scholarly journals Surgical Treatment of C2 Odontoid Process Intussusception in Combination with Type I Chiari Malformation

2017 ◽  
pp. 66-72 ◽  
Author(s):  
A. N. Shkarubo ◽  
A. A. Kuleshov ◽  
I. V. Chernov ◽  
V. A. Shakhnovich ◽  
E. V. Mitrofanova ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chiari Malformation ◽  
Odontoid Process ◽  
Type I ◽  
Basilar Impression ◽  
Posterior Decompression ◽  
Developmental Abnormalities ◽  
Brainstem Compression ◽  
Upper Cervical ◽  
One Step

Type I Chiari malformation is often accompanied by congenital developmental abnormalities such as platybasia, basilar impression and C2 odontoid process retroflexion that may cause anterior compression of brainstem structures and upper cervical segments of spinal cord. Formerly the conventional method was posterior decompression even in presence of anterior brainstem compression. This article presents on a kinetic example the tactics of one-step treatment of patients with type I Chiari malformation accompanied by basilar impression and C2 odontoid process retroflexion via transoral approach only that was used for both decompression and C1-C2 segment anterior stabilization. Surgical intervention enabled to achieve the decompression of brainstem structures and upper cervical segments of spinal cord, normalization liquor dynamics and subsequent redislocation of cerebellar tonsils to normal position (above the Chamberlain line).

scholarly journals Surgical Treatment of C2 Odontoid Process Intussusception in Combination with Type I Chiari Malformation

2017 ◽  
Vol 24 (1) ◽  
pp. 66-72
Author(s):  
A. N Shkarubo ◽  
A. A Kuleshov ◽  
I. V Chernov ◽  
V. A Shakhnovich ◽  
E. V Mitrofanova ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chiari Malformation ◽  
Odontoid Process ◽  
Type I ◽  
Basilar Impression ◽  
Posterior Decompression ◽  
Developmental Abnormalities ◽  
Brainstem Compression ◽  
Upper Cervical ◽  
One Step

Type I Chiari malformation is often accompanied by congenital developmental abnormalities such as platybasia, basilar impression and C2 odontoid process retroflexion that may cause anterior compression of brainstem structures and upper cervical segments of spinal cord. Formerly the conventional method was posterior decompression even in presence of anterior brainstem compression. This article presents on a kinetic example the tactics of one-step treatment of patients with type I Chiari malformation accompanied by basilar impression and C2 odontoid process retroflexion via transoral approach only that was used for both decompression and C1-C2 segment anterior stabilization. Surgical intervention enabled to achieve the decompression of brainstem structures and upper cervical segments of spinal cord, normalization liquor dynamics and subsequent redislocation of cerebellar tonsils to normal position (above the Chamberlain line).

Microscopic Decompression of the Anterior Upper Cervical Spine: A Case of Odontoid Malunion to the Atlas

Neurosurgery ◽  
1984 ◽  
Vol 14 (5) ◽  
pp. 583-587 ◽  
Author(s):  
Jimmy Miller ◽  
Andrew D. Parent
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Odontoid Process ◽  
Transoral Approach ◽  
Upper Cervical Spine ◽  
Basilar Impression ◽  
Odontoid Fractures ◽  
Surgical Microscope ◽  
The Past ◽  
Upper Cervical

Abstract For the past 20 years, the transoral approach to the upper cervical spine has been utilized for odontoid fractures, the removal of an abnormal odontoid process, decompression of basilar impression, and biopsy or resection of nasopharyngeal or metastatic tumors. The effectiveness and safety of this procedure is well documented. Use of the surgical microscope adds to the efficiency and safety of the procedure. We are reporting a case of fusion of the odontoid base to the anterior arch of the atlas. To our knowledge, this entity has not been described previously. The spinal cord was protected by an initial posterior fusion of C-1, C-2, followed in 10 days by a tracheostomy and the transoral removal of the anterior C-1 arch and the abnormal dens. Because the medical history did not reveal a source of trauma, it is supposed that the patient had malunion of the odontoid process to C-2, with subsequent migration and fusion of the dens to the C-1 arch.

