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Basilar Invagination

Narayanam Anantha Sai Kiran, Veldurti Ananta Kiran Kumar, Laxminadh Sivaraju, Valluri Anil Kumar, Chintakunta Rajesh Reddy, Amit Agrawal
BACKGROUND: Aberrant medial retropharyngeal prevertebral course of internal carotid arteries (ICAs) is extremely uncommon. In oropharyngeal surgeries like trans oral odontoidectomy (TOO) this unrecognized aberrant retropharyngeal course of ICAs can result in devastating complications secondary to inadvertent injury of ICAs. Authors describe this aberrant course of ICAs in a patient with craniovertebral junction (CVJ) anomaly with dysmorphic C1 lateral mass on one side and discuss in detail various management issues in this complex case...
March 12, 2018: World Neurosurgery
Ibrahim Hussain, Theodore H Schwartz, Jeffrey P Greenfield
Basilar invagination is defined as abnormal upward and/or posterior displacement of the odontoid leading to ventral compression of the cervicomedullary junction. This condition leads to lower cranial neuropathies, sensorimotor deficits, and myelopathy. These symptoms can persist even after posterior decompression, which is an indication for ventral decompression. Transoral approaches to the upper cervical spine carry significant morbidity, limiting their utility. The endonasal approach to the upper cervical spine presents an alternative for patients with amenable anatomy...
March 13, 2018: Clinical Spine Surgery
Zhi-Yuan Xia, Zan Chen, Wan-Ru Duan, Xing-Hua Zhao
OBJECTIVE: To analyze axis deformities and the biomechanics related to atlanto-axial dislocation in patients with basilar invagination. METHODS: Seventy-six patients were retrospectively analyzed, including 21 patients who had basilar invagination (group B), 32 patients with basilar invagination and atlanto-axial dislocation (group C), and 23 non-deformity control subjects (group A). Using 3D computed topography (CT) imaging the distance from the tip of the dens above the Chamberlain line in the sagittal plane, atlanto-dental interval (ADI), sagittal inclination, coronal inclination, craniocervical tilt, the height of the odontoid and the ratio of the height to the odontoid basal width was measured in each patient...
March 9, 2018: World Neurosurgery
Veysel Antar, Okan Turk
OBJECTIVE: Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture...
March 2018: Journal of Korean Neurosurgical Society
Qing Wang, Xinjie Wu, Mingsheng Tan, Gaoju Wang, Shuang Xu, Yingna Qi
OBJECTIVE: To describe lower cranial nerve palsy (LCNP) following vertical over-distraction when performing occipitocervical fusion (OCF) to treat vertical atlantoaxial dislocation (AAD) and basilar invagination (BI) and to investigate its possible causes. METHODS: We report 4 cases with vertical AAD and BI who postoperatively presented with neurogenic dysphagia, dysarthria, and bucking after undergoing anatomical reduction. RESULTS: Patients underwent revision surgery to achieve partial reduction and demonstrated remarkable recovery of 9th , 10th and 11th nerve deficits...
March 7, 2018: World Neurosurgery
Atul Goel, Apurva Prasad, Abhidha Shah, Sandeep More
BACKGROUND: We present 2 cases involving a previously unreported clinical situation in which basilar invagination, atlantoaxial instability, and C2-3 instability were associated with a bifid posterior arch of the axis bone. CASE DESCRIPTIONS: Two young males presented with limb weakness, spasticity, and paresthesias. Both patients had altered voice quality, with reduced and thin volume, and difficulty sleeping supine. Radiologic imaging showed an absence of the posterior elements of the C2 vertebrae...
February 2018: World Neurosurgery
Atul Goel, Sonal Jain, Abhidha Shah
OBJECTIVE: To evaluate the musculoskeletal and soft tissue neural alterations in cases with group A basilar invagination. METHODS: Between January 2007 and August 2016, 510 patients with group A basilar invagination were surgically treated. The radiologic images of these patients were reviewed retrospectively. The patients were divided into 4 groups: group A1, comprising 60 patients with syringomyelia; group A2, comprising 354 patients with "external syrinx," marked by excessive cerebrospinal fluid (CSF) in the extramedullary space; group A3, comprising 51 patients with both syringomyelia and external syrinx; and group A4, comprising 45 patients with no abnormality of CSF cavitation in the spinal canal...
