Posterior transdural approach for odontoidectomy in a child: case report

2020 ◽  
Vol 25 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Jacob Archer ◽  
Meena Thatikunta ◽  
Andrew Jea
Keyword(s):  
Spinal Cord ◽  
Tube Feeding ◽  
Odontoid Process ◽  
Cord Compression ◽  
Basilar Invagination ◽  
Craniocervical Junction ◽  
Csf Leak ◽  
Prolonged Intubation ◽  
Soft Tissue Dissection ◽  
Transdural Approach

The transoral transpharyngeal approach is the standard approach to resect the odontoid process and decompress the cervicomedullary spinal cord. There are some significant risks associated with this approach, however, including infection, CSF leak, prolonged intubation or tracheostomy, need for nasogastric tube feeding, extended hospitalization, and possible effects of phonation. Other ventral approaches, such as transmandibular and circumglossal, endoscopic transcervical, and endoscopic transnasal, are also viable alternatives but are technically challenging or may still traverse the nasopharyngeal cavity. Far-lateral and posterior extradural approaches to the craniocervical junction require extensive soft-tissue dissection. Recently, a posterior transdural approach was used to resect retro-odontoid cysts in 3 adult patients. The authors present the case of a 12-year-old girl with Down syndrome and significant spinal cord compression due to basilar invagination and a retro-flexed odontoid process. A posterior transdural odontoidectomy prior to occiptocervical fusion was performed. At 12 months after surgery, the authors report satisfactory clinical and radiographic outcomes with this approach.

scholarly journals Posterior Transdural Approach for Odontoidectomy in a Child: Case Report

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jacob B Archer ◽  
Meena Thatikunta ◽  
Andrew H Jea
Keyword(s):  
Spinal Cord ◽  
Tube Feeding ◽  
Odontoid Process ◽  
Cord Compression ◽  
Basilar Invagination ◽  
Csf Leak ◽  
Prolonged Intubation ◽  
Radiographic Outcomes ◽  
Viable Approach ◽  
Transdural Approach

Abstract INTRODUCTION The transoral transpharyngeal approach is the standard approach to resect the odontoid process and decompress the cervicomedullary spinal cord. There are some significant risks associated with this approach, however, including infection, CSF leak, prolonged intubation or tracheostomy, need for nasogastric tube feeding, extended hospitalization, and possible effects of phonation. Recently, a posterior transdural approach was used to resect retro-odontoid cysts in 3 adult patients. We sought to use a similar approach to perform a posterior transdural odontoidectomy METHODS We present the case of a 12-yr-old girl with Down syndrome and significant spinal cord compression from basilar invagination and a retro-flexed odontoid process. We performed a posterior transdural odontoidectomy prior to occiptocervical fusion. RESULTS At 12-mo follow-up, we report satisfactory clinical and radiographic outcomes with this approach. CONCLUSION In carefully selected patients, a posterior odonoidectomy is a viable approach that can safely provide adequate ventral decompression of the spinal cord.

Endoscopic transcervical odontoidectomy for pediatric basilar invagination and cranial settling

2008 ◽  
Vol 1 (4) ◽  
pp. 337-342 ◽  
Author(s):  
Matthew J. McGirt ◽  
Frank J. Attenello ◽  
Daniel M. Sciubba ◽  
Ziya L. Gokaslan ◽  
Jean-Paul Wolinsky
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Tube Feeding ◽  
Basilar Invagination ◽  
Craniocervical Junction ◽  
Consecutive Series ◽  
Initial Experience ◽  
Prolonged Intubation ◽  
Alternative Approach

