Transoral plate and screw fixation of the craniovertebral region–a preliminary report

Goel, Atul; Karapurkar, Anil

doi:10.3109/02688699409101191

“…Since Goel et al [10] first reported a case of transoral plate and screw fixation of the clivus to the body of the cervical vertebra, several studies have been published using the clival screw fixation for the craniovertebral region [8,9]. However, the anatomy of the clivus and the geometry of the craniocervical junction present challenges for the placement of instrumentation, and also there are no literature that have document the entry point, trajectory, and optimal length of clival screws; our next logical step was to study the anatomic of clival screw fixation for the craniovertebral region.…”

Section: Discussionmentioning

confidence: 99%

“…Rawlins et al [9] used a titanium plate to fix the bone graft into the clivus and the body of the 3rd cervical vertebra, as the anterior reconstruction. Goel et al [10] reported a patient with congenital basilar invagination after odontoidectomy performed with plate and screw fixation of the clivus to the body of the 3rd cervical vertebra. It was considered that direct fixation to the clivus may be a more rigid alternative to previously described techniques [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

The anatomic study of clival screw fixation for the craniovertebral region

Ji

¹

,

Wang

²

,

Xu

³

et al. 2012

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Purpose To study the anatomic parameters related to clival screw and establish reference data concerning the craniovertebral fixation technique. Methods Morphometric measurement of the clivus and the surrounding anatomic structures were obtained on 41 dry bone specimens. Then, 2-D CT reconstruction of the craniovertebral region of 30 patients (19 men and 11 women, ranging in age from 20-64 years with an average age of 38.8 years) were performed to measure the safety range for a 3.5-mm screw placement. Nine entry points were evaluated. Finally, one male fresh cadaver specimen (age 46 years) was dissected to observe the craniovertebral region. Results The clivus faces the basilar artery, the V * XII cranial nerves, the pons, and ventral medulla oblongata at its intracranial surface. The longitudinal diameter of extracranial clivus was 25.87 ± 2.64 mm. The narrowest diameter of the clivus was 12.84 ± 1.08 mm, the distance between the left and right hypoglossal canal was 32.70 ± 2.09 mm at its widest part. The distance between the left and right structures, the maximum value was 49.31 ± 4.16 mm at carotid canal, the minimum value was 16.54 ± 2.04 mm at the occipital condyle. The measurement of clival screws placement simulation via 2-D CT reconstruction images shows the maximum upper insertion angle of three components the optimal entry points, the candidate points, the limit entry points was 130.19°, 125.23°and 85.72°, and the total mean screw length was 7.57, 10.13 and 15.6 mm at the vertical entry angle, respectively. Conclusions Clival screw placement is a viable option for craniovertebral fixation. There is a safe scope for the screw length and angle of the screw placement. And, these parameters obtained in the present study will be helpful for anyone contemplating the use of clival screw fixation.

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“…According to Menezes and Van Gilder 17 , when osteoarthritis was present in the atlantoaxial joints, posterior fi xation was often not required. Although some authors mention ventral fi xation [26][27][28] , posterior stabilization is more practical and safer 7,29 . Of 38 patients, 18 underwent a posterior fi xation using an inside-outside technique as proposed by Pait et al 7 and two were already fi xed with the Ransford loop technique 29 .…”

Section: Discussionmentioning

confidence: 99%

Transoral approach to the craniovertebral junction

Landeiro

¹

,

Boechat

²

,

Christoph

³

et al. 2007

Arq. Neuro-Psiquiatr.

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-The transoral approach provides a safe exposure to lesions in the midline and the ventral side of the craniovertebral junction. The advantages of the transoral approach are 1) the impinging bony pathology and granulation tissue are accessible only via the ventral route; 2) the head is placed in the extended position, thus decreasing the angulation of the brainstem during the surgery; and 3) surgery is done through the avascular median pharyngeal raphe and clivus. We analyzed the clinical effects of odontoidectomy after treating 38 patients with basilar invagination. The anterior transoral operation to treat irreducible ventral compression in patients with basilar invagination was performed in 38 patients. The patients' ages ranged from 34 to 67 years. Fourteen patients had associated Chiari malformation and eight had previously undergone posterior decompressive surgery. The main indication for surgery was significant neurological deterioration. Symptoms and signs included neck pain, myelopathy, lower cranial nerve dysfunction, nystagmus and gait disturbance. Extended exposure was performed in 24 patients. The surgery was beneficial to the majority of patients. There was one death within 10 days of surgery, due to pulmonary embolism. Postoperative complications included two cases of pneumonia, three cases of oronasal fistula with regurgitation and one cerebrospinal fluid leak. In patients with marked ventral compression, the transoral approach provides direct access to the anterior face of the craniovertebral junction and effective means for odontoidectomy.KEY WORDS: basilar invagination, odontoidectomy, transoral approach. Acesso transoral para a junção craniocervicalRESUMO -O acesso transoral é uma via direta e segura às lesões situadas na linha média e na face anterior da junção craniocervical. As vantagens do acesso transoral são as seguintes:1) a compressão óssea e o tecido de granulação localizam-se anteriormente e são accessíveis pela via anterior; 2) a cabeça do paciente é colocada em extensão, diminuindo a angulação do tronco cerebral durante a cirurgia; e 3) a cirurgia é feita através de um plano avascular na linha média faríngea e clivo. Analisamos os resultados obtidos após odontoidectomia por via transoral em 38 pacientes portadores de invaginação basilar. Trinta e oito pacientes com compressão ventral da junção craniocervical foram submetidos a odontoidectomia por via transoral. A idade dos pacientes variou de 34 a 67 anos. Quatorze pacientes apresentavam associação com malformação de Chiari tipo I e 8 já haviam sido submetidos à cirurgia descompressiva por via posterior. A maioria dos pacientes apresentou nucalgia, mielopatia, déficits dos nervos cranianos baixos, nistagmo, e distúrbio da marcha. Em 24 pacientes foi necessário ampliar o acesso transoral através de miotomia do palato mole, ou osteotomia do palato duro ou maxilotomia. A cirurgia proporcionou melhora dos sintomas na maioria dos pacientes. Um paciente faleceu no pós-operatório imediato por causa de embolia pulmonar. Dois paci...

