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Clivoaxial angle

Daniel Felbaum, Steven Spitz, Faheem A Sandhu
A subset of patients with Chiari Type I malformation may develop neurological dysfunction secondary to an abnormally obtuse clivoaxial angle (CXA) and clivoaxial deformity causing deformative stress injury to the neural axis. Clivoaxial deformity can occur after initial standard suboccipital craniectomy, duraplasty, and C-1 laminectomy for brainstem compression, or severe clivoaxial deformity may be present in conjunction with a Chiari malformation. Clivoaxial deformity and abnormal CXA can be treated with an occipitocervical fusion (OCF)...
July 2015: Journal of Neurosurgery. Spine
Robert J Bollo, Jay Riva-Cambrin, Meghan M Brockmeyer, Douglas L Brockmeyer
OBJECT: Chiari malformation Type I (CM-I) is a congenital anomaly often treated by decompressive surgery. Patients who fail to respond to standard surgical management often have complex anomalies of the craniovertebral junction and brainstem compression, requiring reduction and occipitocervical fusion. The authors hypothesized that a subgroup of "complex" patients defined by specific radiographic risk factors may have a higher rate of requiring occipitocervical fusion. METHODS: A retrospective review was conducted of clinical and radiographic data in pediatric patients undergoing surgery for CM-I between 1995 and 2010...
August 2012: Journal of Neurosurgery. Pediatrics
Nobuhide Ogihara, Jun Takahashi, Hiroki Hirabayashi, Hiroyuki Hashidate, Hiroyuki Kato
BACKGROUND: Instability of the occipitocervical junction can present challenging surgical problems because of the unique anatomic and biomechanical characteristics of this region. The purpose of this study was to evaluate the long-term surgical results and usefulness of a computed tomography (CT)-based navigation system for the occipitocervical reconstruction. METHODS: Twenty-three patients (10 men, 13 women; mean age at surgery 57.9 years; mean follow-up periods 52...
June 2010: World Neurosurgery
K Kohno, S Sakaki, T Shiraishi, K Matsuoka, H Okamura
A case of adult type I Arnold-Chiari malformation associated with basilar impression, syringomyelia, atlantoaxial dislocation, and occipitalization of the atlas is reported. Preoperative magnetic resonance imaging clearly revealed evidence of severe anterior compression of the cervicomedullary junction due to basilar impression and a sharp clivoaxial angle. Therefore, transoral anterior decompression and fusion were performed, resulting in an improvement of the patient's neurologic signs and symptoms. Postoperative magnetic resonance imaging showed an obvious reduction of the tonsillar herniation and syringomyelia, as well as an improvement of the cervicomedullary compression...
April 1990: Surgical Neurology
K Kohno, S Sakaki, H Nakamura, M Sakoh, S Takeda, K Sadamoto
Anterior or posterior decompression of the foramen magnum was performed in three patients with syringomyelia associated with basilar impression and Chiari I malformation. The operative results were evaluated using the pre- and postoperative magnetic resonance (MR) images. Two patients with combined anterior and posterior cervicomedullary compression due to basilar impression and tonsillar descent received suboccipital craniectomy, upper cervical laminectomy, and dural plasty without any intradural manipulations via the posterior approach...
November 1991: Neurologia Medico-chirurgica
J J Corbett, A B Butler, B Kaufman
Syncope precipitated by sneezing in an adult male associated with an Arnold-Chiari type I malformation and basilar invagination presents a clinical problem in the differential diagnosis and pathological anatomy of Valsalva-related syncope. An abnormally acute clivoaxial angle, small foramen magnum, and type I Arnold-Chiari malformation appear to be a combination of features intolerant of Valsalva-induced changes in cerebral volume, brain-stem position, CSF fluid dynamics, or blood vessel relationships. Proposed mechanisms of pressure transmission to the area of intracranial pathology are discussed...
April 1976: Journal of Neurology, Neurosurgery, and Psychiatry
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