Posterior Fossa Epidural Hematomas: Rare but Serious Complication of Occipitocervical Fusion Surgery

Rong, Zhu Chang; Wang, Jianhua; Dai, Jianqiang; Chen, Kun; Xia, Hong

doi:10.1016/j.wneu.2018.04.069

Cited by 8 publications

(3 citation statements)

References 12 publications

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“…What's more, there is report of epidural hematomas in the posterior cranial fossa. [11] The C-arm X-ray machine is used to repeatedly guide the screw placement in traditional surgery; there are some other problems such as high surgical risk, prolonged operation time, and low efficiency. Various individuals have anatomical differences in the upper cervical spine, thus unified screw placement cannot be selected.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment for upper cervical deformity with atlantoaxial joint dislocation using individualized 3D printing occipitocervical fusion instrument

et al. 2021

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To introduce a novel technique of using individualized 3D printing occipitocervical fusion instrument (3D-OCF) for the treatment of upper cervical deformity with atlantoaxial joint dislocation. The surgery for deformity of the craniocervical junction area is a challenge in the field of spine. If the surgical deviation is too large to injure the spinal cord or vertebral artery, it will cause catastrophic damage to the patient. Therefore, it is controversial whether these patients should undergo surgical treatment. We provide a novel surgical approach for the challenging upper cervical surgery through 3D-OCF and a typical patient. We present a 54-year-old female patient, who suffered from dizziness and numbness in her limbs for 8 months. After the patient was admitted, we performed the three-dimensional CT scan, modeled using Mimics software 17.0, and designed customized occipitocervical fusion instrument. Besides, we repeatedly perform simulated surgery based on 3D-printed models before surgery. The operative time was 142 minutes and the intraoperative blood loss was 700 mL. X-ray showed reduction of atlantoaxial dislocation and accurate position of internal fixation. The patient's symptoms were significantly relieved: the sensation of dizziness and numbness of limbs was obviously relieved, and the sense of banding in chest, abdomen, and ankle was disappeared. At the last follow-up, imaging showed that 3D-OCF had bone-integration and Syringomyelia was disappeared. The patient's cervical JOA (Japanese Orthopaedic Association) score increased from 10 points to 17 points. Individualized 3D-OCF can improve the safety and accuracy of upper cervical surgery, reduce the operative time and the number of fluoroscopy. Our study provides a novel surgical approach for the challenging upper cervical surgery.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment for upper cervical deformity with atlantoaxial joint dislocation using individualized 3D printing occipitocervical fusion instrument

et al. 2021

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“…Ще однією з причин збільшення внутрішньочерепного об'єму є порушення відтоку ліквору зі шлуночкової системи при оклюзії різних відділів ліквороносних шляхів (отвору Монро, сильв ієвого водопровіду тощо). Токсичні сполуки, які виробляють КМГМ, спричиняють збільшення набряку в прилеглій до КМГМ мозковій речовині [14].…”

Section: Ukrainian Neurosurgical Journal Vol 25 N1 2019unclassified

Features of diagnosis and surgical treatment of acute dislocation syndrome in patients with intracranial cystic meningiomas

et al. 2019

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Ме та: визначити особливос ті діагнос тики і к лінічного перебіг у дислокаційного синдрому (ДС) у хворих з кістозними менінгіомами головного мозку (КМГМ) залежно від форми та ступеня дислокації мозку, а також методи їх хірургічної корекції. Матеріали і методи. Проведено клінічні та інструментальні обстеження, а також хірургічне лікування 38 (100%) хворих з КМГМ, які перебували на стаціонарному лікуванні у відділенні позамозкових пухлин ДУ «Інститут нейрохірургії ім. акад. А.П. Ромоданова НАМН України» в 2010-2017 рр. Серед пацієнтів переважали жінки (26). У 30 (78,94%) пацієнтів мав місце гострий ДС до операції, у 18 (47,36%)-після операції. Критеріями відбору хворих у дослідження були: наявність ДС при КМГМ, вік від 20 до 70 років, відсутність черепно-мозкових травм, абсцесів і соматичної патології. Вивчали результати лікування хворих з ДС у післяопераційний період залежно від форми та ступеня ДС. Результати. При цинг улярній формі дислокації добрі результати лікування відзначено в 73,4% спостережень. При скронево-тенторіальній дислокації результати лікування були незадовільними в 35,78% випадках, а при скронево-тенторіальній і форамінальній дислокації-майже в усіх випадках. Висновки. Профілактика дислокаційних ускладнень полягає в зниженні внутрішньочерепного тиску, ліквідації вклинення структур великого мозку шляхом радикального видалення КМГМ з використанням сучасних хірургічних технологій та патогенетично обґунтованої ранньої комплексної медикаментозної інтенсивної терапії.

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“… 5 - 7 Despite careful preoperative planning, complications are relatively common from surgery and can often lead to debilitating or fatal consequences. 8 - 11 In many instances, the undesirable outcomes may be secondary to the unique anatomy of the occipitocervical junction posing substantial surgical challenges. In many instances, the occiput precludes easy access for instrumentation and provides limited space for the multiple fixation points required as part of appropriate surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Anatomical Parameters for Occipital Condyle Screws: An Analysis of 500 Condyles Using CT Scans

Bernstein

Ikpeze

Foxx

et al. 2021

Global Spine Journal

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Study Design: Retrospective observational study. Objective: To establish occipital condyle dimensions (length, width, height), as well as the medialization angle necessary for safe occipital condyle screw placement in occipitocervical fixation. Methods: Between 1/2014-6/2014, patients who presented to a single level 1 academic trauma center emergency room and received computed tomography (CT) imaging of the cervical spine as part of routine clinical care were identified. After excluding patients with cervical fractures, neoplastic disease, or infection, 500 condyles representing 250 patients were analyzed. Condyle length, height, and width (all reported in millimeters [mm]) were evaluated on the sagittal, coronal, and axial series, respectively. Medialization angle (reported in degrees) was evaluated on the axial series of CT imaging. Measurements were compared by sex and age. Results: The average condyle length, width, and height were 18.6 millimeters (mm) (range, 14.5-23.0 mm), 10.5 mm (range, 7.4-13.8 mm), and 11.3 mm (7.1-15.3 mm), respectively. Additionally, the average occipital condyle medialization angle was 23° (range, 14-32°). Occipital condyles of men were significantly longer, wider, and taller (all comparisons, p < 0.05). The medialization angle was significantly steeper for women than men (p < 0.05). No measurement differences were appreciated by age. Conclusion: Our findings are similar to previous studies in the field; however, length appears slightly shorter. Further, measurement differences were appreciated by sex but not age. