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Atul Goel - One of the best experts on this subject based on the ideXlab platform.
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Atlantoaxial fixation as treatment of trigeminal neuralgia in a patient having Basilar Invagination
World neurosurgery, 2019Co-Authors: Atul Goel, Abhidha Shah, Tejas Vaja, Saswat Dandpat, Nilesh BakaleAbstract:Background Trigeminal neuralgia can rarely be identified in association with Basilar Invagination. The presented case report observes that the treatment of Basilar Invagination by atlantoaxial fixation can result in lasting relief from trigeminal neuralgia. Case Description We report a case of a 36-year-old male patient who presented with the primary symptom of trigeminal neuralgia for a period of 2 years. Investigations revealed the presence of Basilar Invagination and an ectatic vertebral artery loop in the vicinity of the trigeminal nerve. The patient underwent atlantoaxial fixation on the basis of the concept that atlantoaxial instability is the nodal point of pathogenesis of Basilar Invagination. Atlantoaxial fixation resulted in complete and lasting relief from symptom of trigeminal neuralgia. Conclusions The pathogenesis of trigeminal neuralgia and its relationship with atlantoaxial instability is speculated.
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Radiological Evaluation of 510 Cases of Basilar Invagination with Evidence of Atlantoaxial Instability (Group A Basilar Invagination).
World neurosurgery, 2018Co-Authors: Atul Goel, Sonal Jain, Abhidha ShahAbstract:Objective To evaluate the musculoskeletal and soft tissue neural alterations in cases with group A Basilar Invagination. Methods Between January 2007 and August 2016, 510 patients with group A Basilar Invagination were surgically treated. The radiologic images of these patients were reviewed retrospectively. The patients were divided into 4 groups: group A1, comprising 60 patients with syringomyelia; group A2, comprising 354 patients with “external syrinx,” marked by excessive cerebrospinal fluid (CSF) in the extramedullary space; group A3, comprising 51 patients with both syringomyelia and external syrinx; and group A4, comprising 45 patients with no abnormality of CSF cavitation in the spinal canal. Results A number of musculoskeletal and neural parameters, including the extent of Basilar Invagination, degree of angulation of the odontoid process, and facet malalignment, were evaluated in each of the 4 groups. The degree of Basilar Invagination was 6–27.4 mm (average, 15.85 mm) in group A1, 4.3–24.5 mm (average, 12.56 mm) in group A2, 5.6–17.6 mm (average 10.8 mm) in group A3, and 5.2–17.3 mm (average, 11.74 mm) in group A4. The angle of inclination of the odontoid process was 61.1–90.7 degrees (average, 71.4 degrees) in group A1, 30.5–79.8 degrees (average, 60.05 degrees) in group A2, 68.5–78.3 degrees (average, 73.4 degrees) in group A3, and 62.2–87.4 degrees (average, 71.2 degrees) in group A4. Conclusions The nature of bone malformations directly influences the presence or absence of external syrinx and syringomyelia.
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Craniovertebral realignment for Basilar Invagination
Indian Journal of Neurosurgery, 2017Co-Authors: Atul GoelAbstract:The understanding of pathogenesis and treatment of Basilar Invagination has been evolving for over a century. The concepts regarding nature of atlantoaxial instability in such cases are also under discussion. The author presents personal evolving concepts on the subject. The technique of craniovertebral realigement, its rationale and the outcome of treatment is presented
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Atlantoaxial Fixation for Basilar Invagination without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Outcome Analysis of 63 Surgically Treated Cases.
World neurosurgery, 2016Co-Authors: Atul Goel, Prashant Sathe, Abhidha ShahAbstract:Background We discuss the rationale of surgical treatment of group B Basilar Invagination by atlantoaxial facet joint stabilization and segmental arthrodesis. Methods From January 2010 to April 2016, 63 patients with group B Basilar Invagination were surgically treated. All patients had varying degree of myelopathy-related functional disability. Fifty-two patients had both Chiari malformation and syringomyelia. All patients were treated by atlantoaxial plate and screw fixation with the techniques described by us in 1994 and 2004. Foramen magnum decompression or syrinx manipulation was not carried out in any patient. Occipital bone and subaxial spinal elements were not included in the fixation construct. Results Three patients died in the immediate postoperative phase. In the remaining patients, there was clinical improvement and no patient's neurologic function worsened after surgery. In 12 of 38 patients in whom postoperative magnetic resonance imaging was possible, at a follow-up of at least 3 months, there was reduction in the size of the syrinx. Conclusions The pathogenesis of Basilar Invagination in group B is related to atlantoaxial instability. The clinical outcome suggests that the surgical treatment in these cases should be directed toward atlantoaxial stabilization and aimed at segmental arthrodesis. Inclusion of the occipital bone in the fixation construct is not necessary. Foramen magnum decompression and procedures involving manipulation of Chiari malformation and syringomyelia are not necessary.
