scholarly journals Occipitoaxial spinal interarticular stabilization with vertebral artery preservation for atlantal lateral mass failure

2015 ◽  
Vol 22 (2) ◽  
pp. 134-138 ◽  
Author(s):  
Lukas Bobinski ◽  
Marc Levivier ◽  
John M. Duff
Keyword(s):  
Vertebral Artery ◽  
Tumor Resection ◽  
Craniocervical Junction ◽  
Single Stage ◽  
Lateral Mass ◽  
One Stage ◽  
Craniocervical Instability ◽  
Mass Failure ◽  
Titanium Cages ◽  
Mass Reconstruction

The treatment of craniocervical instability caused by diverse conditions remains challenging. Different techniques have been described to stabilize the craniocervical junction. The authors present 2 cases in which tumoral destruction of the C-1 lateral mass caused craniocervical instability. A one-stage occipitoaxial spinal interarticular stabilization (OASIS) technique with titanium cages and posterior occipitocervical instrumentation was used to reconstruct the C-1 lateral mass and stabilize the craniocervical junction. The ipsilateral vertebral artery was preserved. The OASIS technique offers single-stage tumor resection, C-1 lateral mass reconstruction, and stabilization with a loadsharing construct. It could be an option in the treatment of select cases of C-1 lateral mass failure.

scholarly journals Transoral digital reduction of complete anterior odontoid dislocation followed by fiducial-based navigated transcondylar screw fixation: illustrative case

2022 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Spinal Fusion ◽  
Screw Fixation ◽  
Treatment Options ◽  
Pedicle Screws ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Illustrative Case ◽  
Trauma Patients ◽  
Lateral Mass ◽  
Craniocervical Instability

BACKGROUND Posterior atlantoaxial dislocations (i.e., complete anterior odontoid dislocation) without C1 arch fractures are a rare hyperextension injury most often found in high-velocity trauma patients. Treatment options include either closed or open reduction and optional spinal fusion to address atlantoaxial instability due to ligamentous injury. OBSERVATIONS A 60-year-old male was struck while on his bicycle by a truck and sustained an odontoid dislocation without C1 arch fracture. Imaging findings additionally delineated a high suspicion for craniocervical instability. The patient had neurological issues due to both a head injury and ischemia secondary to an injured vertebral artery. He was stabilized and transferred to our facility for definitive neurosurgical care. LESSONS The patient underwent a successful transoral digital closed reduction and posterior occipital spinal fusion via a fiducial-based transcondylar, C1 lateral mass, C2 pedicle, and C3 lateral mass construct. This unique reduction technique has not been recorded in the literature before and avoided potential complications of overdistraction and the need for odontoidectomy. Furthermore, the use of bone fiducials for navigated screw fixation at the craniocervical junction is a novel technique and recommended particularly for placement of technically demanding transcondylar screws and C2 pedicle screws where pars anatomy is potentially unfavorable.

Endoscope-assisted far-lateral transcondylar approach for craniocervical junction chordomas: a retrospective case series and cadaveric dissection

2021 ◽  
pp. 1-12
Author(s):  
Arianna Fava ◽  
Paolo di Russo ◽  
Valentina Tardivo ◽  
Thibault Passeri ◽  
Breno Câmara ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Tumor Resection ◽  
Case Series ◽  
Craniocervical Junction ◽  
Anatomical Landmarks ◽  
Total Resection ◽  
Female Ratio ◽  
Cadaveric Dissection ◽  
Transcondylar Approach ◽  
Far Lateral

