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Surgical treatment of congenital basilar invagination with different pathological characteristics: Report of 139 cases

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Translational Neuroscience and Clinics 2017年第4期3卷 204-212页

作者： Yinqian Wang Tao Fan Xingang Zhao Cong Liang Qifei Ga Haijun Zhao Department of Neurosurgery Sanbo Brain HospitalCapital Medical University

Objective: To describe the different pathological characteristics of congenital basilar invaginations and discuss the surgical treatment of such cases. Methods: A total of 139 patients diagnosed with basilar invaginations underwent surgical treatment from 2008 to 2015. Based on Atul Goel's classification and simultaneous consideration of atlantoaxial dislocation or syringomyelia,the cases were subdivided into four groups. Individualized posterior surgical decompression and/or atlantoaxial reset procedures were performed to correct atlantoaxial dislocation,decompress the brain stem,or resolve syringomyelia. The indications and critical points of each procedure were documented. Results: All 139 patients were surgically treated; 27 patients(19.4%) had underwent at least one decompression surgery previously. On an average,there was gratifying clinical improvement based on the Japanese Orthopaedic Association score *** patient exhibited severe post-operative infection,and the fusion instrument was removed. One patient experienced fracture of internal fixation. Two patients exhibited persistent respiratory symptoms at early stages after the surgery. Four patients felt worse at the latest follow-up. There was no surgical mortality. The poor outcome/morbidity in this series was 5.8%(8/139). Conclusion: The different pathological image characteristics of congenital basilar invaginations based on the presence or absence of syringomyelia and/or atlantoaxial dislocation,reflected the pathological features of complicated basilar invaginations more accurately. Based on these features,different posterior decompression and/or reset procedures,combined with occipitocervical fusion and C1-2 fusion,could be tailored to different patients. These individualized surgeries could reduce surgical complications,decrease morbidity and mortality,and further promote positive outcomes.

关键词： basilar invagination syringomyelia atlantoaxial dislocation chiari malformation surgical treatment

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Surgical outcomes of occipitocervical and atlantoaxial fusion in patients with basilar invagination and atlantoaxial dislocation

Surgical outcomes of occipitocervical and atlantoaxial fusio...

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第十三届中国医师协会神经外科医师年会

作者： James Wang Linkai Jing Zhenxing Sun Guihuai Wang Department of Neurosurgery Beijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua University School of Clinical Medicine Tsinghua University

Object basilar invagination(BI)and atlantoaxial dislocation(AAD)are challenging surgical problems due to unique anatomic and biomechanical characteristics of occipitocervical *** aim of the present study was to assess surgical outcomes of occipitocervical and atlantoaxial fusion in patients with BI and *** The authors retrospectively reviewed the demographics,procedural date,and outcomes of 30 consecutive patients who underwent posterior occipitocervical and atlantoaxial fusion with O-arm-based navigation between January 2015 and December 2017 at Beijing Tsinghua Changgung *** The average age in this series was 39.93±15.43 years and the average duration of symptoms was 50.01±54.76 *** common clinical presentation of patients were paresis and paresthesia(83.33% vs.76.67%,respectively).Twenty-eight patients were performed with direct posterior occipitocervical fixation,one patient with posterior atlantoaxial fusion,and one patient with anterior transoral decompression followed by posterior internal fixation.A total of 86 occipital and 136 cervical screws was inserted using the O-arm-based navigation *** a mean follow-up of 7.07±5.82 months,Japanese Orthopedic Association(JOA)scoring system indicated significant improvement compared with their status preoperatively(p<0.05).All radiological measurement showed statistically significant(p<0.05)at the *** patients required the second operation because of the infection in 3 months after transoral decompression and one patient needed anterior transoral decompression followed by posterior occipitocervical fusion due to trauma after occipitocervical *** The posterior occipitocervical and atlantoaxial fusion is an effective and safe method for the treatment of BI and *** decompression is necessary for patients with irreducible *** O-arm-based navigation system is a useful tool for accurate and safe occipitocervical screw insertion.

关键词： atlantoaxial dislocation atlantoaxial fusion basilar invagination occipicalcervical fusion treatment

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Endoscopic endonasal approach to the craniovertebral junction

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2022年第1期8卷 16-24页

作者： Ashleigh A.Halderman Samuel L.Barnett Department of Otolaryngology Head and Neck Surgery University of Texas Southwestern Medical CenterDallasTexasUSA Department of Neurological Surgery University of Texas Southwestern Medical CenterDallasTexasUSA

The surgical approach to lesions of the ventral craniovertebral junction(CVJ)has evolved significantly in the last several years with the advent of endoscopic skull base *** pathologies of the CVJ can result in irreducible compression of the cervicomedullary *** endoscopic endonasal approach lends itself well to this region due to the ventral location,and while there is a steep learning curve,is a safe and effective way to perform decompression of the cervicomedullary ***,we discuss the anatomy of the CVJ,preoperative evaluation and surgical considerations,our surgical approach,complications,and outcomes.

关键词： basilar invagination craniovertebral junction endonasal surgery endoscopic skull base surgery odontoidectomy

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

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中华神经外科杂志(英文) 2021年第1期6卷 28-35页

作者： Wang Xingwen Ma Longbing Liu Zhenlei Chen Zan Wu Hao Jian Fengzeng Department of Neurological Surgery Xuanwu Hospital Capital Medical University Beijing 100053 China

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 ***: 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 ***: 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 ***: 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.

关键词： Transoral approach Odontoidectomy basilar invagination Atlantoaxial dislocation Image-guided navigation

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