scholarly journals The So-Called Anterior Meningeal Artery: An Anatomic Study for Treatment Modalities

2004 ◽  
Vol 10 (4) ◽  
pp. 293-299 ◽  
Author(s):  
S. Shimizu ◽  
A.S. Garcia ◽  
N. Tanriover ◽  
K. Fujii
Keyword(s):  
Soft Tissues ◽  
Deep Layer ◽  
Odontoid Process ◽  
Posterior Longitudinal Ligament ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Treatment Modalities ◽  
Upper Cervical ◽  
Vertebral Bodies ◽  
Meningeal Artery

The so called anterior meningeal artery (AMA) is a branch of the vertebral artery (VA), which had been interpreted as a supplying vessel of the dura in the foramen magnum and upper cervical level. In this study, we examined the anatomy of this artery and relationships to its surrounding structures for treatment modalities. With the aid of magnification, five adult cadaveric head and neck complex and five cervical spines were examined after perfusion of the vessels with colored silicone. The AMA arose from the VA between the C2 and C3 level, and passed medially through the intrervertebral foramen anterior to the dural sheath of the third cervical nerve root. It ran upwards dorsal to the deep layer of the posterior longitudinal ligament (PLL) with anterior internal vertebral venous plexus. Rostrally, it formed an arcade above the apex of the odontoid process with its contralateral mate. The AMA gave off several tiny branches to the deep layer of the PLL, ligaments and soft tissues above the apex of the odontoid process, and vertebral bodies of the axis. At the level of the foramen magnum, it ended in several small twigs to the dura. Anastomoses between the AMA system and adjacent vessels were observed. One was directed through the hypoglossal canal to the ascending pharyngeal artery and the other was with the V3 segment of the VA. The origin and course of the two AMA, and anastomoses were symmetric. Although the AMA feeds the ventral dura of the foramen magnum, the perfusion area is larger than its name suggests, including the bony and ligamentous structures in the craniovertebral junction. Anatomical knowledge of the AMA, including its anastomoses and layer relationships to the surrounding structures, may help to perform treatment modalities in this region rationally.

Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation

2004 ◽  
Vol 1 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Atul Goel
Keyword(s):  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Atlantoaxial Joint ◽  
Lateral Mass ◽  
Content Type ◽  
Joint Distraction ◽  
History Of ◽  
Fine Print

Object. The author discusses the successful preliminary experience of treating selected cases of basilar invagination by performing atlantoaxial joint distraction, reduction of the basilar invagination, and direct lateral mass atlantoaxial plate/screw fixation. Methods. Twenty-two patients with basilar invagination—in which the odontoid process invaginated into the foramen magnum and the tip of the odontoid process was above the Chamberlain, McRae foramen magnum, and Wackenheim clival lines—were selected to undergo surgery. In all patients fixed atlantoaxial dislocations were documented. The 16 male and six female patients ranged in age from 8 to 50 years. A history of trauma prior to the onset of symptoms was documented in 17 patients. Following surgery, the author observed minimal-to-significant reduction of basilar invagination and alteration in other craniospinal parameters resulting in restoration of alignment of the tip of the odontoid process and the clivus and the entire craniovertebral junction in all patients. In addition to neurological and radiological improvement, preoperative symptoms of torticollis resolved significantly in all patients. The minimum follow-up period was 12 months and the mean was 28 months. Conclusions. Joint distraction and firm lateral mass fixation in selected cases of basilar invagination is a reasonable surgical treatment for reducing the basilar invagination, restoring craniospinal alignment, and establishing fixation of the atlantoaxial joint.

scholarly journals Far Lateral Transcondylar Approach for Anterior Foramen Magnum Lesions

2020 ◽  
Vol 24 (2) ◽  
pp. 149-155
Author(s):  
WAQAS MEHDI ◽  
AZAM NIAZ ◽  
MUHAMMAD IRFAN ◽  
SHAHZAIB TASDIQUE ◽  
SAMRA MAJEED
Keyword(s):  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Initial Assessment ◽  
Cervical Cord ◽  
Total Excision ◽  
Cardiorespiratory Arrest ◽  
Transcondylar Approach ◽  
Upper Cervical ◽  
Far Lateral ◽  
Malignant Lesions