OBJECTIVE Craniocervical junction (CCJ) chordomas are a neurosurgical challenge because of their deep localization, lateral extension, bone destruction, and tight relationship with the vertebral artery and lower cranial nerves. In this study, the authors present their surgical experience with the endoscope-assisted far-lateral transcondylar approach (EA-FLTA) for the treatment of CCJ chordomas, highlighting the advantages of this corridor and the integration of the endoscope to reach the anterior aspect and contralateral side of the CCJ and the possibility of performing occipitocervical fusion (OCF) during the same stage of surgery. METHODS Nine consecutive cases of CCJ chordomas treated with the EA-FLTA between 2013 and 2020 were retrospectively reviewed. Preoperative characteristics, surgical technique, postoperative results, and clinical outcome were analyzed. A cadaveric dissection was also performed to clarify the anatomical landmarks. RESULTS The male/female ratio was 1.25, and the median age was 36 years (range 14–53 years). In 6 patients (66.7%), the lesion showed a bilateral extension, and 7 patients (77.8%) had an intradural extension. The vertebral artery was encased in 5 patients. Gross-total resection was achieved in 5 patients (55.6%), near-total resection in 3 (33.3%), and subtotal resection 1 (11.1%). In 5 cases, the OCF was performed in the same stage after tumor removal. Neither approach-related complications nor complications related to tumor resection occurred. During follow-up (median 18 months, range 5–48 months), 1 patient, who had already undergone treatment and radiotherapy at another institution and had an aggressive tumor (Ki-67 index of 20%), showed tumor recurrence at 12 months. CONCLUSIONS The EA-FLTA provides a safe and effective corridor to resect extensive and complex CCJ chordomas, allowing the surgeon to reach the anterior, lateral, and posterior portions of the tumor, and to treat CCJ instability in a single stage.

scholarly journals Foramen Magnum Meningioma: Microsurgical Endoscopic-Controlled Resection via a Lateral Suboccipital Retrocondylar Approach with Preservation of Posterior Arch of Atlas Integrity

2019 ◽  
Vol 80 (S 04) ◽  
pp. S352-S354
Author(s):  
Hischam Bassiouni
Keyword(s):  
Vertebral Artery ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Radical Resection ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Cervical Cord ◽  
Posterior Arch ◽  
Suboccipital Craniotomy ◽  
Upper Cervical

Abstract Objective Surgical treatment of foramen magnum (FM) meningiomas is challenging due to proximity of the tumor to critical neurovascular structures, namely, the lower brainstem/upper cervical cord, vertebral artery, PICA, and lower cranial nerves. Controversies in microsurgical resection of meningiomas in this location include the necessity for condyle drilling and the need for vertebral artery mobilization. However, a laminectomy or hemilaminectomy of the C1 posterior arch is usually routinely performed. We herein present microsurgical, endoscopic-controlled resection of a FM meningioma via a posterolateral retrocondylar suboccipital craniotomy with preservation of the integrity of the posterior arch of the atlas. Setting Our patient, a 57-year-old patient, suffered from right-sided hemiparesis due to a right-sided ventrolateral FM meningioma compromising the medulla oblongata and upper cervical cord. The tumor at the craniocervical junction was resected through a posterolateral suboccipital retrocondylar craniotomy. Results Radical resection of the FM meningioma was accomplished via a lateral suboccipital retrocondylar craniotomy with preservation of posterior arch of atlas integrity. The postoperative course was uneventful with full preservation of neurological function. Preoperative hemiparesis subsided completely after surgery. Conclusion Anterior-laterally located FM meningiomas can be safely and completely resected via a suboccipital retrocondylar craniotomy. A laminectomy or hemilaminectomy of the posterior arch of C1 is not routinely required for complete and safe resection of these tumors at the craniocervical junction. Neuroendoscopy is beneficial for control of complete tumor resection.The link to the video can be found at: https://youtu.be/DBk6qoJ6OzQ.

Resection of a cervical dumbbell schwannoma with stabilization through a single stage extended posterior approach

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video2 ◽  
Author(s):  
Paul C. McCormick
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Posterior Approach ◽  
Tumor Resection ◽  
Patient Positioning ◽  
Single Stage ◽  
Spinal Stability ◽  
Dural Repair ◽  
Instrumented Fusion ◽  
Link Type

Dumbbell tumors of the cervical spine can present considerable management challenges related to adequate exposure of both intraspinal and paraspinal tumor components, potential injury to the vertebral artery, and spinal stability. This video demonstrates the microsurgical removal of a large cervical dumbbell schwannoma with instrumented fusion via a single stage extended posterior approach. The video shows patient positioning, tumor exposure, and the sequence and techniques of tumor resection, vertebral artery identification and protection, and dural repair.The video can be found here: http://youtu.be/3lIVfKEcxss.

scholarly journals One-stage Stent-assisted Coil Embolization for Rupture-side-unknown Bilateral Vertebral Artery Dissecting Aneurysms in an Acute Stage: A Case Report

2018 ◽  
Vol 5 (2) ◽  
pp. 45-49
Author(s):  
Mio Terashima ◽  
Yoichi Miura ◽  
Fujimaro Ishida ◽  
Naoki Toma ◽  
Tomohiro Araki ◽  
...  
Keyword(s):  
Case Report ◽  
Vertebral Artery ◽  
Coil Embolization ◽  
Acute Stage ◽  
One Stage ◽  
Dissecting Aneurysms

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.