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Radiologic Evaluation of Basilar Invagination Without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Analysis Based on a Study of 75 Patients
World neurosurgery, 2016Co-Authors: Atul Goel, Abhidha Shah, Prashant Sathe, Trimurti Nadkarni, Manoj PatilAbstract:Background We evaluated the radiologic features of 75 patients with group B Basilar Invagination who exhibited no evidence of atlantoaxial instability based on the conventional parameter of an abnormal increase in the atlantodental interval. We specifically studied the variability and possible significance of the presence of cerebrospinal fluid (CSF) within and outside the confines of neural tissues. Materials and Methods During the period January 2008–May 2015, we encountered 75 cases with group B Basilar Invagination. These patients were divided into 4 groups depending on cervical spinal imaging that showed the presence of syringomyelia (group B1), increased CSF volume in the extramedullary space or external syrinx (group B2), the presence of both syringomyelia and external syrinx (group B3), and no abnormality of CSF cavitation in the spinal canal (group B4). Results Our cohort comprised 39 group B1 cases, 10 group B2 cases, 20 group B3 cases, and 6 group B4 cases. The neck size and posterior fossa height were simultaneously reduced, by 15.89% and 15%, respectively, but the length of the neural structures remained within the normal range. Excessive amounts of CSF were present within or outside the confines of neural structures, including the spinal cord, brainstem, and cerebellum. Conclusions In cases of Basilar Invagination, various musculoskeletal and neural alterations seem to have a common functional role in protecting the craniocervical cord and delaying or stalling neurologic dysfunction.
Abhidha Shah - One of the best experts on this subject based on the ideXlab platform.
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Atlantoaxial fixation as treatment of trigeminal neuralgia in a patient having Basilar Invagination
World neurosurgery, 2019Co-Authors: Atul Goel, Abhidha Shah, Tejas Vaja, Saswat Dandpat, Nilesh BakaleAbstract:Background Trigeminal neuralgia can rarely be identified in association with Basilar Invagination. The presented case report observes that the treatment of Basilar Invagination by atlantoaxial fixation can result in lasting relief from trigeminal neuralgia. Case Description We report a case of a 36-year-old male patient who presented with the primary symptom of trigeminal neuralgia for a period of 2 years. Investigations revealed the presence of Basilar Invagination and an ectatic vertebral artery loop in the vicinity of the trigeminal nerve. The patient underwent atlantoaxial fixation on the basis of the concept that atlantoaxial instability is the nodal point of pathogenesis of Basilar Invagination. Atlantoaxial fixation resulted in complete and lasting relief from symptom of trigeminal neuralgia. Conclusions The pathogenesis of trigeminal neuralgia and its relationship with atlantoaxial instability is speculated.
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Radiological Evaluation of 510 Cases of Basilar Invagination with Evidence of Atlantoaxial Instability (Group A Basilar Invagination).