✓ Pediatric basilar invagination and cranial settling have traditionally been approached through a transoral–transpharyngeal route with or without extended maxillotomy or mandibulotomy for resection of the anterior portion of C-1 and the odontoid. The authors hypothesize that application of a recently described endoscopic transcervical odontoidectomy (ETO) technique would allow an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients. The authors performed ETO in a consecutive series of pediatric patients presenting with myelopathy or bulbar dysfunction resulting from basilar invagination or cranial settling. All clinical, radiographic, surgical, and follow-up data were prospectively collected. The initial experience with ETO in the pediatric population is analyzed and outcomes are reported. Three patients required ETO for basilar invagination and 1 required ETO with anterior C-1 arch and distal clivus resection for cranial settling. All patients presented with myelopathy. One patient was wheelchair bound with severe quadriparesis. The mean age was 14 ± 3 years (mean ± standard deviation [SD]) in the 2 male and 2 female patients. The ETO and posterior fusion were performed as a 2-stage procedure in 2 (50%) and as a single-stage procedure in 2 (50%) cases. Prolonged intubation or postoperative placement of a gastrostomy tube was not needed in any case. The postoperative hospitalization lasted 9 ± 4 days (mean ± SD). At last follow-up (mean 5 months), head and neck pain had resolved and motor strength had improved or stabilized in all cases. All 4 children were independently functioning and ambulatory at the last follow-up. In the authors' initial experience, ETO has allowed ventral brainstem decompression without the need for prolonged intubation, worsening dysphagia requiring enteral tube feeding, or prolonged hospitalization, and has resulted in cosmetically appealing results. The ETO technique allows an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients.

Endoscopic image-guided odontoidectomy for decompression of basilar invagination via a standard anterior cervical approach

2007 ◽  
Vol 6 (2) ◽  
pp. 184-191 ◽  
Author(s):  
Jean-Paul Wolinsky ◽  
Daniel M. Sciubba ◽  
Ian Suk ◽  
Ziya L. Gokaslan
Keyword(s):  
Spinal Cord ◽  
Oral Cavity ◽  
Surgical Approach ◽  
Tube Feeding ◽  
Cerebrospinal Fluid Leak ◽  
Basilar Invagination ◽  
Anterior Portion ◽  
Prolonged Intubation ◽  
Pathological Conditions ◽  
Spinal Cord Decompression

✓Symptomatic irreducible basilar invagination has traditionally been approached through a transoral–transpharyngeal route with resection of the anterior portion of C-1 and the odontoid. Modification of this exposure with either a Le Fort osteotomy or a transmandibular osteotomy and circumglossal approach has increased the access to pathological conditions in this region. These traditional routes all require traversing the oral cavity and accepting the associated potential complications. The authors have developed a novel surgical approach, an endoscopic transcervical odontoidectomy, which allows access for resection of the odontoid and for brainstem and spinal cord decompression without traversing the oral cavity. In this paper they describe the technique and its advantages and present three cases in which patients underwent the endoscopic transcervical odontoidectomy for basilar invagination. Three consecutive patients (age range 42–74 years) who had irreducible basilar invagination underwent the endoscopic transcervical odontoidectomy. All were symptomatic and had neck pain and myelopathy. All were evaluated preoperatively and postoperatively with computed tomography and magnetic resonance imaging. In all cases the procedure resulted in complete decompression. There were no serious complications. No patient required prolonged intubation, tracheostomy, or enteral tube feeding. One patient had an intraoperative cerebrospinal fluid leak, which had no postoperative sequelae. The authors present an alternative surgical approach for treating ventral compression of the brainstem and spinal cord. The technique is safe and effective for decompression and provides a surgical route that can be added to the armamentarium of treatments for pathological conditions in this region.

Odontoid cervical gout causing atlantoaxial instability: case report

2019 ◽  
Vol 30 (4) ◽  
pp. 541-544
Author(s):  
Justin Slavin ◽  
Marcello DiStasio ◽  
Paul F. Dellaripa ◽  
Michael Groff
Keyword(s):  
Rheumatoid Arthritis ◽  
Spinal Cord ◽  
Case Report ◽  
Physical Examination ◽  
Odontoid Process ◽  
Signs And Symptoms ◽  
Cord Compression ◽  
Atlantoaxial Instability ◽  
Posterior Stabilization ◽  
Rotatory Subluxation

