A 6-Year Experience of 100 Cases of Pediatric Bony Craniovertebral Junction Abnormalities: Treatment and Outcomes

Abstract

The authors studied 100 consecutive cases of pediatric bony craniovertebral junction abnormalities operated between 2001 and 2006. The pathologies were developmental (n = 86), traumatic (n = 10) and tuberculous (n = 4). Surgical procedures included transoral decompression (n = 59), occipitocervical fusion (OCF, n = 69), C₁-C₂ fusion (n = 22), occiput-C₂ wiring (n = 5), and posterior fossa decompression (n = 5). Implants for OCF included contoured stainless steel rods (n = 47), titanium lateral mass screws and plates (n = 16) and steel wires (n = 5). Adequate bone fusion was observed in all patients with OCF at a mean follow-up of 16.5 months, irrespective of the type of implant used for posterior fixation. Good neurological outcome was observed even in poor-grade patients. No significant effect on the curvature or growth of the spine was observed at follow-up.

Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval

“…8,9,[12][13][14]16,17,19,21,25,32 One type of upper cervical spine injury, atlantooccipital dislocation (AOD), is a severe injury associated with high mortality rates. 1,2,11,12,[16][17][18][19][20]22,24 In postmortem examinations, evidence of AOD is present in 20%-31% of deaths due to cervical spine injuries.…”

Transnasal endoscopic approach to the pediatric craniovertebral junction and rostral cervical spine: case series and literature review

“…By contrast, in their series of 59 cases of ventral cervicomedullary decompression using a transoral approach, Yerramneni et al reported a postoperative CSF leak or meningitis in 5 patients (8.5%). 40 Despite concerns for an elevated risk of unintended durotomy and an increased difficulty of repair when using an endoscopic transnasal approach rather than a transoral approach, limited current data do not support this conclusion.…”

“…7,19,21,28,38 Rates of significant upper respiratory tract edema requiring intervention following transoral approaches have been reported in up to 5% of adults and 4% of children, but this rate may be artificially low due to a more cautious timetable for extubation. 6,9,13,20,26,27,36,39,40 Additionally, an endoscopic transnasal approach may allow for a more prompt return to a normal oral diet. 21,24 The incidence of new-onset dysphagia after a traditional transoral approach ranges from 0%-20% in adults and 0%-4% in the pediatric population, which is not unexpected given the dissection of the posterior pharyngeal tissues that is required.…”

“…21,24 The incidence of new-onset dysphagia after a traditional transoral approach ranges from 0%-20% in adults and 0%-4% in the pediatric population, which is not unexpected given the dissection of the posterior pharyngeal tissues that is required. 6,9,13,26,27,34,36,39,40 A final potential advantage of endoscopic transnasal approaches versus transoral approaches is greater access to the structures superior to the soft palate, facilitating a more direct trajectory to the rostral CVJ. This reduces the frequent need to split the palate, which may be required in up to 29% of adult patients undergoing transoral surgery.…”

“…Reoperation for other indications occurred in 3 other patients. 40 Further experience with the endoscopic transnasal approach and analyses of larger case series will be required to determine if the incidence of reoperation is indeed higher than that of traditional transoral approaches to the CVJ and rostral cervical spine. With increased use of spinal navigation systems, intraoperative CT quality imaging is likely to reduce the incidence of incomplete resection and reoperation.…”