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.

Basilar invagination: a study based on 190 surgically treated patients

1998 ◽  
Vol 88 (6) ◽  
pp. 962-968 ◽  
Author(s):  
Atul Goel ◽  
Mohinish Bhatjiwale ◽  
Ketan Desai
Keyword(s):  
Chiari Malformation ◽  
Odontoid Process ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Transoral Surgery ◽  
Content Type ◽  
Group I ◽  
Brainstem Compression ◽  
Group Ii ◽  
Fine Print

Object. The authors analyzed the cases of 190 patients with basilar invagination that was diagnosed on the basis of criteria laid down in 1939 by Chamberlain to assess the appropriate surgical procedure. Methods. Depending on the association with Chiari malformation, the anomaly of basilar invagination was classified into two groups. Eighty-eight patients who had basilar invagination but no associated Chiari malformation were assigned to Group I; the remainder of the patients, who had both basilar invagination and Chiari malformation, were assigned to Group II. The principal pathological characteristic was observed to be direct brainstem compression due to odontoid process indentation in Group I and a reduction in posterior cranial fossa volume in Group II. Conclusions. Despite the anterior concavity of the brainstem in both groups, transoral surgery was the most suitable procedure for those patients in Group I and decompression of the foramen magnum was found to be appropriate for patients in Group II. After surgical decompression, a fixation procedure was found to be necessary in most Group I cases, but only in a small minority of Group II cases.

Inclination of the odontoid process in the pediatric Chiari I malformation

2003 ◽  
Vol 98 (1) ◽  
pp. 43-49 ◽  
Author(s):  
R. Shane Tubbs ◽  
John C. Wellons ◽  
Jeffrey P. Blount ◽  
Paul A. Grabb ◽  
W. Jerry Oakes
Keyword(s):  
Odontoid Process ◽  
Postoperative Outcome ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Magnetic Resonance Images ◽  
Posterior Aspect ◽  
Content Type ◽  
Chiari I ◽  
Fine Print

Object. The quantitative analysis of odontoid process angulation has had scant attention in the Chiari I malformation population. In this study the authors sought to elucidate the correlation between posterior angulation of the odontoid process and patients with Chiari I malformation. Methods. Magnetic resonance images of the craniocervical junction obtained in 100 children with Chiari I malformation and in 50 children with normal intracranial anatomy (controls) were analyzed. Specific attention was focused on measuring the degree of angulation of the odontoid process and assigning a score to the various degrees. Postoperative outcome following posterior cranial fossa decompression was then correlated to grades of angulation. Other measurements included midsagittal lengths of the foramen magnum and basiocciput, the authors' institutions' previously documented pB—C2 line (a line drawn perpendicular to one drawn between the basion and the posterior aspect of the C-2 body), level of the obex from a midpoint of the McRae line, and the extent of tonsillar herniation. Higher grades of odontoid angulation (retroflexion) were found to be more frequently associated with syringomyelia and particularly holocord syringes. Higher grades of angulation were more common in female patients and were often found to have obices that were caudally displaced greater than three standard deviations below normal. Conclusions. These results not only confirm prior reports of an increased incidence of a retroflexed odontoid process in Chiari I malformation but quantitatively define grades of inclination. Grades of angulation were not found to correlate with postoperative outcome. It is the authors' hopes that these data add to our current limited understanding of the mechanisms involved in hindbrain herniation.

Extreme lateral—transatlas approach for resection of the dens of the axis

2002 ◽  
Vol 96 (1) ◽  
pp. 73-82 ◽  
Author(s):  
Uğur Türe ◽  
M. Necmettin Pamir
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Clinical Experiences ◽  
Occipitocervical Fusion ◽  
Content Type ◽  
Advantages And Disadvantages ◽  
Alternative Approach ◽  
Craniocervical Instability ◽  
Fine Print

