Basilar invagination: Surgical results

Abstract

Introduction:Basilar invagination (BI) is a congenital craniocervical junction (CCJ) anomaly represented by a prolapsed spine into the skull-base that can result in severe neurological impairment.Materials and Methods:In this paper, we retrospective evaluate the surgical treatment of 26 patients surgically treated for symptomatic BI. BI was classified according to instability and neural abnormalities findings. Clinical outcome was evaluated using the Nürick grade system.Results:A total of 26 patients were included in this paper. Their age ranged from 15 to 67 years old (mean 38). Of which, 10 patients were male (38%) and 16 (62%) were female. All patients had some degree of tonsillar herniation, with 25 patients treated with foramen magnum decompression. Nine patients required a craniocervical fixation. Six patients had undergone prior surgery and required a new surgical procedure for progression of neurological symptoms associated with new compression or instability. Most of patients with neurological symptoms secondary to brainstem compression had some improvement during the follow-up. There was mortality in this series, 1 month after surgery, associated with a late removal of the tracheal cannula.Conclusions:Management of BI requires can provide improvements in neurological outcomes, but requires analysis of the neural and bony anatomy of the CCJ, as well as occult instability. The complexity and heterogeneous presentation requires attention to occult instability on examination and attention to airway problems secondary to concomitant facial malformations.

Direct Intraoperative Reduction of Basilar Invagination Associated with Atlantoaxial Subluxation – Technical Note

“…[2][3][4][5][6] It is defined when the apex of the odontoid process is at least 2.5 mm above the Chamberlain, although other thresholds were proposed, such as 5 mm. [2][3][4][5][6][7] When symptomatic, BI may present with many clinical syndromes, isolated or combined, such as: cervical pain, cranial nerve syndromes, superficial and deep sensory syndromes, cerebellar symptoms, intracranial syndrome and hydrocephalus, bulbar symptoms, vertebrobasilar insufficiency, among others. [8][9][10][11][12] The first publication on the surgical treatment of BI was made by Ebenius 13 in 1934.…”

“…[8][9][10][11][12] The first publication on the surgical treatment of BI was made by Ebenius 13 in 1934. Throughout the years, occipitocervical fixation techniques with external orthoses were initially proposed, followed by the use of autologous bone grafts (such as the fibular strut), and cables and wires for fixation and fusion [2][3][4][5][6] . More recently, screws, rods and plates have been employed with immediate stabilization and high fusion rates.…”

3-D simulation of posterior fossa reduction in Chiari I

“…, Andrei Fernandes Joaquim 1,3 Chiari I (CI) is one of the most common congenital craniocervical disorders and its diagnosed when there is tonsillar herniation into the foramen magnum of up to 3-5 mm 1,2 . The impaction of the tonsils at the level of the foramen magnum can lead to interruption of the cerebrospinal fluid flow and clinical symptoms, with upper cervical spine compression 2,3,4 .…”

“…The impaction of the tonsils at the level of the foramen magnum can lead to interruption of the cerebrospinal fluid flow and clinical symptoms, with upper cervical spine compression 2,3,4 . The incidence of CI in a general population is estimate in about 0.1-0.5%, even though most of them are asymptomatic 5,6 .…”

“…The incidence of CI in a general population is estimate in about 0.1-0.5%, even though most of them are asymptomatic 5,6 . One of the potential reasons for CI is decreased posterior fossa, secondary to shortness of the clivus and platybasia, commonly found in patients with this anomaly 3,4,7 . However, the role of loss of posterior fossa volume (PFV) secondary to clivus shortness and platybasia were not clearly measured yet.…”