The authors present a case report of a patient discovered to have a rotatory subluxation of the C1–2 joint and a large retroodontoid pannus with an enhancing lesion in the odontoid process eventually proving to be caused by gout. This patient represented a diagnostic conundrum as she had known prior diagnoses of not only gout but also sarcoidosis and possible rheumatoid arthritis, and was in the demographic range where concern for an oncological process cannot fully be ruled out. Because she presented with signs and symptoms of atlantoaxial instability, she required posterior stabilization to reduce the rotatory subluxation and to stabilize the C1–2 instability. However, despite the presence of a large retroodontoid pannus, she had no evidence of spinal cord compression on physical examination or imaging and did not require an anterior procedure to decompress the pannus. To confirm the diagnosis but avoid additional procedures and morbidity, the authors proceeded with the fusion as well as a posterior biopsy to the retroodontoid pannus and confirmed a diagnosis of gout.

scholarly journals Pericranial and scalp rotation flaps for occipitocervical hardware exposure with CSF leak in rheumatoid arthritis patient: A case report and review of the literature

2021 ◽  
Vol 12 ◽  
pp. 229
Author(s):  
Claudio Schonauer ◽  
Ciro Mastantuoni ◽  
Oreste de Divitiis ◽  
Francesco D’Andrea ◽  
Raffaele de Falco ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cord Compression ◽  
Craniocervical Junction ◽  
Csf Leak ◽  
Cervical Cord ◽  
Congenital Deformity ◽  
Rotation Flap ◽  
Pull Out ◽  
Csf Leakage ◽  
High Cervical

Background: There are several etiologies of craniocervical junction instability (CCJI); trauma, rheumatoid arthritis (RA), infections, tumors, congenital deformity, and degenerative processes. These conditions often require surgery and craniocervical fixation. In rare cases, breakdown of such CCJI fusions (i.e., due to cerebrospinal fluid [CSF] leaks, infection, and wound necrosis) may warrant the utilization of occipital periosteal rescue flaps and scalp rotation flaps to achieve adequate closure. Case Description: A 33-year-old female with RA, cranial settling, and high cervical cord compression underwent an occipitocervical instrumented C0–C3/C4 fusion. Two months later, revision surgery was required due to articular screws pull out, CSF leakage, and infection. At the second surgery, the patient required screws removal, the application of laminar clamps, and sealing the leak with fibrin glue. However, the CSF leak persisted, and the skin edges necrosed leaving the hardware exposed. The third surgery was performed in conjunction with a plastic surgeon. It included operative debridement and covering the instrumentation with a pericranial flap. The resulting cutaneous defect was then additionally reconstructed with a scalp rotation flap. Postoperatively, the patient adequately recovered without sequelae. Conclusion: A 33-year-old female undergoing an occipitocervical fusion developed a postoperative persistent CSF leak, infection, and wound necrosis. This complication warranted the assistance of plastic surgery to attain closure. This required an occipital periosteal rescue flap with an added scalp rotation flap.

scholarly journals Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior compression

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Xingwen Wang ◽  
Longbing Ma ◽  
Zhenlei Liu ◽  
Zan Chen ◽  
Hao Wu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Intraoperative Ct ◽  
Image Guided ◽  
Transoral Odontoidectomy ◽  
Accurate Localization ◽  
Indirect Decompression ◽  
Challenging Situation

Abstract Background Although the single-stage posterior realignment craniovertebral junction (CVJ) surgery could treat most of the basilar invagination (BI) and atlantoaxial dislocation (AAD), there are still some cases with incomplete decompression of the spinal cord, which remains a technique challenging situation. Methods Eleven patients were included with remained myelopathic symptoms after posterior correction due to incomplete decompression of the spinal cord. Transoral odontoidectomy assisted by image-guided navigation and intraoperative CT was performed. Clinical assessment and image measurements were performed preoperatively and at the most recent follow-up. Results Eleven patients were followed up for an average of 47 months. Symptoms were alleviated in 10 of 11 patients (90.9%). One patient died of an unknown reason 1 week after the transoral approach. The clinical and radiological parameters pre- and postoperatively were reported. Conclusion Transoral odontoidectomy as a salvage surgery is safe and effective for properly selected BI and AAD patients after inadequate indirect decompression from posterior distraction and fixation. Image-guided navigation and intraoperative CT can provide precise information and accurate localization during operation, thus enabling complete resection of the odontoid process and decompression of the spinal cord.