Object. Various approaches have been described for resection of the dens of the axis, each of which has potential advantages and disadvantages. Anterior approaches such as the transoral route or its modifications are the most commonly used for resection of this structure. The transcondylar approach, however, which allows the surgeon to view the craniovertebral junction (CVJ) from a lateral perspective, has been introduced by Al-Mefty, et al., as an alternative approach. In this report, the authors describe the surgical technique of the extreme lateral—transatlas approach and their clinical experiences. Methods. The authors first examined the surgical approach to the dens from a lateral perspective in five cadaveric heads. They found that removal of the lateral mass of the atlas provided adequate exposure for resection of the dens. Following this cadaveric study, the extreme lateral—transatlas approach was successfully performed at the authors' institution over a 1-year period (September 1998–August 1999) in five patients with basilar invagination due to congenital anomaly of the CVJ and rheumatoid arthritis. Furthermore, during the same procedure, unilateral occipitocervical fusion was performed following resection of the dens. In all cases complete resection of the dens was achieved using the extreme—lateral transatlas approach. This procedure provides a sterile operative field and the ability to perform occipitocervical fusion immediately following the resection. No postoperative complications or craniocervical instability were observed. The mean follow-up period was 17.2 months (range 13–24 months). Conclusions. The extreme lateral—transatlas approach for resection of the dens was found to be safe and effective. Knowledge of the anatomy of this region, especially of the V3 segment of the vertebral artery, is essential for the success of this procedure.

Cervical disc herniation presenting as a mass lesion posterior to the odontoid process

1991 ◽  
Vol 75 (6) ◽  
pp. 954-959 ◽  
Author(s):  
William S. Rosenberg ◽  
Andrew E. Rosenberg ◽  
Charles E. Poletti
Keyword(s):  
Differential Diagnosis ◽  
Intervertebral Disc ◽  
Elderly Women ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Cervical Disc ◽  
Content Type ◽  
Healthy Elderly ◽  
Herniated Intervertebral Disc ◽  
Fine Print

✓ The authors report two cases of herniated intervertebral disc presenting as a mass posterior to the odontoid process and causing myelopathy in previously healthy elderly women. The differential diagnosis of a mass at the craniovertebral junction is reviewed, and the implications of these cases are discussed.

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.

Syringomyelia as a complication of Paget's disease

1987 ◽  
Vol 66 (4) ◽  
pp. 611-613 ◽  
Author(s):  
Kost Elisevich ◽  
Suzanne Fontaine ◽  
Gilles Bertrand
Keyword(s):  
Paget’S Disease ◽  
Adult Life ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Paget's Disease ◽  
Content Type ◽  
Chiari Malformations ◽  
Fine Print

✓ Cranial settling and basilar invagination with medullospinal compression is believed to have resulted in the production of a syrinx in a case of Paget's disease of the cranium. This mechanism of compression at the craniovertebral junction resembles the development of syringomyelia in Chiari malformations presenting in adult life.

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.

Craniovertebral instability due to degenerative osteoarthritis of the atlantoaxial joints: analysis of the management of 108 cases

2010 ◽  
Vol 12 (6) ◽  
pp. 592-601 ◽  
Author(s):  
Atul Goel ◽  
Abhidha Shah ◽  
Sanjay Rajan Gupta
Keyword(s):  
Cord Compression ◽  
Basilar Invagination ◽  
Atlantoaxial Instability ◽  
Atlantoaxial Joint ◽  
Lateral Mass ◽  
Tissue Mass ◽  
Degenerative Osteoarthritis ◽  
Joint Distraction ◽  
Atlantoaxial Fixation ◽  
Compression Treatment

Object The authors retrospectively analyzed a series of 108 patients in whom was diagnosed atlantoaxial instability due to degenerative osteoarthritis of the atlantoaxial joints. The management issues in such cases are discussed. Methods One hundred eight patients with osteoarthritis of the atlantoaxial joints and resultant craniovertebral instability—diagnosed on the basis of presenting clinical features, radiological imaging, and direct observation of the joint status during surgery—were retrospectively analyzed. Between 1990 and 2008, these patients were treated with a C1–2 lateral mass plate and screw method of atlantoaxial fixation and joint distraction using bone graft with or without the assistance of metal spacers. Results Patient ages ranged from 48 to 84 years (average 63 years). There was a history of mild to moderate head and/or neck trauma 2 months to 11 years prior to diagnosis in 40% of the cases. All patients had symptoms of neck pain, and 82% of the patients had progressive myelopathy. A reduction in the height of the atlantoaxial lateral mass complex (100%), mobile atlantoaxial dislocation (100%), basilar invagination (68%), and periodontoid degenerative tissue mass (90%) were the more frequently encountered radiological features. Two patients died in the immediate postoperative period. At an average follow-up of 64 months, all surviving patients remarkably improved to varying degrees in their neurological condition. Conclusions Atlantoaxial joint arthritis frequently leads to craniovertebral instability and cord compression. Treatment by joint distraction and lateral mass fixation can be an optimum form of treatment.

