scholarly journals Post-operative pulmonary complications in patients undergoing transoral odontoidectomy and posterior fixation for craniovertebral junction anomalies

2013 ◽  
Vol 29 (2) ◽  
pp. 200 ◽  
Author(s):  
MihirP Pandia ◽  
GirijaP Rath ◽  
ParmodK Bithal ◽  
HariH Dash ◽  
Manish Marda
Keyword(s):  
Craniovertebral Junction ◽  
Pulmonary Complications ◽  
Posterior Fixation ◽  
Transoral Odontoidectomy

scholarly journals Intraoperative Computed Tomography Scanner-Guided Craniovertebral Junction Surgery in a Patient with an Occipitalized C1

2021 ◽  
Author(s):  
Mohammad Ashraf ◽  
Usman Ahmad Kamboh ◽  
Naveed Ashraf
Keyword(s):  
Craniovertebral Junction ◽  
Facet Joints ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Transoral Odontoidectomy ◽  
Posterior Subluxation ◽  
Lateral Mass Screws ◽  
Complex Surgery ◽  
Computed Tomography Scanner

AbstractCraniovertebral junction surgery is associated with unique difficulties. Type 2 odontoid fractures (Anderson and D Alonzo) have a great potential for nonunion and malunion. These fracture patients may require a circumferential decompression and fixation. The addition of intraoperative CT with neuronavigation greatly aids in craniovertebral junction surgery. We operated on a 59-year-old-male with a type 2 fracture with posterior subluxation of C1 anterior arch and a cranially displaced odontoid peg. First, a transoral odontoidectomy was performed followed by a craniocervical fixation. Occipital plates and C3–C4 lateral mass screws were used as C1 was discovered to be occipitalized intraoperatively and atlantoaxial facet joints could not be reduced as discovered by intraoperative CT resconstruction. Intraoperative CT scan was crucial to this circumferential decompression and fixation, allowed us to resect the odontoid peg safely and completely and to confirm adequate screw trajectory making this complex surgery easier for us and safer for the patient. The patient was discharged 4 months after admission with stable neurology. Intraoperative CT was fundamental to correct decision making.

Surgical Management and Outcome of Tuberculous Atlantoaxial Dislocation: A 15-year Experience

Neurosurgery ◽  
2003 ◽  
Vol 52 (2) ◽  
pp. 331-339 ◽  
Author(s):  
Sanjiv Sinha ◽  
Anil Kumar Singh ◽  
Vikas Gupta ◽  
Daljit Singh ◽  
Masakazu Takayasu ◽  
...  
Keyword(s):  
Early Mobilization ◽  
Craniovertebral Junction ◽  
Magnetic Resonance Images ◽  
Atlantoaxial Dislocation ◽  
Direct Access ◽  
Posterior Fixation ◽  
Radical Excision ◽  
Histopathological Analysis ◽  
X Rays ◽  
Delay In Diagnosis