Transnasal odontoid resection followed by posterior decompression and occipitocervical fusion in children with Chiari malformation Type I and ventral brainstem compression

2010 ◽  
Vol 5 (6) ◽  
pp. 549-553 ◽  
Author(s):  
Todd C. Hankinson ◽  
Eli Grunstein ◽  
Paul Gardner ◽  
Theodore J. Spinks ◽  
Richard C. E. Anderson
Keyword(s):  
Chiari Malformation ◽  
Hard Palate ◽  
Transoral Approach ◽  
Comfort Level ◽  
Type I ◽  
Posterior Decompression ◽  
Transnasal Approach ◽  
Chiari Malformation Type I ◽  
Brainstem Compression ◽  
Endoscopic Transnasal Approach

Object In rare cases, children with a Chiari malformation Type I (CM-I) suffer from concomitant, irreducible, ventral brainstem compression that may result in cranial neuropathies or brainstem dysfunction. In these circumstances, a 360° decompression supplemented by posterior stabilization and fusion is required. In this report, the authors present the first experience with using an endoscopic transnasal corridor to accomplish ventral decompression in children with CM-I that is complicated by ventral brainstem compression. Methods Two children presented with a combination of occipital headaches, swallowing dysfunction, myelopathy, and/or progressive scoliosis. Imaging studies demonstrated CM-I with severely retroflexed odontoid processes and ventral brainstem compression. Both patients underwent an endoscopic transnasal approach for ventral decompression, followed by posterior decompression, expansive duraplasty, and occipital-cervical fusion. Results In both patients the endoscopic transnasal approach provided excellent ventral access to decompress the brainstem. When compared with the transoral approach, endoscopic transnasal access presents 4 potential advantages: 1) excellent prevertebral exposure in patients with small oral cavities; 2) a surgical corridor located above the hard palate to decompress rostral pathological entities more easily; 3) avoidance of the oral trauma and edema that follows oral retractor placement; and 4) avoidance of splitting the soft or hard palate in patients with oral-palatal dysfunction from ventral brainstem compression. Conclusions The endoscopic transnasal approach is atraumatic to the oral cavity, and offers a more superior region of exposure when compared with the standard transoral approach. Depending on their comfort level with endoscopic surgical techniques, pediatric neurosurgeons should consider this approach in children with pathological entities requiring ventral brainstem decompression.

Upper cervical myelopathy due to arachnoiditis and spinal cord tethering from adjacent C-2 osteomyelitis

2007 ◽  
Vol 6 (1) ◽  
pp. 64-67 ◽  
Author(s):  
Sharad Rajpal ◽  
Krisada Chanbusarakum ◽  
Praveen R. Deshmukh
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Complete Resolution ◽  
Magnetic Resonance Image ◽  
Epidural Abscess ◽  
Odontoid Process ◽  
Surgical Decompression ◽  
Upper Cervical ◽  
High Cervical ◽  
Spinal Cord Tethering

✓Myelopathy caused by a spinal cord infection is typically related to an adjacent compressive lesion such as an epidural abscess. The authors report a case of progressive high cervical myelopathy from spinal cord tethering caused by arachnoiditis related to an adjacent C-2 osteomyelitis. This 70-year-old woman initially presented with a methicillin-sensitive Staphylococcus aureus osteomyelitis involving the C-2 odontoid process. She was treated with appropriate antibiotic therapy but, over the course of 4 weeks, she developed progressive quadriparesis. A magnetic resonance image revealed near-complete resolution of the C-2 osteomyelitis, but new ventral tethering of the cord was observed at the level of the odontoid tip. She subsequently underwent open surgical decompression and cord detethering. Postoperatively she experienced improvement in her symptoms and deficits, which continued to improve 1 year after her surgery. To the authors’ knowledge, this is the first reported case of progressive upper cervical myelopathy due to arachnoiditis and cord tethering from an adjacent methicillin-sensitive S. aureus C-2 osteomyelitis.