Objective:  To study the efficacy and safety of far-lateral transcondylar approach for anterior foramen magnum lesions with early experience at our Institute. Material and Methods:  We treated six patients, with lesion anterior to the foramen magnum and posterior to the brainstem and cervical cord in a period of 2 years, March 2017 to March 2018.Initial assessment was made by history and examination followed by CT scan and contrast MRI. All were treated using far-lateral transcondylar approach. Result:  Among six patients, there were two were male and four were female. Three of these patients had a meningioma while two patients had neurofibromas and one clival chordoma. Total excision was achieved in five neoplastic cases, while subtotal excision was done in one case. There were no fresh postoperative deficits in any of the other patients. One patient had an unexplained sudden cardiorespiratory arrest 18h after the surgery and succumbed. One patient had cerebrospinal fluid (CSF) discharge from the wound, which was satisfactorily managed by lumber CSF drainage. Conclusion:  This approach provides an excellent approach to lesions located anterior to foramen magnum posterior to the brainstem and upper cervical cord. Gross total excision of these benign and malignant lesions is safely possible through this approach. Keywords:  Craniovertebral Junction, Far-Lateral Transcondylar Approach, Anterior Foramen Magnum, Brain Stem, Chordoma.

Extreme lateral transcondylar approach for resection of ventrally based meningioma of the craniovertebral junction and upper cervical spine

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1
Author(s):  
James K. Liu
Keyword(s):  
Cervical Spine ◽  
Cervical Spinal Cord ◽  
Close Association ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Upper Cervical Spine ◽  
Transcondylar Approach ◽  
Intradural Tumor ◽  
Upper Cervical ◽  
Microsurgical Resection

Ventrally based meningiomas at the craniovertebral junction can be challenging tumors to remove because of their deep location anterior to the lower brainstem and upper cervical spinal cord, and close association with complex neurovascular structures. The extreme lateral transcondylar approach provides excellent access and exposure to anterior and anterolateral intradural tumors involving the region of the craniovertebral junction, including the lower third of the clivus, the foramen magnum, and the upper cervical spine. This approach allows safe access for removal of these difficult tumors without any neural retraction. In this operative video manuscript, the author demonstrates an illustrative step-by-step technique for microsurgical resection of a ventrally based meningioma extending from the foramen magnum to C-2 using the extreme lateral transcondylar approach. The operative technique and surgical nuances, including the surgical approach, intradural tumor removal, and cranial base reconstruction, are illustrated in this video atlas. The video can be found here: http://youtu.be/4uvPpEtEShU.

scholarly journals Endoscopic Endonasal Transclival Odontoidectomy for Basilar Invagination: Operative Video and Technical Nuances

2020 ◽  
Author(s):  
James K. Liu ◽  
Vincent N. Dodson ◽  
Kevin Zhao ◽  
Jean Anderson Eloy
Keyword(s):  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Endoscopic Endonasal ◽  
Motor Weakness ◽  
Cervicomedullary Junction ◽  
Unsteady Gait ◽  
Cervical Traction ◽  
Motor Strength

AbstractBasilar invagination is a congenital or acquired craniovertebral junction abnormality where the tip of the odontoid process projects through the foramen magnum which can cause severe symptomatic compression of the brainstem and spinal cord. If left untreated, patients can develop progressive quadriparesis. Traditionally, basilar invagination can be treated with cervical traction and posterior stabilization. However, in irreducible cases, anterior decompression via a transoral or endonasal approach may be necessary. In this operative video, we demonstrate an endoscopic endonasal transclival approach for odontoidectomy to successfully treat a 37-year-old female with severe basilar invagination causing symptomatic compression on the cervicomedullary junction resulting in unsteady gait and motor weakness. The patient had Klippel–Feil syndrome where the C1 arch was assimilated to the foramen magnum and transclival drilling was needed to adequately access the odontoid process for removal. A second-stage posterior occipitocervical stabilization and fusion was performed the following day. Immediate postoperative imaging showed excellent decompression of the cervicomedullary junction. Postoperatively, the patient had significant improvement in gait and motor strength in all extremities, and was ambulating independently without assistance at 1 year after surgery. The endoscopic endonasal transclival odontoidectomy is a useful strategy to treat severe irreducible basilar invagination causing symptomatic neural compression. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video.The link to the video can be found at: https://youtu.be/HL4K7KqJEJM.

