scholarly journals Delayed neurological deterioration following atlantoaxial facet joint distraction and fixation in a patient with Chiari malformation type I

2018 ◽  
Vol 28 (3) ◽  
pp. 262-267 ◽  
Author(s):  
Tatsushi Inoue ◽  
Natsuki Hattori ◽  
Tsukasa Ganaha ◽  
Tadashi Kumai ◽  
Shinichiro Tateyama ◽  
...  
Keyword(s):  
Chiari Malformation ◽  
Intervention Strategy ◽  
Essential Element ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Type I ◽  
Atlantoaxial Joint ◽  
Chiari Malformation Type I ◽  
Neurological Improvement ◽  
Joint Distraction

Chiari malformation type I (CM-I) is typically treated with foramen magnum decompression. However, a recent study proposed a new technique for patients with CM-I, wherein only short atlantoaxial joint fusion and distraction is applied. Posterior fusion with or without atlantoaxial distraction is a potential option for patients with CM-I associated with basilar invagination or complex anomalous bony craniovertebral junction pathology, since this procedure allows clinicians to avoid using the technically demanding transoral approach in which some or all of the odontoid tip is invisible. Distraction of the atlantoaxial joint reduces ventral cervicomedullary compression, leading to neurological improvement. Here, the authors report the case of a 50-year-old woman with CM-I plus basilar invagination whose condition immediately improved but then gradually deteriorated following atlantoaxial joint distraction and fusion. Therefore, the authors performed endonasal/transoral odontoidectomy, which resulted in prolonged neurological recovery. Short atlantoaxial fusion with distraction is a smart and ideal surgical planning concept that can result in significant neurological improvement. However, this case suggests that anterior odontoidectomy is still an essential element of the intervention strategy for patients with CM-I with complex craniovertebral junction pathology.

Craniovertebral junction abnormalities with hindbrain herniation and syringomyelia: regression of syringomyelia after removal of ventral craniovertebral junction compression

2012 ◽  
Vol 116 (2) ◽  
pp. 301-309 ◽  
Author(s):  
Arnold H. Menezes
Keyword(s):  
Mr Imaging ◽  
Posterior Fossa ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Os Odontoideum ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Lower Cranial Nerve ◽  
Neurological Improvement ◽  
Hindbrain Herniation

Object Hindbrain herniation syndrome, or Chiari malformation Type I (CM-I), occurs frequently with craniovertebral junction (CVJ) abnormalities when there is reduction in the posterior fossa volume. Syringomyelia is often present. Posterior fossa dorsal decompression (PFDD) is typically performed but has adverse results when ventral bone abnormality exists. This paper presents the results of a prospective study on CVJ abnormalities in patients with CM-I and syringomyelia. Methods Between 1984 and 2008 (the MR imaging era), 298 patients with CVJ abnormalities and CM-I underwent ventral cervicomedullary decompression. Eighty-four patients had associated syringomyelia (15 with secondary invagination and 69 with primary basilar invagination, os odontoideum, or malunion of fractures). Of these 84 patients with CVJ abnormalities, CM-I, and syringomyelia, 46 had previously undergone PFDD, and 28 had previously undergone PFDD combined with fusion procedures or shunt placements. Of the 84 patients, a cervicothoracic syrinx was observed in 57, thoracic syrinx in 14, and holocord syrinx in 13. Studies included CT, MR imaging, and cine flow studies. All 298 patients who underwent ventral CVJ decompression had irreducible or partially reducible pathology. All 84 with syringomyelia showed brainstem dysfunction, lower cranial nerve symptoms, or myelopathy. Results Brainstem signs improved in 66 of the 84 patients, myelopathy improved in 58, and syringomyelia regressed in 64. Conclusions Neurological improvement and syringomyelia resolution can occur using only ventral cervicomedullary junction decompression in patients with basilar invagination and basilar impression. This is likely due to the relief of neural encroachment and reestablishment of CSF pathways.

scholarly journals Results of surgical treatment of patients with basilar invagination associated with type I Chiari malformation

2021 ◽  
Vol 23 (1) ◽  
pp. 83-90
Author(s):  
D. S. Epifanov ◽  
V. B. Lebedev ◽  
A. A. Zuev
Keyword(s):  
Surgical Treatment ◽  
Clinical Picture ◽  
Chiari Malformation ◽  
Neurological Status ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Type I ◽  
Posterior Decompression ◽  
National Medical ◽  
Specific Symptoms

Introduction. Each of the pathologies is rare and can lead to compression of the brainstem and spinal cord, with the development of a “mixed” clinical picture. The tactics of treating such patients differs from one author to another.The objective is to present the author’s experience in treating patients with basilar invagination associated with type I Chiari malformation and to analyze the literature on the methods of surgical treatment of this pathology.Materials and methods. From 2014 to 2019, 3 patients with a basilar invagination and type I Chiari malformation were surgically treated at the N. I. Pirogov National Medical and Surgical Center. Indications for surgical intervention were long-term progressive neurological disorders, lack of effect from conservative therapy. Patients underwent anterior transnasal and posterior decompression of nerve structures followed by stabilization.Results. All patients were evaluated 12 months after surgery. All patients in neurological status showed positive dynamics. According to magnetic resonance imaging of the craniovertebral junction, 2 patients showed positive dynamics: regression of the myelopathy, a decrease in the diameter of the syringomyelic cyst.Conclusion. The criteria for anterior transnasal decompression are the predominance of bulbar disorders and / or paresis in the extremities in the clinical picture; posterior decompression of nerve structures, indicated in the presence of specific symptoms of type I Chiari malformation and / or syringomyelia. Taking into account the results of the latest published studies it can be assumed that stabilization is a necessary option in the treatment of patients with this pathology.