February 2018: World Neurosurgery
P B Karthik, Jayesh Sardhara, Nachiketa Tiwari, Sanjay Behari
The most common type of congenital C1-2 dislocation is a combined type in which atlanto-axial dislocation (AAD) and basilar invagination (BI) are often associated with a rotational dislocation and coronal tilt. An optimal surgical treatment involves reduction of AAD and BI with simultaneous correction of the rotation and coronal tilt to achieve an optimal cervical canal decompression, sagittal and coronal realignment and bony fusion. The most acceptable technique to facilitate this correction is the C1-C2 distraction technique, which is accomplished by the manual joint manipulation...
January 2018: Neurology India
Tatsushi Inoue, Natsuki Hattori, Tsukasa Ganaha, Tadashi Kumai, Shinichiro Tateyama, Yuichi Hirose
Chiari malformation type I (CM-I) is typically treated with foramen magnum decompression. However, a recent study proposed a new technique for patients with CM-I, wherein only short atlantoaxial joint fusion and distraction is applied. Posterior fusion with or without atlantoaxial distraction is a potential option for patients with CM-I associated with basilar invagination or complex anomalous bony craniovertebral junction pathology, since this procedure allows clinicians to avoid using the technically demanding transoral approach in which some or all of the odontoid tip is invisible...
January 5, 2018: Journal of Neurosurgery. Spine
Pravin Salunke, Madhivanan Karthigeyan, Narasimhaiah Sunil, Vasundhara Rangan
OBJECTIVES: Manifestation of congenital anomalies of cranio-vertebral junction (CVJ) in the later half of life is unusual and intriguing. Coexisting cervical spondylotic changes with multilevel compression, poorer bone quality as well as less smooth post-surgical recuperation make management of elderly Congenital Atlantoaxial Dislocation/ Basilar Invagination (CAAD/BI) challenging. The clinico-radiological presentation, pathogenesis and outcome are analysed here. PATIENTS AND METHODS: Clinico-radiological data of 20 patients of CAAD/BI (with markers of congenital anomalies) presenting after 50 years of age, the challenges faced and outcomes after C1-C2 fusion have been analysed...
December 21, 2017: Clinical Neurology and Neurosurgery
Shuaishuai Xu, Shidong Ruan, Xiaoyu Song, Jinyu Yu, Jianrong Xu, Ruozhen Gong
OBJECTIVE: To evaluate vertebral artery anomaly at the craniovertebral junction (CVJ) in patients with basilar invagination (BI) by computed tomographic angiography (CTA), and to discuss the prevention strategy of vascular injury. METHODS: The primary axial, multiple planar reconstruction and volume-rendering cervicocranial CTA images of 39 BI patients were analysed to evaluate vertebral artery anomaly at the CVJ: persistent first intersegmental artery (PFIA), fenestrated vertebral artery (FEN), and extracranial C1/2 origin of posterior inferior cerebellar artery (PICA), high-riding vertebral artery, side-to-side asymmetry and irregular midline carotid artery loop was determined by subjective vision...
December 29, 2017: European Spine Journal
Hai Liu, Chenlong Yang, Jun Yang, Yulun Xu
Chiari malformation type I (CM-I) is a common hindbrain disorder that is associated with deformity and elongation of the cerebellar tonsils. Although CM-I occurs in both pediatric and adult patients, its prevalence, clinical features and management in the pediatric population are not well defined. The current study evaluated a consecutive case series of 92 children (38 females and 54 males) who were diagnosed with congenital CM-I. All patients underwent small-bone-window posterior fossa decompression with autologous-fascia duraplasty...
December 2017: Experimental and Therapeutic Medicine
Sibin Lan, Junjie Xu, Zenghui Wu, Hong Xia, Xiangyang Ma, Kai Zhang, Fuzhi Ai, Jianhua Wang, Qingshui Yin, Honglei Yi, Mingyang Duan
No abstract text is available yet for this article.