Biomechanical evaluation of the craniovertebral junction after inferior-third clivectomy and intradural exposure of the foramen magnum: implications for endoscopic endonasal approaches to the cranial base

2013 ◽  
Vol 18 (4) ◽  
pp. 327-332 ◽  
Author(s):  
Andrew S. Little ◽  
Luis Perez-Orribo ◽  
Nestor G. Rodriguez-Martinez ◽  
Phillip M. Reyes ◽  
Anna G. U. S. Newcomb ◽  
...  
Keyword(s):  
Axial Rotation ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Lateral Bending ◽  
Endoscopic Endonasal ◽  
Flexion Extension ◽  
Upper Cervical ◽  
Biomechanical Evaluation ◽  
Ventral Skull Base ◽  
Modest Degree

Object Endoscopic endonasal approaches to the craniovertebral junction (CVJ) and clivus are increasingly performed for ventral skull-base pathology, but the biomechanical implications of these approaches have not been studied. The aim of this study was to investigate the spinal biomechanics of the CVJ after an inferior-third clivectomy and anterior intradural exposure of the foramen magnum as would be performed in an endonasal endoscopic surgical strategy. Methods Seven upper-cervical human cadaveric specimens (occiput [Oc]–C2) underwent nondestructive biomechanical flexibility testing during flexion-extension, axial rotation, and lateral bending at Oc–C1 and C1–2. Each specimen was tested intact, after an inferior-third clivectomy, and after ligamentous complex dissection simulating a wide intradural exposure using an anterior approach. Angular range of motion (ROM), lax zone, and stiff zone were determined and compared with the intact state. Results Modest, but statistically significant, hypermobility was observed after inferior-third clivectomy and intradural exposure during flexion-extension and axial rotation at Oc–C1. Angular ROM increased incrementally between 6% and 12% in flexion-extension and axial rotation. These increases were primarily the result of changes in the lax zone. No significant changes were noted at C1–2. Conclusions Inferior-third clivectomy and an intradural exposure to the ventral CVJ and foramen magnum resulted in hypermobility at Oc–C1 during flexion-extension and axial rotation. Although the results were statistically significant, the modest degree of hypermobility observed compared with other well-characterized CVJ injuries suggests that occipitocervical stabilization may be unnecessary for most patients.

Fusion and instrumentation at C1–3 via the high anterior cervical approach

2000 ◽  
Vol 92 (1) ◽  
pp. 24-29 ◽  
Author(s):  
John R. Vender ◽  
Steven J. Harrison ◽  
Dennis E. McDonnell
Keyword(s):  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Upper Cervical ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Solid Fusion ◽  
Posterior Procedure ◽  
Fine Print

Object. The high anterior cervical, retropharyngeal approach to the anterior foramen magnum and upper cervical spine is a favorable alternative to the transoral and posterolateral approaches, which both cause instability of the craniovertebral junction. Previously, such instability was corrected via an occipitocervical fusion during a separate surgical procedure. Methods. Seven patients requiring C-2 corpectomy (foramen magnum meningioma [two patients], critical stenosis secondary to rheumatoid arthritis [two patients], C-2 fracture [two patients], and stenosis secondary to Rickets [one patient]) are presented. All patients underwent C1–3 fusion followed by instrumentation with a Caspar plate. A solid fusion was achieved in six patients. One patient experienced erosion of the anterior arch of C-1 requiring posterior stabilization. Conclusions. Fusion and instrumentation at C1–3 can be performed safely and with minimal increase in surgical time. In selected patients, this may eliminate the need for an additional posterior procedure and maintain occipital—C1 mobility.

scholarly journals Increase of the clivus-canal angle in patients with basilar invagination, without atlantoaxial displacement, treated with a simple maneuver of indirect decompression of the odontoid with the head clamp, during posterior occipitocervical arthrodesis

2021 ◽  
Vol 12 ◽  
pp. 260
Author(s):  
Claudio Henrique F. Vidal ◽  
Ricardo Brandao Fonseca ◽  
Bruno Leimig ◽  
Walter F. Matias-Filho ◽  
Geraldo Sa Carneiro-Filho
Keyword(s):  
Postoperative Period ◽  
Posterior Approach ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Occipitocervical Fixation ◽  
Significant Difference ◽  
Indirect Decompression ◽  
Head Clamp