scholarly journals Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis

2020 ◽  
Vol 162 (7) ◽  
pp. 1553-1563 ◽  
Author(s):  
Arthur Wagner ◽  
Lukas Grassner ◽  
Nikolaus Kögl ◽  
Sebastian Hartmann ◽  
Claudius Thomé ◽  
...  
Keyword(s):  
Literature Review ◽  
Critical Analysis ◽  
Chiari Malformation ◽  
Basilar Invagination ◽  
Atlantoaxial Instability ◽  
Type I ◽  
Chiari Malformation Type I

scholarly journals Basilar invagination associated with chiari malformation type I: A literature review

Clinics ◽  
2019 ◽  
Vol 74 ◽  
Author(s):  
José Nazareno Pearce de Oliveira Brito ◽  
Bruna Afonso dos Santos ◽  
Isys Fialho Nascimento ◽  
Leonardo Augusto Martins ◽  
Cléciton Braga Tavares
Keyword(s):  
Literature Review ◽  
Chiari Malformation ◽  
Basilar Invagination ◽  
Type I ◽  
Chiari Malformation Type I

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 Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis

2020 ◽  
Vol 162 (11) ◽  
pp. 2925-2925
Author(s):  
Bernhard Meyer ◽  
Arthur Wagner ◽  
Lukas Grassner ◽  
Nikolaus Kögl ◽  
Sebastian Hartmann ◽  
...  
Keyword(s):  
Literature Review ◽  
Critical Analysis ◽  
Chiari Malformation ◽  
Basilar Invagination ◽  
Atlantoaxial Instability ◽  
Type I ◽  
Chiari Malformation Type I

scholarly journals Chiari Malformation- Report of 3 Cases

2010 ◽  
Vol 23 (1) ◽  
pp. 84-86
Author(s):  
Md Zahed Hossain ◽  
Md Kafil Uddin
Keyword(s):  
Chiari Malformation ◽  
Craniovertebral Junction ◽  
Sensory Loss ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Suboccipital Craniectomy ◽  
Classical Picture

3 cases of chiari malformation type-I were presented with classical picture of spasticity, quadriparesis and dissociated sensory loss and were operated ( Craniovertebral junction decompression by midline suboccipital craniectomy with removal of C1 arch and duroplasty). All the 3 patients were improved. Among them one patient recovered with some morbidity for postoperative other diseases. TAJ 2010; 23(1): 84-86

scholarly journals Relationship of syrinx size and tonsillar descent to spinal deformity in Chiari malformation Type I with associated syringomyelia

2014 ◽  
Vol 13 (4) ◽  
pp. 368-374 ◽  
Author(s):  
Jakub Godzik ◽  
Michael P. Kelly ◽  
Alireza Radmanesh ◽  
David Kim ◽  
Terrence F. Holekamp ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Chiari Malformation ◽  
Craniovertebral Junction ◽  
Primary Objective ◽  
Spine Deformity ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Increased Risk ◽  
Relationship Of ◽  
Tonsillar Descent

Object Chiari malformation Type I (CM-I) is a developmental abnormality often associated with a spinal syrinx. Patients with syringomyelia are known to have an increased risk of scoliosis, yet the influence of specific radiographically demonstrated features on the prevalence of scoliosis remains unclear. The primary objective of the present study was to investigate the relationship of maximum syrinx diameter and tonsillar descent to the presence of scoliosis in patients with CM-I–associated syringomyelia. A secondary objective was to explore the role of craniovertebral junction (CVJ) characteristics as additional risk factors for scoliosis. Methods The authors conducted a retrospective review of pediatric patients evaluated for CM-I with syringomyelia at a single institution in the period from 2000 to 2012. Syrinx morphology and CVJ parameters were evaluated with MRI, whereas the presence of scoliosis was determined using standard radiographic criteria. Multiple logistic regression was used to analyze radiological features that were independently associated with scoliosis. Results Ninety-two patients with CM-I and syringomyelia were identified. The mean age was 10.5 ± 5 years. Thirty-five (38%) of 92 patients had spine deformity; 23 (66%) of these 35 patients were referred primarily for deformity, and 12 (34%) were diagnosed with deformity during workup for other symptoms. Multiple regression analysis revealed maximum syrinx diameter > 6 mm (OR 12.1, 95% CI 3.63–40.57, p < 0.001) and moderate (5–12 mm) rather than severe (> 12 mm) tonsillar herniation (OR 7.64, 95% CI 2.3–25.31, p = 0.001) as significant predictors of spine deformity when controlling for age, sex, and syrinx location. Conclusions The current study further elucidates the association between CM-I and spinal deformity by defining specific radiographic characteristics associated with the presence of scoliosis. Specifically, patients presenting with larger maximum syrinx diameters (> 6 mm) have an increased risk of scoliosis.

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