Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients

1999 ◽  
Vol 90 (1) ◽  
pp. 206-219 ◽  
Author(s):  
Eduardo Salas ◽  
Laligam N. Sekhar ◽  
Ibrahim M. Ziyal ◽  
Anthony J. Caputy ◽  
Donald C. Wright
Keyword(s):  
Cervical Spine ◽  
Medulla Oblongata ◽  
Sigmoid Sinus ◽  
Vascular Lesions ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Bypass Procedure ◽  
Transcondylar Approach ◽  
Upper Cervical ◽  
Fine Print

Object. The aim of this study was to describe six variations of the extreme-lateral craniocervical approach, their application, and treatment results. Methods. During a 4-year period 69 patients underwent surgery in which six variations of the extreme-lateral craniocervical approach were performed. The variations included: the transfacetal approach (TFA), performed to treat four lesions in the upper cervical spine anterior or anterolateral to the spinal cord; the retrocondylar approach, to treat five intradural lesions located anterolateral to the medulla oblongata and six vascular lesions to expose the extradural segment of the vertebral artery (VA); the partial transcondylar approach (PTCA), to treat 18 intradural lesions located anterior to the medulla oblongata; the complete transcondylar approach (CTCA), to treat 13 extradural lesions that involved the lower clivus and anterior upper cervical spine; the extreme-lateral transjugular approach, to treat 14 jugular foramen tumors; and the transtubercular approach with or without division of the sigmoid sinus, to treat complex VA and vertebrobasilar junction aneurysms. An anatomical prosection was performed to study the surgical exposure of each of the six variations of the extreme-lateral craniocervical approach. Total removal was achieved in 35 (69%) of the patients with tumor; subtotal resection was achieved in 16 (31%) of those patients. In the 12 patients with VA aneurysms, seven underwent clipping, three underwent trapping and a vein graft bypass procedure, and two underwent trapping without the use of a bypass procedure. In five other patients, different cystic, inflammatory, and other vascular lesions were successfully treated. Fifty percent of the patients who underwent surgery via the TFA, 83% via the of the CTCA, and 11% via the PTCA required an occipitocervical fusion procedure. The mean Karnofsky Performance Scale score was 74.7 preoperatively and 76.4 postoperatively. Major complications were hydrocephalus (nine patients), cerebrospinal fluid leakage (seven patients), worsened cranial nerve function (seven patients), vertebrobasilar vasospasm (one patient), and sigmoid sinus thrombosis (one patient). Conclusions. To treat lesions in the region of the foramen magnum and surrounding areas, the approach should be tailored to each specific lesion to provide the needed exposure without unnecessary operative steps.

Fractures of the C-2 vertebral body

1994 ◽  
Vol 81 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Edward C. Benzel ◽  
Blaine L. Hart ◽  
Perry A. Ball ◽  
Nevan G. Baldwin ◽  
William W. Orrison ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Mr Imaging ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Body Fracture ◽  
Pars Interarticularis ◽  
Upper Cervical ◽  
Type 3 ◽  
Fine Print

✓ Vertical C-2 body fractures are presented in 15 patients with clinical and imaging correlations that suggest the existence of a variety of mechanisms of injury. In these patients, clinical and imaging correlations were derived by: 1) defining the point of impact by clinical examination; 2) defining the point of impact by soft-tissue changes on cranial magnetic resonance (MR) imaging or computerized tomography (CT); 3) obtaining an accurate history of the mechanism of injury; and 4) spine imaging (x-ray studies, CT, and MR imaging) of the C-2 body fracture and surrounding bone and soft tissue. The cases presented involve the region located between the dens and the pars interarticularis of the axis. Although these fractures are rarely reported, they are not uncommon. An elucidation of their pathological anatomy helps to further the understanding of the mechanistic etiology of upper cervical spine trauma. A spectrum of mechanisms of injury causing upper cervical spine fractures was observed. The type of injury incurred is determined predominantly by the force vector applied during impact and the intrinsic strength and anatomy of C-2 and its surrounding spinal elements. From this clinical experience, two types of vertical C-2 body fractures are defined and presented: coronally oriented (Type 1) and sagittally oriented (Type 2). A third type of C-2 body fracture, the horizontal rostral C-2 fracture (Type 3), is added for completeness; this Type 3 fracture is the previously described Type III odontoid process fracture described by Anderson and D'Alonzo.