Abstract OBJECTIVE Tuberculous atlantoaxial dislocation is a rare disease entity. However, tuberculosis continues to be endemic in developing countries. Its earliest clinical presentation may be nonspecific, and delay in diagnosis may lead to irreversible neurological deficit. The management of tuberculous atlantoaxial dislocation includes ventral cervicomedullary decompression, occipitocervical arthrodesis, and administration of antituberculous medications. METHODS Eighteen patients with tuberculous atlantoaxial dislocation who presented with neck pain and/or occipital headache, restriction of neck movement, difficulty swallowing, and signs of myelopathy were studied. Four patients had evidence of associated pulmonary tuberculosis. Plain x-rays of the cervical spine, computed tomographic scans, and magnetic resonance images were obtained in all patients for diagnosis and to assess the degree of dislocation and cervicomedullary compression. Simultaneous anterior neural decompression, via a transcervical retropharyngeal approach, and posterior arthrodesis were performed on all patients while they remained under anesthesia. Antituberculous chemotherapy was continued for 18 months. RESULTS Histopathological analysis of excised tissue was consistent with tuberculosis in all patients. However, Ziehl-Neelsen staining for acid-fast bacilli was positive in two cases, and culture for Mycobacterium tuberculosis was negative in all patients. Patients with severe myelopathy experienced marked improvement. One patient died of fulminant resistant tuberculous meningitis. CONCLUSION The transcervical retropharyngeal approach to the craniovertebral junction provides direct access to the lesion and avoids the potential bacterial contamination of the oral and pharyngeal cavity. It also prevents the development of persistent fistulae. Posterior stabilization should be performed directly after anterior neural decompression, while the patient remains under anesthesia, to prevent neurological deterioration before subsequent posterior fixation. This technique also is helpful for early mobilization of patients. The aim of surgical treatment should be to obtain biopsy tissue and to perform radical excision of epidural granulation tissue/abscess and infected bone using microsurgical technique. Antituberculous medication must be continued for 18 months with four drug regimens, and continuous monitoring of drug toxicity should be performed throughout the course of treatment.

scholarly journals Endoscopic Endonasal Odontoidectomy Preserving Atlantoaxial Stability: a Pediatric Case

2020 ◽  
Author(s):  
Pierlorenzo Veiceschi ◽  
Fabio Pozzi ◽  
Francesco Restelli ◽  
Tommaso Alfiero ◽  
Paolo Castelnuovo ◽  
...  
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Chiari I Malformation ◽  
Lower Limbs ◽  
University Hospital ◽  
Third Ventriculostomy ◽  
Posterior Fixation ◽  
Endoscopic Endonasal ◽  
Postoperative Mri ◽  
Chiari I

Abstract Objectives We illustrate endoscopic endonasal odontoidectomy for the Chiari-I malformation respecting craniovertebral junction (CVJ) stability. Design Case report of a 12-year-old girl affected by the Chiari-I malformation. Magnetic resonance imaging (MRI) showed tonsillar herniation, basilar invagination, and dental retroversion, causing angulation and compression of the bulbomedullary junction. Patient underwent endoscopic third ventriculostomy (ETV) with reduction of ventricular size and resolution of gait disturbances, but she complained the Valsalva-induced headaches, hiccup, and dysesthesias in the lower limbs. Endoscopic endonasal odontoidectomy was chosen to decompress the cervicomedullary junction. Setting The research was conducted at University Hospital “Ospedale di Circolo,” Department of Neurosurgery at Varese in Italy. Participants Patients were from neurosurgical and ENT (ear, nose, and throat) skull base team. Main Outcome Measures A bilateral paraseptal approach was performed, using a four-hand technique. After resection of posterior edge of the nasal septum, the choana is entered and a rhinopharynx muscle–mucosal flap is dissected subperiosteal and transposed in oral cavity. The CVJ is exposed and, using neuronavigation and neuromonitoring, odontoidectomy is fulfilled until dura is reached, preserving the anterior arch of C1. Reconstruction is obtained suturing the flap previously harvested. Results Postoperative course was unremarkable and the patient experienced improvement of symptoms. Postoperative MRI documented the appearance of tight cerebrospinal fluid (CSF) film anterior to bulbomedullary junction and in retrotonsillar spaces, opening of the bulbomedullary angle, and slight tonsils reduction. No CVJ instability was occurred with any need of posterior fixation. Conclusion Endoscopic endonasal odontoidectomy is a feasible approach for CVJ malformation. In this case, bulbar decompression was achieved preserving CVJ stability and avoiding posterior fixation.The link to the video can be found at: https://youtu.be/VIobocHfCuc.

scholarly journals Foramen magnum decompression without bone removal: C1–C2 posterior fixation for Chiari with congenital atlantoaxial dislocation/basilar invagination

