Arterial Fencing: A Challenge During Complex Craniovertebral Junction Surgery

Das, Kuntal Kanti; Pattankar, Sanjeev; Srivastava, Arun Kumar

doi:10.1016/j.wneu.2022.02.111

Cited by 2 publications

(1 citation statement)

References 5 publications

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“…Furthermore, the learning curve of anterior decompression is very steep. Decompression and instrumentation after acceptable reduction with the posterior approach is feasible in many cases, where the lesion can be managed with less complications related to the anterior approach [33]. Recently, a new endonasal endoscopic approach to pathologies of the anterior craniocervical junction was reported [34].…”

Section: Discussionmentioning

confidence: 99%

A Novel Technique for Basilar Invagination Treatment in a Patient with Klippel–Feil Syndrome: A Clinical Example and Brief Literature Review

Tanaka,

Askar,

Kumawat

et al. 2024

Medicina

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Objectives and Background: To present a novel technique of treatment for a patient with basilar invagination. Basilar invagination (BI) is a congenital condition that can compress the cervicomedullary junction, leading to neurological deficits. Severe cases require surgical intervention, but there is debate over the choice of approach. The anterior approach allows direct decompression but carries high complication rates, while the posterior approach provides indirect decompression and offers good stability with fewer complications. Materials and Methods: A 15-year-old boy with severe myelopathy presented to our hospital with neck pain, bilateral upper limb muscle weakness, and hand numbness persisting for 4 years. Additionally, he experienced increased numbness and gait disturbance three months before his visit. On examination, he exhibited hyperreflexia in both upper and lower limbs, muscle weakness in the bilateral upper limbs (MMT 4), bilateral hypoesthesia below the elbow and in both legs, mild urinary and bowel incontinence, and a spastic gait. Radiographs revealed severe basilar invagination (BI). Preoperative images showed severe BI and that the spinal cord was severely compressed with odontoid process. Results: The patient underwent posterior surgery with the C-arm free technique. All screws including occipital screws were inserted into the adequate position under navigation guidance. Reduction was achieved with skull rotation and distraction. A follow-up at one year showed the following results: Manual muscle testing results and sensory function tests showed almost full recovery, with bilateral arm recovery (MMT 5) and smooth walking. The cervical Japanese Orthopedic Association score of the patient improved from 9/17 to 16/17. Postoperative images showed excellent spinal cord decompression, and no major or severe complications had occurred. Conclusions: Basilar invagination alongside Klippel–Feil syndrome represents a relatively uncommon condition. Utilizing a posterior approach for treating reducible BI with a C-arm-free technique proved to be a safe method in addressing severe myelopathy. This novel navigation technique yields excellent outcomes for patients with BI.

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Section: Discussionmentioning

confidence: 99%

A Novel Technique for Basilar Invagination Treatment in a Patient with Klippel–Feil Syndrome: A Clinical Example and Brief Literature Review

Tanaka,

Askar,

Kumawat

et al. 2024

Medicina

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A Novel Technique for Basilar Invagination Treatment in a Patient with Klippel-Feil Syndrome

Tanaka,

Askar,

Kumawat

et al. 2024

Preprint

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Study design: Technical note. Objectives: To present a novel technique of treatment for patient with basilar invagination. Background : Basilar invagination (BI) is considered a congenital condition and can compress the cervicomedullary junction, causing neurologic deficit. Severe neurological deficit due to BI should be treated surgically. However, there is controversy regarding whether an anterior or posterior approach should be used. Anterior approach is optimal for decompression of cervicomedullary junction, but this approach has high complication rates. Posterior reduction has a high risk of occipital screws backout and/or instrument failure. Materials and Methods : A 15-year-old boy with severe myelopathy was referred to our hospital. He had neck pain, muscle weakness of bilateral upper limbs, gait disturbance appeared 3 months before he visited our hospital, he drops a cup several times recently. In the examination, he had hyperreflexia of upper and lower limbs and muscle weakness of bilateral arms (MMT 4), hypoesthesis was observed bilaterally below elbow and both legs. He also had clumsiness of bilateral hands, mild urinary and bowel incontinence, and spastic gait. His 10 second grip and release test was 16 in both hands. His grip power was 20 kg in right and 17 kg in left. Radiograms showed severe BI and spinal cord was severely compressed with odontoid process.. Results : The patinet underwent posterior surgery with C-arm free technique. All screws including occipital screws were inserted adequate position under navigation guidance. Reduction was achieved with skull rotation and distraction. A follow-up at one year we have these results : Manual muscle testing results and sensory function tests showed almost full recovery, bilateral arms (MMT 5) ,walking smoothly. Cervical Japanese orthopedic association score of the patient has improved from 9/17 to 16/17. Post-operative images showed an excellent spinal cord decompression, and no major or severe complications has occured . Conclusions/Level of Evidence : Basilar invagination with Klippel-Feil syndrome is relatively rare condition. Posterior approach and occipito-cervical fixation for BI treatment with navigation technique is a safe method to treat severe myelopaty with reducible odontoid. This novel navigation technique provides an excellent results for a patient with BI. Level V.

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Arterial Fencing: A Challenge During Complex Craniovertebral Junction Surgery

Cited by 2 publications

References 5 publications

A Novel Technique for Basilar Invagination Treatment in a Patient with Klippel–Feil Syndrome: A Clinical Example and Brief Literature Review

A Novel Technique for Basilar Invagination Treatment in a Patient with Klippel–Feil Syndrome: A Clinical Example and Brief Literature Review

A Novel Technique for Basilar Invagination Treatment in a Patient with Klippel-Feil Syndrome

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