World neurosurgery, 2018Co-Authors: Atul Goel, Sonal Jain, Abhidha ShahAbstract:Objective To evaluate the musculoskeletal and soft tissue neural alterations in cases with group A Basilar Invagination. Methods Between January 2007 and August 2016, 510 patients with group A Basilar Invagination were surgically treated. The radiologic images of these patients were reviewed retrospectively. The patients were divided into 4 groups: group A1, comprising 60 patients with syringomyelia; group A2, comprising 354 patients with “external syrinx,” marked by excessive cerebrospinal fluid (CSF) in the extramedullary space; group A3, comprising 51 patients with both syringomyelia and external syrinx; and group A4, comprising 45 patients with no abnormality of CSF cavitation in the spinal canal. Results A number of musculoskeletal and neural parameters, including the extent of Basilar Invagination, degree of angulation of the odontoid process, and facet malalignment, were evaluated in each of the 4 groups. The degree of Basilar Invagination was 6–27.4 mm (average, 15.85 mm) in group A1, 4.3–24.5 mm (average, 12.56 mm) in group A2, 5.6–17.6 mm (average 10.8 mm) in group A3, and 5.2–17.3 mm (average, 11.74 mm) in group A4. The angle of inclination of the odontoid process was 61.1–90.7 degrees (average, 71.4 degrees) in group A1, 30.5–79.8 degrees (average, 60.05 degrees) in group A2, 68.5–78.3 degrees (average, 73.4 degrees) in group A3, and 62.2–87.4 degrees (average, 71.2 degrees) in group A4. Conclusions The nature of bone malformations directly influences the presence or absence of external syrinx and syringomyelia.
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Atlantoaxial Fixation for Basilar Invagination without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Outcome Analysis of 63 Surgically Treated Cases.
World neurosurgery, 2016Co-Authors: Atul Goel, Prashant Sathe, Abhidha ShahAbstract:Background We discuss the rationale of surgical treatment of group B Basilar Invagination by atlantoaxial facet joint stabilization and segmental arthrodesis. Methods From January 2010 to April 2016, 63 patients with group B Basilar Invagination were surgically treated. All patients had varying degree of myelopathy-related functional disability. Fifty-two patients had both Chiari malformation and syringomyelia. All patients were treated by atlantoaxial plate and screw fixation with the techniques described by us in 1994 and 2004. Foramen magnum decompression or syrinx manipulation was not carried out in any patient. Occipital bone and subaxial spinal elements were not included in the fixation construct. Results Three patients died in the immediate postoperative phase. In the remaining patients, there was clinical improvement and no patient's neurologic function worsened after surgery. In 12 of 38 patients in whom postoperative magnetic resonance imaging was possible, at a follow-up of at least 3 months, there was reduction in the size of the syrinx. Conclusions The pathogenesis of Basilar Invagination in group B is related to atlantoaxial instability. The clinical outcome suggests that the surgical treatment in these cases should be directed toward atlantoaxial stabilization and aimed at segmental arthrodesis. Inclusion of the occipital bone in the fixation construct is not necessary. Foramen magnum decompression and procedures involving manipulation of Chiari malformation and syringomyelia are not necessary.
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Radiologic Evaluation of Basilar Invagination Without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Analysis Based on a Study of 75 Patients
World neurosurgery, 2016Co-Authors: Atul Goel, Abhidha Shah, Prashant Sathe, Trimurti Nadkarni, Manoj PatilAbstract:Background We evaluated the radiologic features of 75 patients with group B Basilar Invagination who exhibited no evidence of atlantoaxial instability based on the conventional parameter of an abnormal increase in the atlantodental interval. We specifically studied the variability and possible significance of the presence of cerebrospinal fluid (CSF) within and outside the confines of neural tissues. Materials and Methods During the period January 2008–May 2015, we encountered 75 cases with group B Basilar Invagination. These patients were divided into 4 groups depending on cervical spinal imaging that showed the presence of syringomyelia (group B1), increased CSF volume in the extramedullary space or external syrinx (group B2), the presence of both syringomyelia and external syrinx (group B3), and no abnormality of CSF cavitation in the spinal canal (group B4). Results Our cohort comprised 39 group B1 cases, 10 group B2 cases, 20 group B3 cases, and 6 group B4 cases. The neck size and posterior fossa height were simultaneously reduced, by 15.89% and 15%, respectively, but the length of the neural structures remained within the normal range. Excessive amounts of CSF were present within or outside the confines of neural structures, including the spinal cord, brainstem, and cerebellum. Conclusions In cases of Basilar Invagination, various musculoskeletal and neural alterations seem to have a common functional role in protecting the craniocervical cord and delaying or stalling neurologic dysfunction.
