scholarly journals A combined approach for stabilization and endoscopic/ endonasal odontoid and clivus resection for treatment of basilar invagination

2021 ◽  
Vol 12 ◽  
pp. 511
Author(s):  
Lance Michael Villeneuve ◽  
Zoya Voronovich ◽  
Alexander Evans ◽  
Edward T. El Rassi ◽  
Ian F. Dunn ◽  
...  
Keyword(s):  
Treatment Options ◽  
Basilar Invagination ◽  
Chiari I Malformation ◽  
Cervical Cord ◽  
Endoscopic Endonasal ◽  
Transoral Odontoidectomy ◽  
Upper Cervical ◽  
Cervical Traction ◽  
Chiari I ◽  
Anterior Posterior

Background: Basilar invagination (BI) is a complex condition characterized by prolapse of the odontoid into the brain stem/upper cervical cord. This lesion is often associated with Chiari malformations, and rheumatoid arthritis (RA). Treatment options for BI typically include cervical traction, an isolated anterior transoral odontoidectomy, anterior endonasal odontoidectomy, an isolated posterior fusion, or combined anterior/ posterior surgical approach. Case Description: A 45-year-old female with a Chiari I malformation and RA underwent a combined posterior C0-C5 posterior decompression/fusion, followed by an anterior odontoidectomy (i.e. endoscopic/endonasal under neuronavigation). Postoperatively, the patient’s symptoms and neurological signs resolved. Conclusion: BI in was successfully managed with a combined posterior C0-C5 decompression/fusion followed by an anterior endoscopic/endonasal odontoidectomy performed under neuronavigation.

scholarly journals Endoscopic Endonasal Odontoidectomy Preserving Atlantoaxial Stability: a Pediatric Case

2020 ◽  
Author(s):  
Pierlorenzo Veiceschi ◽  
Fabio Pozzi ◽  
Francesco Restelli ◽  
Tommaso Alfiero ◽  
Paolo Castelnuovo ◽  
...  
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Chiari I Malformation ◽  
Lower Limbs ◽  
University Hospital ◽  
Third Ventriculostomy ◽  
Posterior Fixation ◽  
Endoscopic Endonasal ◽  
Postoperative Mri ◽  
Chiari I

Abstract Objectives We illustrate endoscopic endonasal odontoidectomy for the Chiari-I malformation respecting craniovertebral junction (CVJ) stability. Design Case report of a 12-year-old girl affected by the Chiari-I malformation. Magnetic resonance imaging (MRI) showed tonsillar herniation, basilar invagination, and dental retroversion, causing angulation and compression of the bulbomedullary junction. Patient underwent endoscopic third ventriculostomy (ETV) with reduction of ventricular size and resolution of gait disturbances, but she complained the Valsalva-induced headaches, hiccup, and dysesthesias in the lower limbs. Endoscopic endonasal odontoidectomy was chosen to decompress the cervicomedullary junction. Setting The research was conducted at University Hospital “Ospedale di Circolo,” Department of Neurosurgery at Varese in Italy. Participants Patients were from neurosurgical and ENT (ear, nose, and throat) skull base team. Main Outcome Measures A bilateral paraseptal approach was performed, using a four-hand technique. After resection of posterior edge of the nasal septum, the choana is entered and a rhinopharynx muscle–mucosal flap is dissected subperiosteal and transposed in oral cavity. The CVJ is exposed and, using neuronavigation and neuromonitoring, odontoidectomy is fulfilled until dura is reached, preserving the anterior arch of C1. Reconstruction is obtained suturing the flap previously harvested. Results Postoperative course was unremarkable and the patient experienced improvement of symptoms. Postoperative MRI documented the appearance of tight cerebrospinal fluid (CSF) film anterior to bulbomedullary junction and in retrotonsillar spaces, opening of the bulbomedullary angle, and slight tonsils reduction. No CVJ instability was occurred with any need of posterior fixation. Conclusion Endoscopic endonasal odontoidectomy is a feasible approach for CVJ malformation. In this case, bulbar decompression was achieved preserving CVJ stability and avoiding posterior fixation.The link to the video can be found at: https://youtu.be/VIobocHfCuc.

