Patient-reported outcomes of occipitocervical and atlantoaxial fusions in children

Vedantam, Aditya; Hansen, Daniel; Briceño, Valentina; Brayton, Alison; Jea, Andrew

doi:10.3171/2016.8.peds16286

Cited by 16 publications

(10 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, craniocervical fixation procedures can have implications for longitudinal growth and occipitocervical alignment as pediatric patients mature, with generally good clinical and patient-reported outcomes but variable growth and alignment reported. 51,52 Institutional Review Olfactory neuroblastoma searched to identify all patients with tumors of the skull base, age 18 or less at time of surgery. From 1992 to 2002, 24 patients meeting these criteria were identified and the details of their management have been previously published.…”

Section: Craniocervical Anomaliesmentioning

confidence: 99%

Developmental Considerations in Pediatric Skull Base Surgery

2018

View full text Add to dashboard Cite

To review developmental surgical anatomy and technical nuances related to pediatric skull base surgery. Retrospective, single-center case series with literature review. MD Anderson Cancer Center. Patients undergoing pediatric skull base surgery. Review developmental anatomy of the pediatric skull base as it relates to technical nuance of various surgical approaches and insight gained from a 25-year institutional experience with this unique patient population. Thirty-nine patients meeting these criteria were identified over a 13-year period from 2003 to 2016 and compared to a previously reported earlier cohort from 1992 to 2002. The most common benign pathologies included nerve sheath tumors (11%), juvenile nasopharyngeal angiofibromas (9.5%), and craniopharyngiomas (4.8%). The most common malignancies were chondrosarcoma (11%), chordoma (11%), and rabdomyosarcoma (11%). Varied surgical approaches were utilized and were similar between the two cohorts save for the increased use of endoscopic surgical techniques in the most recent cohort. The most common sites of tumor origin were the infratemporal fossa, sinonasal cavities, clivus, temporal bone, and parasellar region. Gross total resection and postoperative complication rates were similar between the two patient cohorts. Pediatric skull base tumors, while rare, often are treated surgically, necessitating an in depth understanding of the anatomy of the developing skull base.

show abstract

Section: Craniocervical Anomaliesmentioning

confidence: 99%

Developmental Considerations in Pediatric Skull Base Surgery

2018

View full text Add to dashboard Cite

show abstract

“…Kennedy et al report on favorable outcomes after craniocervical fusion in children, although a proportion of the cohort may experience difficulties in compensating for the fused segments [56]. The patient-reported outcomes seem to be satisfying, however, although no study has examined a homogenous CM population undergoing C1-2 fixation only [49,79,91].…”

Section: Goel's Hypothesismentioning

confidence: 99%

Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis

et al. 2020

View full text Add to dashboard Cite

Introduction Recently, a novel hypothesis has been proposed concerning the origin of craniovertebral junction (CVJ) abnormalities. Commonly found in patients with these entities, atlantoaxial instability has been suspected to cause both Chiari malformation type I and basilar invagination, which renders the tried and tested surgical decompression strategy ineffective. In turn, C1-2 fusion is proposed as a single solution for all CVJ abnormalities, and a revised definition of atlantoaxial instability sees patients both with and without radiographic evidence of instability undergo fusion, instead relying on the intraoperative assessment of the atlantoaxial joints to confirm instability. Methods The authors conducted a comprehensive narrative review of literature and evidence covering this recently emerged hypothesis. The proposed pathomechanisms are discussed and contextualized with published literature. Conclusion The existing evidence is evaluated for supporting or opposing sole posterior C1-2 fusion in patients with CVJ abnormalities and compared with reported outcomes for conventional surgical strategies such as posterior fossa decompression, occipitocervical fusion, and anterior decompression. At present, there is insufficient evidence supporting the hypothesis of atlantoaxial instability being the common progenitor for CVJ abnormalities. Abolishing tried and tested surgical procedures in favor of a single universal approach would thus be unwarranted.

show abstract

“…[ 3 ] This procedure was first introduced by Atul Goel in 1994 and then further developed by Harms in 2001. [ 5 6 ] CCJ dislocation and instability are understood to affect patients’ health-related quality of life (HRQoL),[ 7 8 ] but the quantification of this phenomenon is yet to be determined. Moreover, HRQoL after craniocervical fusion is also unknown.…”

Section: Introductionmentioning

confidence: 99%

EuroQol-5 dimensions health-related quality of life questionnaire in craniovertebral instability treated with posterior fixation with or without occipital plating

Klepinowski

Sagan

2022

Journal of Craniovertebral Junction and Spine

View full text Add to dashboard Cite

Objective: Health-related quality of life (HRQoL) in craniocervical instability (CCI) before and after posterior fixation is yet to be determined. This study aimed to deliver novel and clinically relevant data about HRQoL (baseline, at follow-up, predictors, and correlates) in subjects with CCI treated with posterior fixation with or without occipital plating, and to compare it with matched datasets. Methods: EuroQol-5 dimensions (EQ-5D) questionnaires were collected to evaluate HRQoL before surgery and at follow-up. Study sample size was estimated at 58. Comparison with representative datasets was done by matching on a many-to-many basis. Classic CCI parameters were measured. Strengthening the Reporting of Observational Studies in Epidemiology was followed. Results: Sixty subjects were included. The mean age was 37.2 years. The median follow-up for EQ-5D was 26.3 months with interquartile range (IQR) 10.8 to 47.3 months. The median preoperative score of the 3-level version of EQ-5D (EQ-5D-3L) was 0.254 (IQR = −0.025 to 0.504), whereas at follow-up, it increased to 0.779 (IQR = 0.387–0.864) which is still worse than the 25 th percentile (0.894) of the age-matched population. Occipital plating ( n = 35; 58.3%) did not influence HRQoL trajectory ( P = 0.692). In multiple linear regression, HRQoL at follow-up was affected by the age (β = −0.004; P = 0.049) and length of hospitalization (β = −0.134; P = 0.010). Of radiologic measurements, preoperative Wackenheim line correlated with HRQoL at follow-up (rho = −0.432; P = 0 − 028). Conclusions: HRQoL is significantly reduced in CCI. Although this can be improved with posterior fixation, it is still worse than the age-matched population. Occipital plating may not influence HRQoL. HRQoL of the elderly might not increase as much as of the younger subjects. The longer hospitalization, the worse HRQoL could be expected. Preoperative Wackenheim parameter could correlate with HRQoL at follow-up.

show abstract

Patient-reported outcomes of occipitocervical and atlantoaxial fusions in children

Cited by 16 publications

References 29 publications

Developmental Considerations in Pediatric Skull Base Surgery

Developmental Considerations in Pediatric Skull Base Surgery

Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis

EuroQol-5 dimensions health-related quality of life questionnaire in craniovertebral instability treated with posterior fixation with or without occipital plating

Contact Info

Product

Resources

About