2019 ◽  
Vol 10 ◽  
pp. 38 ◽  
Author(s):  
Pravin Salunke ◽  
Madhivanan Karthigeyan ◽  
Puneet Malik
Keyword(s):  
Posterior Fossa ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Atlantoaxial Dislocation ◽  
Posterior Fixation ◽  
Foramen Magnum Decompression ◽  
Radiological Data ◽  
C2 Fixation ◽  
Small Posterior Fossa

Background: Atlantoaxial dislocation (AAD) and basilar invagination (BI) may coexist with Chiari malformations (CM) and a small posterior fossa volume. These are typically treated with craniovertebral junction fusion and foramen magnum decompression (FMD). Here, we evaluated whether C1–C2 posterior reduction and fixation (which possibly opens up the ventral foramen magnum) would effectively treat AAD and CM without additionally performing FMD. Methods: This is a retrospective analysis of 38 patients with BI, AAD, and CM who underwent C1–C2 posterior reduction and fusion without FMD. Baseline and follow-up clinical, demographic, and radiological data were evaluated. Results: The vast majority of patients (91.9%) improved both clinically and radiographically following C1–C2 fixation alone; none later required direct FMD. Notably, AAD was irreducible in 25 (65.8%) patients. Preoperatively, syringomyelia was present in 28 (73.7%) patients and showed resolution. In 3 (8.1%) patients, resolution of syrinxes did not translate into clinical improvement. Of interest, 5 patients who sustained inadvertent dural lacerations exhibited transient postoperative neurological worsening. Conclusions: Posterior C1–C2 distraction and fusion alone effectively treated AAD, BI, accompanied by CM. The procedure sufficiently distracted the dens, reversed dural tenting, and restored the posterior fossa volume while relieving ventral brainstem compression making FMD unnecessary. Surgeons should, however, be aware that inadvertent dural lacerations might contribute to unwanted neurological deterioration.

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 Transoral odontoidectomy for pediatric craniovertebral junction anomaly: Is it redundant now?

2021 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
ArunKumar Srivastava ◽  
Suyash Singh ◽  
Jayesh Sardhara ◽  
Sanjay Behari
Keyword(s):  
Craniovertebral Junction ◽  
Transoral Odontoidectomy

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.

scholarly journals Image-injected frameless stereotactic approach to the anterior craniovertebral junction

1999 ◽  
Vol 6 (6) ◽  
pp. E11 ◽  
Author(s):  
Timothy Ryken ◽  
Terrence Julien ◽  
Bruce Frankel ◽  
Greg Canute ◽  
John Haller ◽  
...  
Keyword(s):  
Craniovertebral Junction ◽  
Sufficient Accuracy ◽  
Field Of View ◽  
Operating Microscope ◽  
Registration Process ◽  
Transoral Odontoidectomy ◽  
Cervicomedullary Junction ◽  
Stereotactic Technique ◽  
Complex Anatomy ◽  
Cadaveric Model

Transoral odontoidectomy is often performed in the treatment of cervicomedullary junction disease. The operating microscope is frequently used to improve visualization in this narrow field of view. In the setting of complex anatomy or surgical revision the authors hypothesized that combining frameless stereotactic technique with intraoperative microscopy would improve the ability to visualize and identify intraoperative anatomy. In addition they believed that the ability to visualize the targeted region directly in the operating microscope "image injection" would be of particular interest in this setting, provided that sufficient accuracy for use could be obtained in the registration process. The authors assessed the efficacy of this approach in a cadaveric model and obtained sufficient accuracy to warrant use in the operating room. This technique was applied in the surgical management of a 56-year-old woman with rheumatoid arthritis who had undergone a previous decompressive transoral procedure. Subsequently she suffered progressive deterioration and was found to have residual bony compression of the anterior cervicomedullary junction. The authors performed decompressive surgery and obtained satisfactory results by using the image-injected technique, and the patient experienced subsequent clinical improvement. The authors conclude that the image-injected frameless stereotactic technique is of potential benefit, particularly in the narrow window of approach of the transoral odontoidectomy.

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