scholarly journals Increase of the clivus-canal angle in patients with basilar invagination, without atlantoaxial displacement, treated with a simple maneuver of indirect decompression of the odontoid with the head clamp, during posterior occipitocervical arthrodesis

2021 ◽  
Vol 12 ◽  
pp. 260
Author(s):  
Claudio Henrique F. Vidal ◽  
Ricardo Brandao Fonseca ◽  
Bruno Leimig ◽  
Walter F. Matias-Filho ◽  
Geraldo Sa Carneiro-Filho
Keyword(s):  
Postoperative Period ◽  
Posterior Approach ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Occipitocervical Fixation ◽  
Significant Difference ◽  
Indirect Decompression ◽  
Head Clamp

Background: Basilar invagination (BI) can be defined as the insinuation of the content of the craniovertebral junction through the foramen magnum toward the posterior fossa. BI is a prevalent condition in Northeast Brazil. The present study describes the changes in the clivus-canal angle (CCA) in the postoperative period in patients with symptomatic BI operated by a posterior approach, using a simple technique of indirect reduction of the odontoid associated with occipitocervical fixation. Methods: Patients underwent radiological evaluations by magnetic resonance imaging in the pre and postoperative periods, where the height of the odontoid tip was measured in relation to the Chamberlain line and the ACC. All patients underwent posterior occipitocervical fixation with specific maneuvers of distraction and extension of the cephalic segment with the aid of a head clamp with three fixation points for anterior reduction of the odontoid. Results: Among the 8 patients evaluated in the series, all had increased ACC in the postoperative period, with a mean of 14.81 ± 1.54°, and statistically significant difference between the pre and postoperative periods (P < 0.05). Conclusion: The indirect surgical reduction of the odontoid process by a posterior approach through the manipulation (distraction-extension) of a “Mayfield” type of head clamp followed by occipitocervical fixation proved to be effective in improving the ACC, being easily reproducible.

Bilateral sagittal split mandibular osteotomies as an adjunct to the transoral approach to the anterior craniovertebral junction

1999 ◽  
Vol 90 (2) ◽  
pp. 267-270 ◽  
Author(s):  
A. Giancarlo Vishteh ◽  
Stephen P. Beals ◽  
Edward F. Joganic ◽  
Jacque L. Reiff ◽  
Curtis A. Dickman ◽  
...  
Keyword(s):  
Inferior Alveolar Nerve ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Transoral Approach ◽  
Surgical Instruments ◽  
Content Type ◽  
Mucosal Incision ◽  
The Mean ◽  
Fine Print

✓ Transoral approaches are used to expose the craniovertebral junction anteriorly. In patients in whom there is limited mandibular excursion, the placement of retractors and/or surgical instruments is difficult, and midline “stairstep split mandibulotomy” has been advocated as an adjunctive procedure. Although effective, this approach requires external splitting of the lip as well as median glossotomy or a lateral mucosal incision. The purpose of this study was to show that bilateral sagittal split mandibular osteotomies (BSSMOs), which are used in orthognathic surgery, represent a safer and more effective alternative to the stairstep split mandibulotomy when performed as an adjunct to the transoral approach because all incisions are intraoral and the plane of retraction is rostrocaudal instead of lateral. Hospital records and radiographic files of four patients who underwent BSSMO/transoral approach for odontoidectomy between 1994 and 1997 were reviewed retrospectively. There were three women and one boy (mean age 37.8 years, range 11–68 years). Predisposing conditions included rheumatoid arthritis (two patients), Klippel—Feil syndrome (one patient), and congenital occipitocervical instability (one patient). Jaw mobility was limited in all patients. In addition, one patient had macroglossia, another micrognathia, and another retrognathia. The BSSMO provided excellent exposure for resection of the odontoid process, as verified on follow-up magnetic resonance imaging or computerized tomography studies obtained in all patients. All mandibles were rigidly fixed by placing anterior mandibular border titanium plates and unicortical screws, and there was no incidence of nonunion or of lingual or inferior alveolar nerve injuries. The mean follow-up period was 26 months. The BSSMO is an excellent, less invasive adjunct to the transoral approach in patients with limited jaw mobility.

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