Contribuição ao estudo das malformações occipito-cervical, particularmente da impressão basilar

We describe a rare case of a 30 year-old woman with intense vertiginous sensation, lack of body balance and a tendency to fall backwards, making it necessary for two people to sustain her. The magnetic resonance imaging of the craniocervical junction evidenced tonsilar herniation at the inferior level of C1, and during the operation performed in sitting position, we observed crowding of the cerebellar tonsils at the level of C3. After the osteo-dural-neural decompression, the symptomatology remitted on the same day of the operation.

Section: Retropulsion and Vertigo In The Chiari Malformationmentioning

confidence: 72%

Retropulsion and vertigo in the Chiari malformation: case report

Silva

Holanda

Pereira

et al. 2005

“…It frequently comes in association with other congenital anomalies such as atlas assimilation, Klippel-Feil syndrome, Sprengel's deformity, CM, platybasia and SM as reported by many authors [8][9][10][11][12][13] . Its association with others deformities is directly related to the theory of embryogenetic error.…”

Section: Discussionmentioning

confidence: 99%

“…The high prevalence of BI associated with CM in the Northeast of Brazil was reported by many authors [8][9][10][11][12][13] , although there is no suitable known reason for this fact.…”

mentioning

confidence: 99%

Posterior fossa decompression with tonsillectomy in 104 cases of basilar impression, Chiari malformation and/or syringomyelia

Silva¹,

Santos²,

Melo³

et al. 2011

The prime objective in the surgical treatment of basilar impression (BI), Chiari malformation (CM) and/or syringomyelia (SM) is based on the restoration of the normal cerebrospinal fluid (CSF) dynamics at the craniovertebral junction through the creation of a large artificial cisterna magna. A small suboccipital craniectomy has been emphasized to avoid caudal migration of the hindbrain structures into the vertebral canal. Nevertheless, the results showed downward migration of the hindbrain related to that type of craniectomy. The authors present, otherwise, the results of 104 cases of BI, CM and/or SM, whose surgical treatment was characterized by a large craniectomy with the patient in the sitting position, tonsillectomy, large opening of the fourth ventricle and duraplasty with creation of a large artificial cisterna magna. A significant upward migration of the posterior fossa structures was detected by postoperative magnetic resonance imaging. Key words: basilar impression, Chiari malformation, hindbrain herniation, tonsillectomy, craniovertebral decompression, syringomyelia.Descompressão da fossa posterior com tonsilectomia em 104 casos de impressão basilar, malformação de Chiari e/ou siringomielia RESUMO O principal objetivo no tratamento cirúrgico da impressão basilar, malformação de Chiari e/ou siringomielia fundamenta-se na restauração dinâmica do líquido cefalorraqueano ao nível da transição craniovertebral e criação de ampla cisterna magna. Uma craniectomia suboccipital de pequenas dimensões foi proposta para evitar a migração caudal de estruturas rombencefálicas no canal vertebral. Entretanto, os resultados evidenciaram migração caudal do rombencéfalo. Os autores apresentam, por outro lado, os resultados de 104 casos de malformação de Chiari e/ou siringomielia, nos quais o tratamento cirúrgico se baseou em ampla craniectomia com o paciente em posição sentada, tonsilectomia, abertura ampla do quarto ventrículo e enxerto dural com consequente criação de ampla cisterna magna. Uma significante migração cranial das estruturas da fossa posterior foi detectada pelo emprego pós-operatório da ressonância magnética. Palavras-Chave: impressão basilar, malformação de Chiari, herniação rombencefálica, tonsilectomia, descompressão craniovertebral, siringomielia.

“…The high prevalence of BI associated with CM in the Northeast of Brazil was reported by many authors [8][9][10][11][12] , although there is no suitable known reason for this fact.…”

Section: Resultsmentioning

confidence: 99%

“…In cases of CM, it may take the shape of an open C 9,13 , which is not a pathognomonic sign of CM. Ventriculography may confirm CM when it depicts an elongated fourth ventricle and downward migration of the cerebellar tonsils 8,9,13 . As to the surgical technique, the patients underwent osteodural decompression without tonsillectomy with large suboccipital craniectomy associated with laminectomy varying from C1 to C3 level depending on the tonsillar herniation, dural opening in Y format, dissection of the arachnoidal of the right PICA and a left hypoplastic PICA in one case, and, finally, looping sign of both PICAS in 66 cases.…”

Section: Methodsmentioning

confidence: 98%

Suboccipital craniectomy with opening of the fourth ventricle and duraplasty: study of 192 cases of craniovertebral malformations

Silva¹,

Santos

Costa

et al. 2013

The prime objective in the surgical treatment of basilar impression (BI), Chiari malformation (CM), and/or syringomyelia (SM) is based on restoration of the normal cerebrospinal fluid (CSF) dynamics at the craniovertebral junction and creation of a large artificial cisterna magna, avoiding the caudal migration of the hindbrain. It is observed that a large craniectomy might facilitate an upward migration of the posterior fossa structures. There are many surgical techniques to decompress the posterior fossa; however, a gold standard approach remains unclear. The authors present the results of 192 cases of BI, CM, and SM treated between 1975 and 2008 and whose surgical treatment was characterized by a large craniectomy without tonsillectomy with the patient in the sitting position, large opening of the fourth ventricle, and duraplasty.Key words: basilar impression, Chiari malformation, hindbrain herniation, craniovertebral decompression, syringomyelia. RESUMOO principal objetivo no tratamento cirúrgico da impressão basilar, malformação de Chiari e/ou siringomielia fundamenta-se na restauração da dinâmica do líquido cefalorraqueano ao nível da transição craniovertebral e criação de cisterna magna ampla. Isto é fator importante para evitar a migração caudal das estruturas da fossa posterior. A craniectomia ampla facilita a migração cranial dessas estruturas. Existem várias técnicas cirúrgicas para descomprimir a fossa posterior, mas não há evidência sobre qual a melhor.. Os autores apresentam os resultados de 192 casos de impressão basilar, malformação de Chiari e siringomielia, operados entre 1975 e 2008, nos quais o tratamento cirúrgico se baseou em ampla craniectomia com o paciente em posição sentada, sem tonsilectomia, abertura ampla do quarto ventrículo e enxerto dural.Palavras-Chave: impressão basilar, malformação de Chiari, herniação rombencefálica, descompressão craniovertebral, siringomielia. Suboccipital craniectomy with opening of the fourth ventricle and duraplasty: study of 192 cases of craniovertebral malformationsDescompressão da fossa posterior sem tonsilectomia em 192 casos de impressão basilar, malformação de Chiari e/ou siringomielia