Abnormal spinal cord motion at the craniocervical junction in hypermobile Ehlers-Danlos patients

2021 ◽  
pp. 1-7
Author(s):  
Petra M. Klinge ◽  
Abigail McElroy ◽  
John E. Donahue ◽  
Thomas Brinker ◽  
Ziya L. Gokaslan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Neck Pain ◽  
Craniocervical Junction ◽  
Head Movements ◽  
Ehlers Danlos Syndrome ◽  
Transmission Electron ◽  
Pathogenic Factors ◽  
Healthy Control ◽  
Craniocervical Instability ◽  
Danlos Syndrome

OBJECTIVE The craniocervical junction (CCJ) is anatomically complex and comprises multiple joints that allow for wide head and neck movements. The thecal sac must adjust to such movements. Accordingly, the thecal sac is not rigidly attached to the bony spinal canal but instead tethered by fibrous suspension ligaments, including myodural bridges (MDBs). The authors hypothesized that pathological spinal cord motion is due to the laxity of such suspension bands in patients with connective tissue disorders, e.g., hypermobile Ehlers-Danlos syndrome (EDS). METHODS The ultrastructure of MDBs that were intraoperatively harvested from patients with Chiari malformation was investigated with transmission electron microscopy, and 8 patients with EDS were compared with 8 patients without EDS. MRI was used to exclude patients with EDS and craniocervical instability (CCI). Real-time ultrasound was used to compare the spinal cord at C1–2 of 20 patients with EDS with those of 18 healthy control participants. RESULTS The ultrastructural damage of the collagen fibrils of the MDBs was distinct in patients with EDS, indicating a pathological mechanical laxity. In patients with EDS, ultrasound revealed increased cardiac pulsatory motion and irregular displacement of the spinal cord during head movements. CONCLUSIONS Laxity of spinal cord suspension ligaments and the associated spinal cord motion disorder are possible pathogenic factors for chronic neck pain and headache in patients with EDS but without radiologically proven CCI.

Stab Wounds at the Craniocervical Junction

Neurosurgery ◽  
1985 ◽  
Vol 17 (6) ◽  
pp. 930-936 ◽  
Author(s):  
J.C. de Villiers ◽  
A. R. Grant
Keyword(s):  
Vertebral Artery ◽  
Surgical Repair ◽  
False Aneurysm ◽  
Craniocervical Junction ◽  
Artery Occlusion ◽  
Cerebrospinal Fluid Leakage ◽  
Warning Sign ◽  
Upper Limbs ◽  
Stab Wounds ◽  
Anatomical Features

Abstract Between 1976 and 1984, 11 patients with stab wounds at the craniocervical junction were seen in the Department of Neurosurgery at Groote Schuur Hospital. The injury usually occurred in males, and the left side was predominantly involved. Because of the anatomical features of this region, the penetrating instrument is deflected by the occipital squama into the atlantooccipital or atlantoaxial interspace, and an almost predictable syndrome occurs. The dura mater is penetrated, so that cerebrospinal fluid leakage and meningitis are common complications (meningitis occurred in 5 patients). A meningocele may develop at this site and did occur in 4 patients, but only 2 required surgical repair. Because of the exposed position of the vertebral artery at this level, this vessel was injured in 4 patients; an arteriovenous fistula developed in 2, vertebral artery occlusion occurred in 1, and a false aneurysm developed in another patient. The neurological deficit varied in magnitude, was often transient, affected the upper limbs more than the lower, was asymmetrical (suggestive of lateralized injury), and at times showed a remarkable tendency to recover. Awareness of the existence of this syndrome may help in forestalling complications. The only warning sign may be an insignificant wound in the suboccipital or retromastoid region.

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