Patients with Chiari malformation Type I presenting with acute neurological deficits: case series

2011 ◽  
Vol 7 (3) ◽  
pp. 244-247 ◽  
Author(s):  
Chester K. Yarbrough ◽  
Alexander K. Powers ◽  
Tae Sung Park ◽  
Jeffrey R. Leonard ◽  
David D. Limbrick ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Posterior Fossa ◽  
Neurological Deficit ◽  
Chiari Malformation ◽  
Acute Onset ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Sensory Deficits ◽  
Operative Notes

Object A subset of patients with Chiari malformation Type I (CM-I) presented with acute onset of a neurological deficit. In this study the authors summarize their experience with these patients' clinical presentation, imaging results, timing of surgery, and outcome following decompression. Methods The authors reviewed clinical records, imaging studies, and operative notes from all patients undergoing posterior fossa decompression for CM-I at St. Louis Children's Hospital from 1990 to 2008. Of the 189 patients who underwent surgery, 6 were identified with the acute onset of a neurological deficit at presentation. Results All 6 children (age range 3–14 years, 3 boys and 3 girls) had either syringomyelia (5 patients) or T2 signal changes in the spinal cord (1 patient) and CM-I on initial MR imaging. Three patients presented after minor trauma (1 with paraparesis, 2 with sensory deficits). Three patients presented without a clear history of trauma (1 with abrupt onset of spontaneous dysphagia and ataxia, 2 with sensory deficits). Decompression was performed at a mean 7.7 ± 4.9 days after symptom onset (7.0 ± 1.6 days after neurosurgical evaluation). In 1 patient, symptoms had resolved by the time of surgery; in the remainder of the patients, clear improvements were noted within 2 weeks of surgery, with complete resolution of symptoms by 12 months postoperatively. Follow-up MR images were obtained in 4 patients, demonstrating improvement in the extent of the syrinx in each patient. Conclusions Children with CM-I and syringomyelia can develop acute spinal cord or bulbar deficits with relatively minor head or neck injuries. The prognosis for symptomatic improvement in the observed deficit is good, with each patient in our series showing resolution of deficits over time. However, based on this relatively limited experience, the authors suggest that patients who present with an acute neurological deficit and are found to have CM-I be managed with early posterior fossa decompression. Patients with CM-I and syringomyelia may be at higher risk of acute neurological deficit than those without a syrinx.

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 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.

scholarly journals Odontoid process inclination in normal adults and in an adult population with Chiari malformation Type I

2015 ◽  
Vol 23 (6) ◽  
pp. 701-706 ◽  
Author(s):  
David A. Besachio ◽  
Ziyad Khaleel ◽  
Lubdha M. Shah
Keyword(s):  
Chiari Malformation ◽  
Pediatric Population ◽  
Adult Population ◽  
Odontoid Process ◽  
Normative Values ◽  
Control Group ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Significant Difference ◽  
The Mean

OBJECT Posterior odontoid process inclination has been demonstrated as a factor associated with Chiari malformation Type I (CM-I) in the pediatric population; however, no studies to date have examined this measurement in the adult CM-I population. The purpose of this study was to evaluate craniocervical junction (CCJ) measurements in adult CM-I versus a control group. METHODS The odontoid retroflexion, odontoid retroversion, odontoid height, posterior basion to C-2 line measured to the dural margin (pB-C2 line), posterior basion to C-2 line measured to the dorsal odontoid cortical margin (pB-C2* line), and clivus-canal angle measurements were retrospectively analyzed in adult patients with CM-I using MRI. These measurements were compared with normative values established from CT scans of the cervical spine in adults without CM-I. RESULTS A statistically significant difference was found between 55 adults with CM-I and 150 sex-matched controls (125 used for analysis) in the mean clivus-canal angle and the mean pB-C2 line. CONCLUSIONS These data suggest that there are sex-specific differences with respect to measurements at the CCJ between men and women, with women showing a more posteriorly inclined odontoid process. There were also differences between the CM-I and control groups: a more acute clivus-canal angle was associated with CM-I in the adult population. These CCJ findings could have an influence on presurgical planning.

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.

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