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“…According to Menezes and Van Gilder 17 , when osteoarthritis was present in the atlantoaxial joints, posterior fi xation was often not required. Although some authors mention ventral fi xation [26][27][28] , posterior stabilization is more practical and safer 7,29 . Of 38 patients, 18 underwent a posterior fi xation using an inside-outside technique as proposed by Pait et al 7 and two were already fi xed with the Ransford loop technique 29 .…”

Section: Discussionmentioning

confidence: 99%

Transoral Approach to the Craniovertebral Junction

Bambakidis¹,

Dickman²,

Spetzler³

et al. 2013

Surgery of the Craniovertebral Junction

0

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-The transoral approach provides a safe exposure to lesions in the midline and the ventral side of the craniovertebral junction. The advantages of the transoral approach are 1) the impinging bony pathology and granulation tissue are accessible only via the ventral route; 2) the head is placed in the extended position, thus decreasing the angulation of the brainstem during the surgery; and 3) surgery is done through the avascular median pharyngeal raphe and clivus. We analyzed the clinical effects of odontoidectomy after treating 38 patients with basilar invagination. The anterior transoral operation to treat irreducible ventral compression in patients with basilar invagination was performed in 38 patients. The patients' ages ranged from 34 to 67 years. Fourteen patients had associated Chiari malformation and eight had previously undergone posterior decompressive surgery. The main indication for surgery was significant neurological deterioration. Symptoms and signs included neck pain, myelopathy, lower cranial nerve dysfunction, nystagmus and gait disturbance. Extended exposure was performed in 24 patients. The surgery was beneficial to the majority of patients. There was one death within 10 days of surgery, due to pulmonary embolism. Postoperative complications included two cases of pneumonia, three cases of oronasal fistula with regurgitation and one cerebrospinal fluid leak. In patients with marked ventral compression, the transoral approach provides direct access to the anterior face of the craniovertebral junction and effective means for odontoidectomy.KEY WORDS: basilar invagination, odontoidectomy, transoral approach. Acesso transoral para a junção craniocervicalRESUMO -O acesso transoral é uma via direta e segura às lesões situadas na linha média e na face anterior da junção craniocervical. As vantagens do acesso transoral são as seguintes:1) a compressão óssea e o tecido de granulação localizam-se anteriormente e são accessíveis pela via anterior; 2) a cabeça do paciente é colocada em extensão, diminuindo a angulação do tronco cerebral durante a cirurgia; e 3) a cirurgia é feita através de um plano avascular na linha média faríngea e clivo. Analisamos os resultados obtidos após odontoidectomia por via transoral em 38 pacientes portadores de invaginação basilar. Trinta e oito pacientes com compressão ventral da junção craniocervical foram submetidos a odontoidectomia por via transoral. A idade dos pacientes variou de 34 a 67 anos. Quatorze pacientes apresentavam associação com malformação de Chiari tipo I e 8 já haviam sido submetidos à cirurgia descompressiva por via posterior. A maioria dos pacientes apresentou nucalgia, mielopatia, déficits dos nervos cranianos baixos, nistagmo, e distúrbio da marcha. Em 24 pacientes foi necessário ampliar o acesso transoral através de miotomia do palato mole, ou osteotomia do palato duro ou maxilotomia. A cirurgia proporcionou melhora dos sintomas na maioria dos pacientes. Um paciente faleceu no pós-operatório imediato por causa de embolia pulmonar. Dois paci...

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Transoral plate and screw fixation of the craniovertebral region–a preliminary report

Abstract: A transoral plate and screw fixation of the clivus to the body of the cervical vertebra is described. The procedure was successfully performed in a patient with congenital basilar invagination after odontoidectomy.

Cited by 37 publications

References 10 publications

The anatomic study of clival screw fixation for the craniovertebral region

The anatomic study of clival screw fixation for the craniovertebral region

Transoral approach to the craniovertebral junction

Transoral Approach to the Craniovertebral Junction

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