| Orginal Article |
|
|
|
|
| Surgical treatment of congenital basilar invagination with different pathological characteristics: Report of 139 cases |
| Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China |
|
|
|
|
Abstract Objective: To describe the different pathological characteristics of congenital basilar invaginations and discuss the surgical treatment of such cases.
Methods: A total of 139 patients diagnosed with basilar invaginations underwent surgical treatment from 2008 to 2015. Based on Atul Goel's classification and simultaneous consideration of atlantoaxial dislocation or syringomyelia, the cases were subdivided into four groups. Individualized posterior surgical decompression and/or atlantoaxial reset procedures were performed to correct atlantoaxial dislocation, decompress the brain stem, or resolve syringomyelia. The indications and critical points of each procedure were documented.
Results: All 139 patients were surgically treated; 27 patients (19.4%) had underwent at least one decompression surgery previously. On an average, there was gratifying clinical improvement based on the Japanese Orthopaedic Association score analysis. One patient exhibited severe post-operative infection, and the fusion instrument was removed. One patient experienced fracture of internal fixation. Two patients exhibited persistent respiratory symptoms at early stages after the surgery. Four patients felt worse at the latest follow-up. There was no surgical mortality. The poor outcome/ morbidity in this series was 5.8% (8/139).
Conclusion: The different pathological image characteristics of congenital basilar invaginations based on the presence or absence of syringomyelia and/or atlantoaxial dislocation, reflected the pathological features of complicated basilar invaginations more accurately. Based on these features, different posterior decompression and/or reset procedures, combined with occipitocervical fusion and C1-2 fusion, could be tailored to different patients. These individualized surgeries could reduce surgical complications, decrease morbidity and mortality, and further promote positive outcomes.
|
|
Received: 16 October 2017
Published: 30 December 2017
|
|
|
|
Corresponding Authors:
Tao Fan,E-mail:fantao971@163.com
E-mail: fantao971@163.com
|
|
|
[1] Klimo P Jr, Rao G, Brockmeyer D. Congenital anomalies of the cervical spine. NeurosurgClin N Am. 2007, 18(3): 463-478.
[2] Menezes AH. Craniocervical developmental anatomy and its implications. Childs Nerv Syst. 2008, 24(10): 1109-1122.
[3] Charnas LR, Marini JC. Communicating hydrocephalus, basilar invagination, and other neurologic features in osteogenesisimperfecta. Neurology 1993, 43(12): 2603-2608.
[4] Smoker WR. Craniovertebral junction: normal anatomy, craniometry, and congenital anomalies. Radiographics. 1994, 14(2): 255-277.
[5] Smoker WR, Khanna G. Imaging the craniocervical junction. Childs Nerv Syst. 2008, 24(10): 1123-1145.
[6] Menezes AH, VanGilder JC, Graf CJ, McDonnell DE. Craniocervicalabnormalities. Acomprehensive surgical approach. J Neurosurg. 1980, 53: 444-455
[7] Goel A. Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine. 2004, 1(3): 281-286.
[8] Justin SS, Christopher IS, Mark FA, Anrnold HM. Basilar Invagination. J Neurosurg. 2010, 66: 39-47.
[9] McGirt MJ, Attenello FJ, Sciubba DM, Gokaslan ZL, Wolinsky JP. Endoscopic transcervicalodontoidectomy for pediatric basilar invagination and cranial settling. Report of 4 cases. J Neurosurg Pediatr. 2008, 1(4): 337-342.
[10] Wolinsky JP, Sciubba DM, Suk I, Gokaslan ZL. Endoscopic image-guided odontoidectomy for decompression of basilar invagination via a standard anterior cervical approach. Technical note. J Neurosurg Spine. 2007, 6(2): 184-191.
[11] Hsu W, Kosztowski TA, Zaidi HA, Gokaslan ZL, Wolinsky JP. Image-guided, endoscopic, transcervical resection of cervical chordoma. J Neurosurg Spine 2010, 12(4): 431- 435.
[12] Bartels RH, Verbeek AL, Benzel EC, Fehlings MG, Guiot BH. Validation of a translated version of the modified Japanese orthopaedic association score to assess outcomes in cervical spondylotic myelopathy: an approach to globalize outcomes assessment tools. J Neurosurg. 2010, 66(5): 1013-1016.
[13] Atul Goel. Is atlantoxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoxial fixation. J Neurosurg Spine 2015(22): 116-127.
[14] Jorg K. Chiari I malformation with and without basilar invagination: a comparative study. Neurosurgery Focus. 2015, 38(4): 1-13 |
|
Viewed |
|
|
|
Full text
|
|
|
|
|
Abstract
|
|
|
|
|
Cited |
|
|
|
|
| |
Shared |
|
|
|
|
| |
Discussed |
|
|
|
|