Use of metrizamide in computerized tomography to diagnose the Chiari I malformation

1982 ◽  
Vol 56 (3) ◽  
pp. 373-376 ◽  
Author(s):  
Ronald E. Woosley ◽  
Robert A. Whaley
Keyword(s):  
Computerized Tomography ◽  
Fourth Ventricle ◽  
Diagnostic Procedure ◽  
Chiari I Malformation ◽  
Cervical Cord ◽  
Content Type ◽  
Plain Films ◽  
The Status ◽  
Upper Cervical ◽  
Chiari I

✓ To properly diagnose and treat the Chiari I malformation, it is necessary to know: 1) the position of the cerebellar tonsils; 2) the degree of compression of the upper cervical cord and medulla; 3) the status of the spinal cord, particularly whether a syringohydromyelic condition exists; 4) whether basal arachnoiditis is present; 5) the nature of the communication between the fourth ventricle and the subarachnoid space; and 6) the overall ventricular size. The use of computerized tomography (CT) alone is not sufficient to furnish all of this information. The addition of metrizamide to the CT study enables the exact delineation of the basic pathology of the Chiari I malformation and its associated complications. A total of seven patients with surgically proven Chiari I malformation were included in this study. In all of these cases, CT with metrizamide was the essential diagnostic procedure. Plain films appear to be necessary only to facilitate the diagnosis of an associated Klippel-Feil syndrome or scoliosis.

Oscillopsia and Primary Cerebellar Ectopia: Case Report and Review of the Literature

Neurosurgery ◽  
1991 ◽  
Vol 29 (6) ◽  
pp. 932-936 ◽  
Author(s):  
Scott I. Gingold ◽  
Jeffrey A. Winfield
Keyword(s):  
Early Recognition ◽  
Complete Recovery ◽  
Visual Disturbance ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Downbeat Nystagmus ◽  
Suboccipital Craniectomy ◽  
Stationary Objects ◽  
Upper Cervical ◽  
Chiari I

Abstract Oscillopsia, the visual sensation of stationary objects swaying back and forth or vibrating, has been described in association with downbeat nystagmus in patients with primary cerebellar ectopia (Chiari I malformation). A patient with symptomatic oscillopsia without downbeat nystagmus, who was diagnosed by magnetic resonance imaging to have displaced cerebellar tonsils below the foramen magnum, is presented here. Suboccipital craniectomy and upper cervical laminectomy completely relieved the visual disturbance of the patient. The pathogenesis and surgical management of oscillopsia are discussed with respect to the current literature. Early recognition and surgical decompression of cerebellar ectopia may lead to complete recovery in patients with minimal symptomatology.

scholarly journals Chiari I Malformation and Basilar Invagination in Fibrous Dysplasia: Prevalence, Mechanisms, and Clinical Implications

2018 ◽  
Vol 33 (11) ◽  
pp. 1990-1998 ◽  
Author(s):  
Kristen S Pan ◽  
John D Heiss ◽  
Sydney M Brown ◽  
Michael T Collins ◽  
Alison M Boyce
Keyword(s):  
Fibrous Dysplasia ◽  
Basilar Invagination ◽  
Chiari I Malformation ◽  
Clinical Implications ◽  
Chiari I

scholarly journals Management of Basilar Invagination

2018 ◽  
Vol 24 (1) ◽  
pp. 53-59
Author(s):  
Andrei Fernandes Joaquim
Keyword(s):  
Treatment Options ◽  
Surgical Techniques ◽  
Basilar Invagination ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Upper Cervical Spine ◽  
Group A ◽  
The Times ◽  
Group B

Basilar invagination (BI) is a development anomaly of the craniocervical junction that results in a prolapsed of the upper cervical spine into the skull base, commonly associated to other bone and neural axis abnormalities, like Chiari I  malformation and syringomyelia. In this paper, we review the concepts necessary to understand and treat BI. The most comprehensive and accepted classification system is the proposed by Goel, which divides patients with BI into two groups, as it follows: group A) patients with clear elements of instability; and group B) BI secondary to clivus hypoplasia. Treatment in group A includes craniocervical realignment and stabilization, most of the times using an isolated posterior approach, obviating an unnecessaryand morbidity of the anterior decompression. In group B, foramen magnum decompression is the treatment of choice. Surgical techniques should be adequate according to patient’s anatomy and surgeon’s experience. Good surgical results can be obtained with the understanding of the main concepts and treatment options of BI.

Treatment Options for Hydrocephalus Following Foramen Magnum Decompression for Chiari I Malformation: A Multicenter Study

Neurosurgery ◽  
2019 ◽  
Author(s):  
Andrea Bartoli ◽  
Jehuda Soleman ◽  
Assaf Berger ◽  
Jeffrey H Wisoff ◽  
Eveline Teresa Hidalgo ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Treatment Options ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Foramen Magnum Decompression ◽  
Chiari I

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.

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