Background: Basilar invagination (BI) can be defined as the insinuation of the content of the craniovertebral junction through the foramen magnum toward the posterior fossa. BI is a prevalent condition in Northeast Brazil. The present study describes the changes in the clivus-canal angle (CCA) in the postoperative period in patients with symptomatic BI operated by a posterior approach, using a simple technique of indirect reduction of the odontoid associated with occipitocervical fixation. Methods: Patients underwent radiological evaluations by magnetic resonance imaging in the pre and postoperative periods, where the height of the odontoid tip was measured in relation to the Chamberlain line and the ACC. All patients underwent posterior occipitocervical fixation with specific maneuvers of distraction and extension of the cephalic segment with the aid of a head clamp with three fixation points for anterior reduction of the odontoid. Results: Among the 8 patients evaluated in the series, all had increased ACC in the postoperative period, with a mean of 14.81 ± 1.54°, and statistically significant difference between the pre and postoperative periods (P < 0.05). Conclusion: The indirect surgical reduction of the odontoid process by a posterior approach through the manipulation (distraction-extension) of a “Mayfield” type of head clamp followed by occipitocervical fixation proved to be effective in improving the ACC, being easily reproducible.

Posterolateral Approaches to the Craniovertebral Junction

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A135-A140 ◽  
Author(s):  
Youssef R. Karam ◽  
Arnold H. Menezes ◽  
Vincent C. Traynelis
Keyword(s):  
Effective Means ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Posterolateral Approach ◽  
Upper Cervical Spine ◽  
Dural Closure ◽  
Far Lateral Approach ◽  
Upper Cervical ◽  
The Stability

Abstract OBJECTIVE The indications and operative technique for a number of posterolateral approaches to the craniovertebral junction (CVJ) are reviewed. METHODS The literature addressing posterolateral approaches to the CVJ is reviewed, and illustrative cases are presented. RESULTS The far lateral approach and its variants, including the transcondylar, supracondylar, and paracondylar approaches, are an effective means of addressing intradural anterior and anterolateral CVJ lesions. These approaches provide exposure of the lower third of the clivus, the foramen magnum, and the upper cervical spine; do not cross contaminated regions; and enable a watertight dural closure to be performed. They are associated with minimal morbidity and usually do not significantly decrease the stability of the CVJ. CONCLUSION All surgeons treating lesions of the CVJ should be familiar with the posterolateral approach and its modifications.

Technical notes on the endoscopic endonasal approach to the craniovertebral junction for odontoidectomy

2018 ◽  
Vol 32 (2) ◽  
pp. 85-86 ◽  
Author(s):  
Dennis Tang ◽  
Christopher Roxbury ◽  
Brian D'Anza ◽  
Varun Kshettry ◽  
Troy Woodard ◽  
...  
Keyword(s):  
Cervical Spinal Cord ◽  
Odontoid Process ◽  
Cervical Vertebra ◽  
Craniovertebral Junction ◽  
Endonasal Approach ◽  
Midline Incision ◽  
Endoscopic Endonasal ◽  
Single Procedure ◽  
Upper Cervical ◽  
Lower Morbidity

Introduction: Odontoidectomy can help decompress ventral compression of the brainstem and upper cervical spinal cord in the presence of bony abnormalities of the craniovertebral junction (CVJ), e.g., an odontoid pannus. Endonasal approaches have been shown to be associated with lower morbidity compared with traditional transoral approaches. We demonstrated an entirely endonasal approach to the CVJ. Materials and Methods: We presented our technique for performing an endoscopic endonasal odontoidectomy. Results: The patient underwent an open posterior cervical spinal fusion to stabilize the CVJ due to destabilization that occurs with odontoidectomy either as part of a single procedure or in a staged manner, depending on the surgeon's preference. By using a two-surgeon, multihanded technique in collaboration with neurosurgery, the anterior CVJ was safely approached endoscopically through the nasopharynx. A midline incision was created and the soft tissue was lateralized widely. The first cervical vertebra (C1) arch was removed with a drill exposing the odontoid process and any associated pannus, which were then resected. Because this approach was entirely extradural, no reconstruction was necessary. Closure was accomplished by placing absorbable packing material in the defect and medializing the nasopharyngeal tissues. Conclusion: Endoscopic endonasal odontoidectomy offers excellent exposure and less morbidity than traditional transoral approaches. This technique should be considered in appropriately selected patients.

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