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Management of Basilar Invagination: A historical perspective
Journal of Craniovertebral Junction and Spine, 2016Co-Authors: Abhidha Shah, Elena SerchiAbstract:For a long time the terms Basilar Invagination and platybasia were used interchangeably. Basilar Invagination has been defined as a prolapse of the vertebral column into the spinal cord. Platybasia is defined as an abnormal obtuse angle between the anterior skull base and the clivus. The authors review the existing literature and summarize the historical and modern perspectives in the management of Basilar Invagination. From radiological curiosities, the subject of Basilar Invagination is now viewed as eminently treatable. The more pronounced understanding of the subject has taken place in the last three decades when on the basis of understanding of the biomechanical subtleties the treatment paradigm has remarkably altered. From surgery that involved decompression of the region, stabilization and realignment now form the basis of treatment.
Jean Paul Wolinsky - One of the best experts on this subject based on the ideXlab platform.
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Spinal Neurosurgery - Basilar Invagination and Cranial Settling
Spinal Neurosurgery, 2018Co-Authors: Benjamin D. Elder, Jean Paul WolinskyAbstract:Basilar impression represents the broader category of occipitocervical junction pathologies, including Basilar impression, Basilar Invagination, and cranial settling. Basilar Invagination results from migration of the entire spine into the skull base. Cranial settling is caused by C1–C2 instability, leading to upward migration and/or rotation of the C2 complex into the cranial vault. Platybasia results from deformation and flattening of the skull base. Many patients present with a combination of neck pain, myelopathy, and potentially lower cranial nerve dysfunction. Computed tomography and magnetic resonance imaging are used to clarify the complex osseous anatomy and compression of neural elements,. Patients with a reducible Basilar Invagination may be treated with posterior decompression and stabilization alone, while non-reducible or partially reducible Invagination must be treated with anterior decompression and posterior stabilization. The goal of treatment is to prevent further neurological decline and provide adequate stabilization of the O-C junction.
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Osteogenesis Imperfecta and Basilar Invagination
Osteogenesis Imperfecta, 2014Co-Authors: Kyriakos Papadimitriou, Ali A. Baaj, Jean Paul WolinskyAbstract:Osteogenesis imperfecta (OI) was first reported to be linked to Basilar impression in 1942. Secondary Basilar impression results from skeletal diseases and resultant bone softening, as is frequently seen in OI, Paget disease, Hurler syndrome, hyperparathyroidism, osteomalacia, Hajdu–Cheney syndrome and achondroplasia. The majority of OI patients with Basilar Invagination (BI) present with severe physical disability and advanced symptomatic BI. Several radiological modalities are utilized to confirm the diagnosis and aid in pre-operative planning. The general goals of nonsurgical management in OI are to decrease the incidence of fractures and increase mobility and independence. If symptomatic BI is present, however, only surgical decompression and stabilization can halt the progression of deficits and potentially reverse them. In this chapter, we outline a review of the diagnosis, management and outcome for patients with OI and BI.
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Endoscopic image-guided transcervical odontoidectomy: outcomes of 15 patients with Basilar Invagination.
Neurosurgery, 2011Co-Authors: Hormuzdiyar H. Dasenbrock, Daniel M. Sciubba, Ziya L. Gokaslan, Michelle J. Clarke, M. D. Ali Bydon, Timothy F. Witham, Jean Paul WolinskyAbstract:BACKGROUND Ventral decompression with posterior stabilization is the preferred treatment for symptomatic irreducible Basilar Invagination. Endoscopic image-guided transcervical odontoidectomy (ETO) may allow for decompression with limited morbidity. OBJECTIVE To describe the perioperative outcomes of patients undergoing anterior decompression of Basilar Invagination with the use of ETO. METHODS Fifteen patients who had a follow-up of at least 16 months were retrospectively reviewed. Intraoperatively, the vertebral body of C2 was removed and the odontoid was resected in a "top-down" manner using endoscopic visualization and frameless stereotactic navigation. Posterior instrumented stabilization was subsequently performed. RESULTS The average (± standard deviation) age of the patients was 42.6 ± 24.5 (range, 11-72) years. Postoperative complications occurred in 6 patients, including a urinary tract infection (n = 2), upper airway swelling (n = 2), dysphagia (n = 2), gastrostomy tube placement (n = 1), and an asymptomatic pseudomeningocele (n = 1). No patients required a tracheostomy, had bacterial meningitis, or developed a venous thromboembolic event; only 1 patient was intubated for more than 48 hours postoperatively. With a mean follow-up of 41.9 ± 14.4 (range, 16-59) months, myelopathy improved in all patients and no patient experienced late neurological deterioration. The mean modified Japanese Orthopedic Association (JOA) score increased from 11.2 ± 4.2 to 15.9 ± 1.4 (P = .002). Patients with a diagnosis other than rheumatoid arthritis or who had a higher preoperative JOA score had a significantly better postoperative neurological recovery (P = .005). CONCLUSION ETO may be a valid treatment for patients with symptomatic irreducible Basilar Invagination that avoids some of the morbidity of transoral surgery and leads to long-term improvement in myelopathy.