Fracture of a sublaminar stainless steel cable in the upper cervical spine with neurological injury

1994 ◽  
Vol 81 (6) ◽  
pp. 932-933 ◽  
Author(s):  
J. Bob Blacklock
Keyword(s):  
Stainless Steel ◽  
Cervical Spine ◽  
Spinal Canal ◽  
Neurological Injury ◽  
Upper Cervical Spine ◽  
Steel Cable ◽  
Content Type ◽  
Atlantoaxial Fusion ◽  
Upper Cervical ◽  
Fine Print

✓ Sublaminar cables have been used to stabilize bone grafts for arthrodesis in the cervical spine in recent years. Previous accounts of their use have indicated no instances of breakage or neurological injury. This report is of a delayed cable fracture that resulted in penetration of the dura with neurological injury in a patient who had undergone atlantoaxial fusion for rheumatoid subluxation. The cable fracture occurred in the epidural space beneath the attempted arthrodesis and resulted in uncoiling of the cable, which penetrated the spinal canal and caused a one-sided sensory deficit.

Diffuse axonal injury due to lateral head rotation in a rat model

2000 ◽  
Vol 93 (4) ◽  
pp. 626-633 ◽  
Author(s):  
He Xiao-Sheng ◽  
Yi Sheng-Yu ◽  
Zhang Xiang ◽  
Fei Zhou ◽  
Zhang Jian-Ning ◽  
...  
Keyword(s):  
Medulla Oblongata ◽  
Rat Model ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Head Rotation ◽  
Cervical Cord ◽  
Content Type ◽  
Upper Cervical ◽  
Lateral Head ◽  
Fine Print

Object. The authors investigated the ramifications of producing diffuse axonal injury (DAI) by lateral head rotation in a rat model.Methods. Using a special injury-producing device, the rat's head was rapidly rotated 90° in the coronal plane at an angular velocity of at least 753.13 rad/second and an angular acceleration of at least 1.806 × 105 rad/second2; the rotation was complete within 2.09 msec. There were no statistically significant changes in PO2, PCO2, pH, or blood pressure values at 5, 15, or 60 minutes after head rotation compared with their respective preinjury baseline values. The rats exhibited posttraumatic behavior suppression for an average of 12.6 minutes. The mortality rate was 17%. The rats that survived had diffuse subarachnoid hemorrhage around the brainstem and upper cervical cord, but no obvious brain contusion. In sections stained with silver or hematoxylin and eosin, axonal swelling and bulblike protrusions at the axonal axis were observed in the medulla oblongata, midbrain, upper cervical cord, and corpus callosum between 6 hours and 144 hours postinjury. The axonal injuries were most severe in the brainstem and were accompanied by parenchymal bleeding. The density of bulblike axonal protrusions peaked 6 hours postinjury in the medulla oblongata and 24 hours postinjury in the midbrain.Conclusions. Rapid lateral head rotation can produce DAI characterized by severe damage to the rat brainstem.

Spectrum of the hangman's fracture

1976 ◽  
Vol 45 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Edward L. Seljeskog ◽  
Shelley N. Chou
Keyword(s):  
Basic Mechanism ◽  
Upper Cervical Spine ◽  
Fracture Treatment ◽  
Mechanism Of Injury ◽  
Hangman’S Fracture ◽  
Content Type ◽  
Upper Cervical ◽  
Fracture Instability ◽  
Hangman's Fracture ◽  
Fine Print

✓ The authors review their experience in managing 26 cases of “hangman's fracture.” The basic mechanism of injury was hyperextension of the upper cervical spine. Radiographic studies revealed a spectrum of injury beginning with the classical hangman's fracture and progressing to the simple C-2 laminar-pedicle fracture. Appreciation of the fracture instability will dictate the method and duration of fracture treatment. Management by a closed, nonoperative means resulted in solid union of the bone in all fully treated cases, with a minimum of morbidity.

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.

Traumatic atlantooccipital dislocation

1977 ◽  
Vol 46 (5) ◽  
pp. 663-666 ◽  
Author(s):  
Alan H. Fruin ◽  
Thomas P. Pirotte
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Upper Cervical Spine ◽  
Nerve Injuries ◽  
Content Type ◽  
Traumatic Dislocation ◽  
Upper Cervical ◽  
Cranial Nerve Injuries ◽  
Atlantooccipital Dislocation ◽  
Fine Print

✓ A case of traumatic atlantooccipital dislocation is presented and the literature reviewed. This type of traumatic dislocation is probably produced by violent hyperextension of the upper cervical spine. Cranial nerve injuries and spinal cord injuries are common. Early fusion is recommended.

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.

Traumatic interdural arachnoid cyst in the upper cervical spine

1996 ◽  
Vol 85 (2) ◽  
pp. 351-353 ◽  
Author(s):  
Han-Jung Chen ◽  
Leung Chen
Keyword(s):  
Cervical Spine ◽  
Arachnoid Cyst ◽  
Neurological Deficits ◽  
Upper Cervical Spine ◽  
Resonance Imaging ◽  
Content Type ◽  
Upper Cervical ◽  
History Of ◽  
Traumatic Origin ◽  
Progressive Weakness

✓ The case of an interdural arachnoid cyst of traumatic origin at the C3–5 level in an 18-year-old man was admitted to our hospital with a 1-year history of progressive weakness in left limbs and numbness below the clavicles is reported. He had had a C-2 fracture at the age of 9 years without definite neurological deficits. Magnetic resonance imaging revealed a cystic lesion in the C3–5 level. Laminectomy was performed, and an interdural cyst was found. Histological examination revealed fibrous thickening of the arachnoid membrane. A cyst located in the interdural space of upper cervical spine is extremely rare.

Avulsion transverse ligament injuries in children: successful treatment with nonoperative management

2002 ◽  
Vol 96 (3) ◽  
pp. 338-342 ◽  
Author(s):  
Patrick A. Lo ◽  
James M. Drake ◽  
Douglas Hedden ◽  
Pradeep Narotam ◽  
Peter B. Dirks
Keyword(s):  
Cervical Spine ◽  
Motor Vehicle ◽  
Ct Scanning ◽  
Upper Cervical Spine ◽  
Transverse Ligament ◽  
Ligament Injuries ◽  
Avulsion Fractures ◽  
Content Type ◽  
Transverse Atlantal Ligament ◽  
Fine Print

✓ Neck injuries in children most commonly affect the upper cervical spine. Injuries of the transverse ligament and its attachments may result in C1–2 instability, but the optimum form of treatment is unknown. Three patients, who ranged in age from 5 to 11 years, sustained transverse atlantal ligament injuries with unilateral avulsion fracture of the osseous tubercle of C-1. One child was injured in a fall and two were involved in motor vehicle accidents. Although all patients presented with neck pain, none exhibited neurological deficits. Plain radiography demonstrated no evidence of osseous injury, but an increased predental interval was noted in each case. Computerized tomography (CT) scanning demonstrated the avulsion fractures, and magnetic resonance imaging revealed evidence of soft-tissue injuries in the occipital—C2 ligamentous complex. All children were managed with external immobilization (halo vest in two and a Sterno-Occipito-Mandibular Immobilizer brace in one), for 6 to 12 weeks. Follow-up CT scanning demonstrated reattachment of the avulsed osseous tubercle, and dynamic cervical spine radiographs revealed the absence of C1–2 instability. The results of these cases suggest a role for external immobilization in the treatment of osseous avulsion injuries of the transverse atlantal ligament in children.

En bloc resection of multilevel cervical chordoma with C-2 involvement

2005 ◽  
Vol 2 (2) ◽  
pp. 199-205 ◽  
Author(s):  
Laurence D. Rhines ◽  
Daryl R. Fourney ◽  
Abdolreza Siadati ◽  
Ian Suk ◽  
Ziya L. Gokaslan
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Biological Behavior ◽  
Upper Cervical Spine ◽  
En Bloc ◽  
Content Type ◽  
Upper Cervical ◽  
The Right ◽  
Cervical Chordoma ◽  
Fine Print

✓ Chordomas are locally aggressive neoplasms with an extremely high propensity to recur locally following resection, despite adjuvant therapy. This biological behavior has led most authors to conclude that en bloc resection provides the best chance for the patient's prolonged disease-free survival and possible cure. The authors present a case of an extensive upper cervical chordoma treated by en bloc resection, reconstruction, and long-segment stabilization. Total spondylectomy of C2–4 with sacrifice of the right C2–4 nerve roots and a segment of the right vertebral artery was performed. The inherent anatomical complexities of en bloc resection in the upper cervical spine are discussed. To the authors' knowledge, this represents the first report of an en bloc resection for multilevel cervical chordoma.

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