Morphologic Analysis of Occipital Sinuses for Occipital Screw Fixation Using Digital Subtraction Angiography

Lee, Dong Hoon; Hong, Jae Taek; Sung, Jae Hoon; Jain, Ashish; Huh, Jae Won; Kim, Sanguk; Kim, Joon‐Young; Kwon, Jae Yoel; Cho, Chul Bum; Kim, Il Sup; Lee, Sang Won

doi:10.1016/j.wneu.2016.04.038

Cited by 11 publications

(13 citation statements)

References 13 publications

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“…However, Izeki et al found that the dural venous sinus is extremely variable between individuals, based on CT venography, so that there is no universal position for safe occipital screw placement that can apply to all individuals [ 10 ]. In particular, the variation of the occipital venous sinus located at the midline of the internal occipital bone should be considered carefully during occipital screw placement [ 4 ]. A prominent occipital venous sinus, as shown in this case, is the main drainage for the deep cerebral veins, and its injury may cause fatal complications such as massive bleeding or occlusion [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the occipital screw has potential risks such as dural injury, cerebrospinal fluid (CSF) leakage, dural venous sinus injury or thrombosis, and sub- or epidural hematoma [ 3 ]. When variations in the dural venous sinuses such as the occipital sinuses are present, surgeons should be cautious to avoid their injury [ 4 ]. Fluoroscopic guidance may be insufficient in that case.…”

Section: Introductionmentioning

confidence: 99%

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Occipital Screw Placement Using a Navigation System for a Pathological Odontoid Fracture With a Dural Venous Sinus Variation

Miura¹,

Koda²,

Funayama³

et al. 2021

Cureus

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Conventional fluoroscopic guidance can provide enough information to precisely insert an occipital screw in ordinary cases. However, the occipital screw creates a potential risk of dural venous sinus injury or thrombosis. In some cases, with dural sinus variation, surgeons must especially be cautious to avoid its injury. We present a rare case of proper occipital screw placement using a navigation system for a pathological odontoid fracture with a high risk of dural venous sinus injury because of anatomical variations in the transverse and occipital sinuses. A 60-year-old man who underwent thyroidectomy at the age of 37 years for thyroid carcinoma developed acute neck pain and quadriparesis due to falling out of bed. He urgently underwent closed reduction and temporary immobilization with a halo-vest for a pathological odontoid fracture and atlantoaxial dislocation. Preoperative contrast-enhanced CT showed an absent right transverse sinus and a prominent occipital sinus as variations of the dural venous sinuses. Occipito-C7 fusion surgery was performed without intraoperative active venous bleeding or postoperative brain disorder by using a navigation system for the occipital screw placement to avoid injury to the dural sinus. Postoperative computed tomography showed bi-cortical occipital screw placement avoiding the prominent occipital sinus. The patient's postoperative course was uneventful. In this case, although rigid occipitocervical fixation using bi-cortical occipital screws was needed for the pathological odontoid fracture, the variation of the occipital sinus created a high risk of injury during occipital screw placement with conventional fluoroscopic guidance. There is an anatomical variation of the dural venous sinuses between individuals. Prominent occipital sinus injury may notably cause fatal complications such as massive bleeding or occlusion. Thus, we safely inserted the occipital screws using a navigation system that enabled us to avoid occipital venous sinus injury. Occipital screw placement with a navigation system can be a better option to prevent dural venous sinus injury in cases where there is variation in the dural venous sinuses, such as with a prominent occipital venous sinus.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Occipital Screw Placement Using a Navigation System for a Pathological Odontoid Fracture With a Dural Venous Sinus Variation

Miura¹,

Koda²,

Funayama³

et al. 2021

Cureus

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“…Its unique structure is responsible for important functions, including head movement and protection of the nervous system. 1,2 The CVJ is composed of bony structures, ligaments and joints, including atlas, axis, transverse ligament, cruciate ligament, occipital-atlantal joint and atlantoaxial joint. [3][4][5] Together, these structures not only maintain the stability of the CVJ, but also are involved in the axial rotation and flexion-extension movements.…”

