Individualized Treatment of Craniovertebral Junction Malformation Guided by Intraoperative Computed Tomography

Li, Lian-Feng; Wang, Peng; Chen, Lifeng; Ma, Xiaodong; Bai, Bo; Yu, Xin-guang

doi:10.1097/bsd.0b013e31820f8afb

Cited by 10 publications

(5 citation statements)

References 24 publications

(26 reference statements)

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“…The application of navigation has been useful in both cranial and spinal surgeries because it provides three-dimensional spatial orientation during surgery 14 , 15 . When dealing with basilar invagination and atlantoaxial dislocation with abnormal anatomy, navigation affords higher precision and accuracy to help with the odontoidectomy 16 . Navigation also decreases the need for intra-operative fluoroscopy, hence decreases the amount of radiation exposure both to the patient and to the operating room staffs.…”

Section: Discussionmentioning

confidence: 99%

Transtubular Transoral Approach for Irreducible Ventral Craniovertebral Junction Compressive Pathologies: Surgical Technique and Outcome

MH,

SN,

et al. 2023

Malays Orthop J

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Introduction To investigate the use of a tubular retractor to provide access to the craniovertebral junction (CVJ) sparing the soft palate with the aim of reducing complications associated with traditional transoral approach but yet allowing adequate decompression of the CVJ. Materials and methods Twelve consecutive patients with severe myelopathy (JOA-score less than 11) from ventral CVJ compression were operated between 2014-2020 using a tubular retractor assisted transoral decompression. Results All patients improved neurologically statistically (p=0.02). There were no posterior pharynx wound infections or rhinolalia. There was one case with incomplete removal of the lateral wall of odontoid and one incidental durotomy. Conclusions A Tubular retractor provides adequate access for decompression of the ventral compression of CVJ. As the tubular retractor pushed away the uvula, soft palate and pillars of the tonsils as it docked on the posterior pharyngeal wall, the traditional complications associated with traditional transoral procedures is completely avoided.

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Section: Discussionmentioning

confidence: 99%

Transtubular Transoral Approach for Irreducible Ventral Craniovertebral Junction Compressive Pathologies: Surgical Technique and Outcome

MH,

SN,

et al. 2023

Malays Orthop J

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“…Deep brain stimulation has been used for two decades to treat movement disorders that are not medically controlled [ 6 ]. Accuracy of target planning and final positioning of the electrode are imperative for effective symptom control [ 7 , 8 ]. Burchiel et al previously demonstrated that with patients under general anesthesia, placing DBS electrodes using an intraoperative CT scanner is at least comparable to the other methods [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…A new generation of mobile scanners now allows for CT scans to be performed in the operating room (OR), potentially allowing for more efficient workflow and intraoperative confirmation of hardware placement for cranial [3] and spine procedures [4][5][6]. Few studies have compared the accuracy of various intraoperative CT scanners (e.g., O-arm {Medtronic Minimally Invasive Therapies, Minneapolis, MN}) with post-operative MRI and fixed CT scans [7][8][9][10][11][12][13][14][15][16][17]. More studies are needed to explore the performance and utility of intraoperative scanners in DBS surgery.…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation Surgery Using a Mobile Intraoperative CT Scanner

Cavalcante¹,

Ghauri²,

Gwinn³

2022

Cureus

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IntroductionDeep brain stimulation (DBS) is widely used for the treatment of movement disorders. Precise placement of electrodes is critical for treatment success. The aim of this study was to analyze the accuracy of the intraoperative computer tomography (CT) images compared to that of a traditional fixed CT for patients undergoing DBS procedures. MethodsWe retrospectively analyzed the charts from 30 patients who underwent DBS. In group 1, 10 patients underwent electrode implantation surgery using a fixed CT scanner for pre-and post-operative (OP) images. In group 2, 20 patients underwent surgery using an intraoperative CT scanner for pre-and post-operative images, as well as a fixed CT scanner for post-operative images. We compared the average pre-operative localizer box registration error acquired in these two groups. We also analyzed, in group 2, the final electrode position given on each post-operative CT images. We compared the average Euclidean distances between each set of cartesian coordinates to assess target accuracy between both scanning methodologies. ResultsThirty patients had ages ranging from 40 to 88 years, with a median of 69 years old. In the 20 patients who utilized an intraoperative CT scanner pre-operatively in group 2, the mean error, given by the Medtronic software (Medtronic Minimally Invasive Therapies, Minneapolis, MN) with the Leksell frame on, was 0.37. For the 10 pre-operative scans with the stealth fixed CT scanner in group 1, the mean error was 0.44 (p = 0.13). In group 2, the average of the 20 Euclidean distances for each target, in those 20 patients who had post-operative images with both scanners, was 0.36. ConclusionWe concluded that the accuracy of the intraoperative CT scanner is comparable to the gold standard fixed CT scanner for DBS electrode planning and placement, as well as for positioning confirmation after the electrodes are in place.

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“…The application of navigation has been useful in both cranial and spinal surgeries because it provides three-dimensional spatial orientation during surgery [ 28 – 30 ]. When dealing with BI and AAD with abnormal anatomy, navigation affords higher precision and accuracy to help with the odontoidectomy.…”

Section: Discussionmentioning

confidence: 99%

Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior compression

Wang

Liu

et al. 2020

Chin Neurosurg Jl

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Background Although the single-stage posterior realignment craniovertebral junction (CVJ) surgery could treat most of the basilar invagination (BI) and atlantoaxial dislocation (AAD), there are still some cases with incomplete decompression of the spinal cord, which remains a technique challenging situation. Methods Eleven patients were included with remained myelopathic symptoms after posterior correction due to incomplete decompression of the spinal cord. Transoral odontoidectomy assisted by image-guided navigation and intraoperative CT was performed. Clinical assessment and image measurements were performed preoperatively and at the most recent follow-up. Results Eleven patients were followed up for an average of 47 months. Symptoms were alleviated in 10 of 11 patients (90.9%). One patient died of an unknown reason 1 week after the transoral approach. The clinical and radiological parameters pre- and postoperatively were reported. Conclusion Transoral odontoidectomy as a salvage surgery is safe and effective for properly selected BI and AAD patients after inadequate indirect decompression from posterior distraction and fixation. Image-guided navigation and intraoperative CT can provide precise information and accurate localization during operation, thus enabling complete resection of the odontoid process and decompression of the spinal cord.

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Individualized Treatment of Craniovertebral Junction Malformation Guided by Intraoperative Computed Tomography

Abstract: iCT scanning with integrated NNS was both feasible and beneficial for the surgical management of complex CVJM. In this unusual patient population, the technique seemed to be valuable in negotiating complex anatomy and achieving a safe and predictable decompression.

Cited by 10 publications

References 24 publications

Transtubular Transoral Approach for Irreducible Ventral Craniovertebral Junction Compressive Pathologies: Surgical Technique and Outcome

Transtubular Transoral Approach for Irreducible Ventral Craniovertebral Junction Compressive Pathologies: Surgical Technique and Outcome

Deep Brain Stimulation Surgery Using a Mobile Intraoperative CT Scanner

Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior compression

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