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Endoscopic transcervical odontoidectomy for pediatric Basilar Invagination and cranial settling. Report of 4 cases.
Journal of neurosurgery. Pediatrics, 2008Co-Authors: Matthew J. Mcgirt, Ziya L. Gokaslan, Daniel M. Sciubba, Frank J. Attenello, Jean Paul WolinskyAbstract:Pediatric Basilar Invagination and cranial settling have traditionally been approached through a transoral-transpharyngeal route with or without extended maxillotomy or mandibulotomy for resection of the anterior portion of C-1 and the odontoid. The authors hypothesize that application of a recently described endoscopic transcervical odontoidectomy (ETO) technique would allow an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients. The authors performed ETO in a consecutive series of pediatric patients presenting with myelopathy or bulbar dysfunction resulting from Basilar Invagination or cranial settling. All clinical, radiographic, surgical, and follow-up data were prospectively collected. The initial experience with ETO in the pediatric population is analyzed and outcomes are reported. Three patients required ETO for Basilar Invagination and 1 required ETO with anterior C-1 arch and distal clivus resection for cranial settling. All patients presented with myelopathy. One patient was wheelchair bound with severe quadriparesis. The mean age was 14 +/- 3 years (mean +/- standard deviation [SD]) in the 2 male and 2 female patients. The ETO and posterior fusion were performed as a 2-stage procedure in 2 (50%) and as a single-stage procedure in 2 (50%) cases. Prolonged intubation or postoperative placement of a gastrostomy tube was not needed in any case. The postoperative hospitalization lasted 9 +/- 4 days (mean +/- SD). At last follow-up (mean 5 months), head and neck pain had resolved and motor strength had improved or stabilized in all cases. All 4 children were independently functioning and ambulatory at the last follow-up. In the authors' initial experience, ETO has allowed ventral brainstem decompression without the need for prolonged intubation, worsening dysphagia requiring enteral tube feeding, or prolonged hospitalization, and has resulted in cosmetically appealing results. The ETO technique allows an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients.
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Endoscopic image-guided odontoidectomy for decompression of Basilar Invagination via a standard anterior cervical approach. Technical note.
Journal of neurosurgery. Spine, 2007Co-Authors: Jean Paul Wolinsky, Daniel M. Sciubba, Ian Suk, Ziya L. GokaslanAbstract:✓Symptomatic irreducible Basilar Invagination has traditionally been approached through a transoral–transpharyngeal route with resection of the anterior portion of C-1 and the odontoid. Modification of this exposure with either a Le Fort osteotomy or a transmandibular osteotomy and circumglossal approach has increased the access to pathological conditions in this region. These traditional routes all require traversing the oral cavity and accepting the associated potential complications. The authors have developed a novel surgical approach, an endoscopic transcervical odontoidectomy, which allows access for resection of the odontoid and for brainstem and spinal cord decompression without traversing the oral cavity. In this paper they describe the technique and its advantages and present three cases in which patients underwent the endoscopic transcervical odontoidectomy for Basilar Invagination. Three consecutive patients (age range 42–74 years) who had irreducible Basilar Invagination underwent the endosco...
Ketan Desai - One of the best experts on this subject based on the ideXlab platform.
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Basilar Invagination: a study based on 190 surgically treated patients
Journal of neurosurgery, 1998Co-Authors: Atul Goel, Mohinish Bhatjiwale, Ketan DesaiAbstract:Object. The authors analyzed the cases of 190 patients with Basilar Invagination that was diagnosed on the basis of criteria laid down in 1939 by Chamberlain to assess the appropriate surgical procedure. Methods. Depending on the association with Chiari malformation, the anomaly of Basilar Invagination was classified into two groups. Eighty-eight patients who had Basilar Invagination but no associated Chiari malformation were assigned to Group I; the remainder of the patients, who had both Basilar Invagination and Chiari malformation, were assigned to Group II. The principal pathological characteristic was observed to be direct brainstem compression due to odontoid process indentation in Group I and a reduction in posterior cranial fossa volume in Group II. Conclusions. Despite the anterior concavity of the brainstem in both groups, transoral surgery was the most suitable procedure for those patients in Group I and decompression of the foramen magnum was found to be appropriate for patients in Group II. A...