scholarly journals Congenital deformation of the posterior arch of the atlas: Subluxation of the atlanto-axial joint with temporary quadriplegia

2019 ◽  
Vol 7 ◽  
pp. 2050313X1882338
Author(s):  
Tobias M Ballhause ◽  
Mirko Velickovic ◽  
Darius M Thiesen ◽  
Marc Dreimann
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Congenital Malformation ◽  
Neurological Disorders ◽  
Odontoid Process ◽  
Craniocervical Junction ◽  
Posterior Arch ◽  
The Third ◽  
Congenital Origin ◽  
Atlanto Axial Joint

Instabilities of the craniocervical junction can be of rheumatic, traumatic, or congenital origin. The reported patient has a congenital malformation of the cervical spine, which is frequently observed in patients with Klippel–Feil syndrome. Her posterior arch of the atlas (C1) is hypoplastic and a chronic subluxation of the atlanto-axial joint would be possible. Although most common fusions in Klippel–Feil syndrome patients exist at C2/3, the majority of studies about Klippel–Feil syndrome deal with pediatric or adolescent individuals. Through extreme flexion of her neck, there was a compression of the spinal cord by the odontoid process. This led to a quadriplegia lasting about 10 min. Over the following weeks, all of her symptoms started to diminish. This situation turned out to be the third episode involving temporary neurological disorders in this 60-year-old female’s life.

scholarly journals Odontoid pseudotumor and serial postfusion radiographic evaluation in a patient with a C1–2 mass

2015 ◽  
Vol 22 (6) ◽  
pp. 605-610 ◽  
Author(s):  
Daniel S. Yanni ◽  
Alexander Y. Halim ◽  
Daniela Alexandru
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Literature Review ◽  
Effective Treatment ◽  
Literature Search ◽  
Odontoid Process ◽  
Craniocervical Junction ◽  
Radiographic Evaluation ◽  
Effective Treatment Option ◽  
Posterior Decompression

Odontoid pseudotumor is a mass occurring around the odontoid process in the cervical spine and can cause significant neurological symptoms at the craniocervical junction due to compression of the spinal cord and cervicomedullary junction at this level. A literature review was performed to provide input on options for treatment and prognosis for this lesion. The literature search found 12 papers in which pseudotumor was treated with posterior decompression and fixation. Posterior decompression and fixation with serial imaging to monitor the size of the pseudotumor postsurgery is a safe and effective treatment option for odontoid pseudotumors.

Endoscopic Transnasal Transclival Odontoidectomy: A New Approach to Decompression: Technical Case Report

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONSE92-ONSE94 ◽  
Author(s):  
Jau-Ching Wu ◽  
Wen-Cheng Huang ◽  
Henrich Cheng ◽  
Muh-Lii Liang ◽  
Ching-Yin Ho ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
New Approach ◽  
Prolonged Intubation ◽  
Less Invasive ◽  
Transoral Odontoidectomy ◽  
Occipitocervical Fixation ◽  
Lateral Mass Screws

Abstract Objective: Endoscopic transnasal transclival resection of the odontoid process is less invasive than the standard transoral odontoidectomy. In this article, we describe our techniques, which are less invasive but provide successful decompression. Clinical Presentation: From September 2004 to April 2007, three consecutive patients with basilar invagination and instability in the craniovertebral junction were enrolled. The causes for the invagination and instability included rheumatoid arthritis in two patients and trauma in one patient, and all patients presented with myelopathy and quadriparesis before intervention. Intervention: All three patients underwent an endoscopic transnasal transclival approach for anterior decompression and resection of the displaced odontoid process and pannus to decompress the underlying medulla. Subsequently, they received occipitocervical fixation by lateral mass screws and bone fusion to ensure stability. Remarkable neurological recovery was observed after surgery in all patients, and no adverse effects were noted. Conclusion: Compared with the standard transoral approach, the transnasal transclival endoscopic approach for decompressing basilar invagination is a feasible and effective alternative that avoids common disadvantages like prolonged intubation, excessive tongue retraction, and the need for palatal incision.

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