Letter to the Editor: Chiari malformation Type 1 and atlantoaxial instability: a letter from the Pediatric Craniocervical Society

Brockmeyer, Douglas L.; Oakes, W. Jerry; Rozzelle, Curtis J.; Johnston, James M.; Rocque, Brandon G.; Anderson, Richard C. E.; Feldstein, Neil A.; Martin, Jonathan E.; Tuite, Gerald F.; Rodríguez, L. F.; Wetjen, Nicholas M.; Aldana, Phillip; Pincus, Dave; Storm, Phillip B.; Proctor, Mark R.; Lew, Sean M.

doi:10.3171/2015.3.spine15233

Cited by 14 publications

(9 citation statements)

References 40 publications

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“…[ 3 4 ] Our conclusions had initiated an international debate on the subject. [ 5 6 7 8 9 10 11 12 13 ] Our increasing clinical experience that we have published recently in the subject reinforces our earlier observation. [ 14 ]…”

Section: Introductionsupporting

confidence: 70%

Atlantoaxial fixation for failed foramen magnum decompression in patients with Chiari formation

Goel

Vutha

Shah

et al. 2020

J Craniovert Jun Spine

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Background: Relationship of atlantoaxial instability with Chiari formation is further analyzed in the report. Objective: The outcome of 25 patients who had failed conventional treatment for Chiari formation that included foramen magnum decompression surgery and were treated by atlantoaxial fixation is analyzed. Materials and Methods: During the period January 2010 to November 2019, we treated 25 patients who had undergone conventionally described surgical procedures; all included foramen magnum decompression for Chiari formation. None of the patients had any craniovertebral junction anomaly. All patients had syringomyelia. All patients had worsened in their neurological condition following surgery either in the immediate or in the delayed postoperative phase. Atlantoaxial instability was diagnosed on the basis of facetal alignment and on the basis of direct observation of joint status by bone manipulation during surgery. The patients were treated by atlantoaxial fixation. Goel clinical grading scale and Japanese Orthopedic Association Score assessed the clinical status both before and after surgery. Results: Following surgery, all patients improved in the clinical condition. The improvement began in the immediate postoperative period and progressed. During the follow-up period that ranged from 4 to 123 months, “significant” neurological recovery and amelioration of presenting symptoms were observed. During the period of follow-up, reduction in the size of syrinx was observed in 14 out of 18 cases where postoperative magnetic resonance imaging was possible. Conclusions: Clinical results reinforce the belief that atlantoaxial instability is the nodal point of pathogenesis of Chiari formation. Atlantoaxial fixation is the treatment.

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Section: Introductionsupporting

confidence: 70%

Atlantoaxial fixation for failed foramen magnum decompression in patients with Chiari formation

Goel

Vutha

Shah

et al. 2020

J Craniovert Jun Spine

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“…53 Brockmeyer et al reviewed the medical literature in 2011 and concluded that C1-C2 fixation is indicated in complex CID patients with basilar invagination (BI) associated with C1-C2 instability. 54,55 It also depends on the type of BI: type I requires instrumentation and fusion plus traction; in BI type II, fixation is recommended for selected cases, and some cases are to be decompressed only. Posterior C1-C2 fusion is also recommended in cases in which wide bone resections are necessary and should include as few levels as possible.…”

Section: Clinical Questions 1) What Is the Definition And Best Nomencmentioning

confidence: 99%

Management of Chiari I deformity in Children and Adolescents: A report from the Consensus Taskforce of the Brazilian Society of Pediatric Neurosurgery

Santos

Furlanetti

Canheu

et al. 2020

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Much controversy remains on the current management of Chiari I deformity (CID) in children, with many clinical, surgical and ethic-legal implications. The Brazilian Society of Pediatric Neurosurgery (SBNPed, in the Portuguese acronym) has put together a panel of experts to analyze updated published data on the medical literature about this matter and come up with several recommendations for pediatric neurosurgeons and allied health professionals when dealing with CID. Their conclusions are reported herein, along with the respective scientific background.

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“…4 These claims have generated considerable discussion in the field. 2,5,6,10 The Pediatric Craniocervical Society even published a report against Goel's novel technique of atlantoaxial fixation for CM-I, 2 since many patients with CM-I without basilar invagination seem to recover well after foramen magnum decompression; thus, there is no need to subject them to the potentially lethal vertebral artery injuries associated with atlantoaxial fixation and screw placement. We adopted Goel's atlantoaxial distraction/fixation technique in the present case because foramen magnum decompression was not successful, and another report stated that his technique provides relief.…”

Section: Fig 4 a And Bmentioning

confidence: 99%

Delayed neurological deterioration following atlantoaxial facet joint distraction and fixation in a patient with Chiari malformation type I

Inoue

Hattori

Ganaha

et al. 2018

Journal of Neurosurgery: Spine

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Chiari malformation type I (CM-I) is typically treated with foramen magnum decompression. However, a recent study proposed a new technique for patients with CM-I, wherein only short atlantoaxial joint fusion and distraction is applied. Posterior fusion with or without atlantoaxial distraction is a potential option for patients with CM-I associated with basilar invagination or complex anomalous bony craniovertebral junction pathology, since this procedure allows clinicians to avoid using the technically demanding transoral approach in which some or all of the odontoid tip is invisible. Distraction of the atlantoaxial joint reduces ventral cervicomedullary compression, leading to neurological improvement. Here, the authors report the case of a 50-year-old woman with CM-I plus basilar invagination whose condition immediately improved but then gradually deteriorated following atlantoaxial joint distraction and fusion. Therefore, the authors performed endonasal/transoral odontoidectomy, which resulted in prolonged neurological recovery. Short atlantoaxial fusion with distraction is a smart and ideal surgical planning concept that can result in significant neurological improvement. However, this case suggests that anterior odontoidectomy is still an essential element of the intervention strategy for patients with CM-I with complex craniovertebral junction pathology.

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Letter to the Editor: Chiari malformation Type 1 and atlantoaxial instability: a letter from the Pediatric Craniocervical Society

Cited by 14 publications

References 40 publications

Atlantoaxial fixation for failed foramen magnum decompression in patients with Chiari formation

Atlantoaxial fixation for failed foramen magnum decompression in patients with Chiari formation

Management of Chiari I deformity in Children and Adolescents: A report from the Consensus Taskforce of the Brazilian Society of Pediatric Neurosurgery

Delayed neurological deterioration following atlantoaxial facet joint distraction and fixation in a patient with Chiari malformation type I

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