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Basilar Invagination: a study based on 190 surgically treated patients
Neurosurgical Focus, 1998Co-Authors: Atul Goel, Mohinish Bhatjiwale, Ketan DesaiAbstract:Object The authors analyzed the cases of 190 patients with Basilar Invagination that was diagnosed on the basis of criteria laid down in 1939 by Chamberlain to assess the appropriate surgical procedure. Methods Depending on the association with Chiari malformation, the anomaly of Basilar Invagination was classified into two groups. Eighty-eight patients who had Basilar Invagination but no associated Chiari malformation were assigned to Group I; the remainder of the patients, who had both Basilar Invagination and Chiari malformation, were assigned to Group II. The principal pathological characteristic was observed to be direct brainstem compression due to odontoid process indentation in Group I and a reduction in posterior cranial fossa volume in Group II. Conclusions Despite the anterior concavity of the brainstem in both groups, transoral surgery was the most suitable procedure for those patients in Group I and decompression of the foramen magnum was found to be appropriate for patients in Group II. After surgical decompression, a fixation procedure was found to be necessary in most Group I cases, but only in a small minority of Group II cases.
Daniel M. Sciubba - One of the best experts on this subject based on the ideXlab platform.
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Occipitocervical Osteotomies and Interfacet Grafts for Reduction of Occipitocervical Kyphosis and Basilar Invagination.
World neurosurgery, 2019Co-Authors: Yuanxuan Xia, Peter G. Passias, Themistocles S. Protopsaltis, Daniel M. SciubbaAbstract:Background Occipitocervical congenital pathologies involving instability of the atlantoaxial joint and Basilar Invagination are challenging to treat owing to the complex anatomy involving neurovascular structures at the skull base and the high-risk nature of surgery close to the brainstem. Case Description A patient presented with Alagille syndrome with multiple segmentation/fusion anomalies of the cervical spine and craniocervical junction, including fusion of the skull base and occipital condyles and partial assimilation of the C1 anterior ring and C2 dens. The head was anteriorly displaced, with C2 located immediately below the foramen magnum. There was significant kyphotic angulation due to nonunion of the base of the dens and the body of C2. The patient underwent occipitocervical osteotomies and occiput-C2 interfacet grafts for reduction of occipitocervical kyphosis along with foramen magnum decompression and occiput-C6 fusion. The patient had significant neurologic improvement and sustained improved craniocervical alignment on last follow-up. Conclusions In patients with atlantoaxial instability with Basilar Invagination, posterior facet release, local distraction, and placement of cortical bone interbody grafts with occipitocervical fusion may be instrumental in reducing craniocervical kyphosis and compression by allowing anterior translation of the upper cervical spine relative to the skull. This method may be a safe and effective posterior-only approach for brainstem/spinal cord decompression for patients with complex craniocervical congenital malformations.
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Endoscopic image-guided transcervical odontoidectomy: outcomes of 15 patients with Basilar Invagination.