December 14, 2017: World Neurosurgery
Ashish B Shah, Breann K Tisano, Osama Elattar, Jackson Rucker Staggers, Sameer Naranje
Introduction: Hajdu-Cheney syndrome (HCS) is a rare autosomal dominant disease characterized by acroosteolysis, wormian skull bones with persistent skull sutures, premature loss of teeth, micrognathia, short stature, hypermobility of the joints, neurologic manifestations such as basilar invagination with subsequent paresthesia, hearing loss, and speech alterations, and osteoporosis with tendency to pathologic fractures of long bones and vertebrae as well as painful hands and feet. Very few cases have been earlier reported in the literature...
September 2017: Journal of Orthopaedic Case Reports
Paola Saccheri, Enrico Crivellato, Francesco Toso, Luciana Travan
An upward displacement of the odontoid process into the foramen magnum was observed in the skeletal remains of a young male unearthed from a 14th-17th century cemetery in the north-eastern Italy. Examination of skull bone vestiges and CT-SCAN analysis of the axis exhibited a clear-cut contact zone between the odontoid process and the anterior border of the foramen magnum. In addition, the odontoid process appeared backward deviated. Findings suggest a possible diagnosis of basilar impression/invagination. This anomalous contact may cause compression of neural and vascular structures with a multifaceted series of clinical symptoms...
December 13, 2017: Folia Morphologica (Warsz)
Pravin Salunke
Introduction: The deformed joints seen in congenital atlantoaxial dislocation (CAAD) are often associated with vascular anomalies. It is important to identify these vascular anomalies and address them appropriately without compromising the manipulation and fusion of C1-C2 joints. The small bones in pediatric age group pose an additional challenge. Materials and Methods: Data of fifty-six children with CAAD operated in the last 4 years was analyzed. A computed tomography angiogram was obtained preoperatively to assess for the course of the third segment of vertebral artery (VA)...
July 2017: Journal of Pediatric Neurosciences
Nouman Aldahak, Bertram Richter, Joseph Syn├Ęse Bemora, Jeffery Thomas Keller, Sebastien Froelich, Khaled Mohamed Abdel Aziz
We aim to establish a complete summary on the Endoscopic Endonasal Approach (EEA) to Cranio Cervical Junction (CCJ): evolution since first description, criteria to predict the feasibility and limitations, anatomical landmarks, indications and biomechanical evaluation after performing the approach. A comprehensive literature search to identify all available literature published between March 2002 and June 2015, the articles were divided into four categories according to their main purpose: 1- surgical technique, 2- anatomical landmarks and limitations, 3- literature reviews to identify main indications, 4- biomechanical studies...
2017: Pan African Medical Journal
Mrityunjoy Sarkar, Ashok Pillai
BACKGROUND AND IMPORTANCE: The lateral suboccipital approach for microvascular decompression (MVD) of the trigeminal nerve has become a standard-of-care over the past several decades. Syndromic cranial base settling, a rare but known cause for trigeminal neuralgia (TN), poses significant dilemmas in clinical management. In such cases, distorted anatomy may render surgery via the suboccipital approach difficult or even impossible. CLINICAL PRESENTATION: A 34-yr-old male with osteogenesis imperfecta and severe basilar invagination suffered from TN that was refractory to medication and stereotactic radiosurgery...
November 18, 2017: Operative Neurosurgery (Hagerstown, Md.)
Kataria Rashim, K Verma Pawan, V D Sinha
Surgery for the Cranio-vertebral (CV) junction anomalies using top loading subocciput (C0)/C1-C2 screws is difficult and requires high level of skill and expertise. This is because of complex abnormal anatomy in that region and other issues including the instrumentation. Thorough knowledge of the 3D anatomy of the Craniovertebral junction of the patient is essential for favourable outcome. The customised 3D printed model of CV junction region of the patient can be used for studying the anatomy and relationship of vertebral artery to the C1-C2 joint before the actual surgery...
November 9, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Colin Y L Woon, Steven M Mardjetko
PURPOSE: To describe the manifestations, surgical treatment, and potential complications of Hajdu-Cheney syndrome (HCS), and the management of these complications. METHODS: The clinical presentation, management and outcome of HCS with severe osteoporosis and open skull sutures is presented, together with a literature review. RESULTS: A 20-year-old female with HCS underwent posterior occipitocervical fusion for symptoms of progressive basilar invagination...
November 4, 2017: European Spine Journal
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