. He had remarkable and sustained relief from symptoms. The authors also review the pathogenesis and treatment of retroodontoid pannus.

scholarly journals A clinical scoring system to identify patients with sebaceous neoplasms at risk for the Muir–Torre variant of Lynch syndrome

2014 ◽  
Vol 16 (9) ◽  
pp. 711-716 ◽  
Author(s):  
Maegan E. Roberts ◽  
Douglas L. Riegert-Johnson ◽  
Brittany C. Thomas ◽  
Kandelaria M. Rumilla ◽  
Colleen S. Thomas ◽  
...  
Keyword(s):  
At Risk ◽  
Lynch Syndrome ◽  
Scoring System ◽  
Clinical Scoring

scholarly journals Development and validation of a novel clinical scoring system for short‐term prediction of death in dogs with acute pancreatitis

2019 ◽  
Vol 33 (2) ◽  
pp. 499-507 ◽  
Author(s):  
Virginie Fabrès ◽  
Olivier Dossin ◽  
Clémence Reif ◽  
Miguel Campos ◽  
Valerie Freiche ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Scoring System ◽  
Short Term ◽  
Term Prediction ◽  
Clinical Scoring ◽  
Short Term Prediction ◽  
Development And Validation

Ventral Surgical Approaches to Craniovertebral Junction Chordomas

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A96-A103 ◽  
Author(s):  
Harminder Singh ◽  
James Harrop ◽  
Paul Schiffmacher ◽  
Marc Rosen ◽  
James Evans
Keyword(s):  
Surgical Management ◽  
Malignant Tumors ◽  
Craniovertebral Junction ◽  
Transoral Approach ◽  
Operative Approach ◽  
Surgical Approaches ◽  
Transnasal Approach ◽  
Neural Axis ◽  
Endoscopic Transnasal Approach

Abstract BACKGROUND Chordomas are primarily malignant tumors encountered at either end of the neural axis; the craniovertebral junction and the sacrococcygeal junction. In this article, we discuss the surgical management of craniovertebral junction chordomas. OBJECTIVE In this paper, we discuss the surgical management of craniovertebral junction chordomas. RESULTS The following approaches are illustrated: transoral-transpalatopharyngeal approach, high anterior cervical retropharyngeal approach, endoscopic transoral approach, and endoscopic transnasal approach. No single operative approach can be used for all craniovertebral chordomas. Therefore, the location of the tumor dictates which approach or approaches should be used.

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