Section: Introductionmentioning

confidence: 99%

Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy

Chang

et al. 2022

Neurospine

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Objective: Diseases of the craniovertebral junction (CVJ) are commonly associated with deformity, malalignment, and subsequent myelopathy. The misaligned CVJ might cause compression of neuronal tissues and subsequently clinical symptoms. The triangular area (TA), measured by magnetic resonance imaging/images (MRI/s), is a novel measurement for quantification of the severity of compression to the brain stem. This study aimed to assess the normal and pathological values of TA by a comparison of patients with CVJ disease to age- and sex-matched controls. Moreover, postoperative TAs were correlated with outcomes.Methods: Consecutive patients who underwent surgery for CVJ disease were included for comparison to an age- and sex-matched cohort of normal CVJ persons as controls. The demographics, perioperative information, and pre- and postoperative 2-year cervical MRIs were collected for analysis. Cervical TAs were measured and compared.Results: A total of 201 patients, all of whom had pre- or postoperative MRI, were analyzed. The TA of the CVJ deformity group was larger than the healthy control group (1.62 ± 0.57 cm2 vs. 1.01 ± 0.18 cm2, p < 0.001). Moreover, patients who had combined anterior odontoidectomy and posterior laminectomy with fixation had the greatest reduction in the TA (1.18 ± 0.58 cm2).Conclusion: In CVJ deformity, the measurement of the cervical TA could indicate the severity of brain stem compression. After surgery, the TA had a varying degree of improvement, which could represent the efficacy of surgery.

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“…Craniovertebral junction (CVJ) is the region around the skull base and the upper cervical spine (atlas and axis), and its alignment is unique regarding the segmental motion and biomechanical perspective. [1][2][3][4] The stability of CVJ is dependent on a robust ligamentous complex and the shape of the bony structures, which are also responsible for much of the axial rotation (C1-2 joint) and flexion-extension movements (C0-1 and C1-2 joint). [5][6][7] Although deformity or malalignment around CVJ is a rare, CVJ deformity results in sagittal and coronal imbalances, which causes significant pain due to arthritis, instability, and C2 foraminal stenosis.…”

Section: Introductionmentioning

confidence: 99%

“…Craniovertebral junction (CVJ) is the region around the skull base and the upper cervical spine (atlas and axis), and its alignment is unique regarding the segmental motion and biomechanical perspective [ 1 - 4 ]. The stability of CVJ is dependent on a robust ligamentous complex and the shape of the bony structures, which are also responsible for much of the axial rotation (C1–2 joint) and flexion-extension movements (C0–1 and C1–2 joint) [ 5 - 7 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation and Surgical Planning for Craniovertebral Junction Deformity

et al. 2020

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Craniovertebral junction (CVJ) deformity is a challenging pathology that can result in progressive deformity, myelopathy, severe neck pain, and functional disability, such as difficulty swallowing. Surgical management of CVJ deformity is complex for anatomical reasons; given the discreet relationships involved in the surrounding neurovascular structures and intricate biochemical issues, access to this region is relatively difficult. Evaluation of the reducibility, CVJ alignment, and direction of the mechanical compression may determine surgical strategy. If CVJ deformity is reducible, posterior in situ fixation may be a viable solution. If the deformity is rigid and the C1-2 facet is fixed, osteotomy may be necessary to make the C1-2 facet joint reducible. C1-2 facet release with vertical reduction technique could be useful, especially when the C1-2 facet joint is the primary pathology of CVJ kyphotic deformity or basilar invagination. The indications for transoral surgery are becoming as narrow as a treatment for CVJ deformity. In this article, we will discuss CVJ alignment and various strategies for the management of CVJ deformity and possible ways to prevent complications and improve surgical outcomes.

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Morphologic Analysis of Occipital Sinuses for Occipital Screw Fixation Using Digital Subtraction Angiography

Cited by 11 publications

References 13 publications

Occipital Screw Placement Using a Navigation System for a Pathological Odontoid Fracture With a Dural Venous Sinus Variation

Occipital Screw Placement Using a Navigation System for a Pathological Odontoid Fracture With a Dural Venous Sinus Variation

Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy

Evaluation and Surgical Planning for Craniovertebral Junction Deformity

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