Neurosurgery, 2011Co-Authors: Hormuzdiyar H. Dasenbrock, Daniel M. Sciubba, Ziya L. Gokaslan, Michelle J. Clarke, M. D. Ali Bydon, Timothy F. Witham, Jean Paul WolinskyAbstract:BACKGROUND Ventral decompression with posterior stabilization is the preferred treatment for symptomatic irreducible Basilar Invagination. Endoscopic image-guided transcervical odontoidectomy (ETO) may allow for decompression with limited morbidity. OBJECTIVE To describe the perioperative outcomes of patients undergoing anterior decompression of Basilar Invagination with the use of ETO. METHODS Fifteen patients who had a follow-up of at least 16 months were retrospectively reviewed. Intraoperatively, the vertebral body of C2 was removed and the odontoid was resected in a "top-down" manner using endoscopic visualization and frameless stereotactic navigation. Posterior instrumented stabilization was subsequently performed. RESULTS The average (± standard deviation) age of the patients was 42.6 ± 24.5 (range, 11-72) years. Postoperative complications occurred in 6 patients, including a urinary tract infection (n = 2), upper airway swelling (n = 2), dysphagia (n = 2), gastrostomy tube placement (n = 1), and an asymptomatic pseudomeningocele (n = 1). No patients required a tracheostomy, had bacterial meningitis, or developed a venous thromboembolic event; only 1 patient was intubated for more than 48 hours postoperatively. With a mean follow-up of 41.9 ± 14.4 (range, 16-59) months, myelopathy improved in all patients and no patient experienced late neurological deterioration. The mean modified Japanese Orthopedic Association (JOA) score increased from 11.2 ± 4.2 to 15.9 ± 1.4 (P = .002). Patients with a diagnosis other than rheumatoid arthritis or who had a higher preoperative JOA score had a significantly better postoperative neurological recovery (P = .005). CONCLUSION ETO may be a valid treatment for patients with symptomatic irreducible Basilar Invagination that avoids some of the morbidity of transoral surgery and leads to long-term improvement in myelopathy.
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Endoscopic transcervical odontoidectomy for pediatric Basilar Invagination and cranial settling. Report of 4 cases.
Journal of neurosurgery. Pediatrics, 2008Co-Authors: Matthew J. Mcgirt, Ziya L. Gokaslan, Daniel M. Sciubba, Frank J. Attenello, Jean Paul WolinskyAbstract:Pediatric Basilar Invagination and cranial settling have traditionally been approached through a transoral-transpharyngeal route with or without extended maxillotomy or mandibulotomy for resection of the anterior portion of C-1 and the odontoid. The authors hypothesize that application of a recently described endoscopic transcervical odontoidectomy (ETO) technique would allow an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients. The authors performed ETO in a consecutive series of pediatric patients presenting with myelopathy or bulbar dysfunction resulting from Basilar Invagination or cranial settling. All clinical, radiographic, surgical, and follow-up data were prospectively collected. The initial experience with ETO in the pediatric population is analyzed and outcomes are reported. Three patients required ETO for Basilar Invagination and 1 required ETO with anterior C-1 arch and distal clivus resection for cranial settling. All patients presented with myelopathy. One patient was wheelchair bound with severe quadriparesis. The mean age was 14 +/- 3 years (mean +/- standard deviation [SD]) in the 2 male and 2 female patients. The ETO and posterior fusion were performed as a 2-stage procedure in 2 (50%) and as a single-stage procedure in 2 (50%) cases. Prolonged intubation or postoperative placement of a gastrostomy tube was not needed in any case. The postoperative hospitalization lasted 9 +/- 4 days (mean +/- SD). At last follow-up (mean 5 months), head and neck pain had resolved and motor strength had improved or stabilized in all cases. All 4 children were independently functioning and ambulatory at the last follow-up. In the authors' initial experience, ETO has allowed ventral brainstem decompression without the need for prolonged intubation, worsening dysphagia requiring enteral tube feeding, or prolonged hospitalization, and has resulted in cosmetically appealing results. The ETO technique allows an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients.
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Endoscopic image-guided odontoidectomy for decompression of Basilar Invagination via a standard anterior cervical approach. Technical note.
Journal of neurosurgery. Spine, 2007Co-Authors: Jean Paul Wolinsky, Daniel M. Sciubba, Ian Suk, Ziya L. GokaslanAbstract:✓Symptomatic irreducible Basilar Invagination has traditionally been approached through a transoral–transpharyngeal route with resection of the anterior portion of C-1 and the odontoid. Modification of this exposure with either a Le Fort osteotomy or a transmandibular osteotomy and circumglossal approach has increased the access to pathological conditions in this region. These traditional routes all require traversing the oral cavity and accepting the associated potential complications. The authors have developed a novel surgical approach, an endoscopic transcervical odontoidectomy, which allows access for resection of the odontoid and for brainstem and spinal cord decompression without traversing the oral cavity. In this paper they describe the technique and its advantages and present three cases in which patients underwent the endoscopic transcervical odontoidectomy for Basilar Invagination. Three consecutive patients (age range 42–74 years) who had irreducible Basilar Invagination underwent the endosco...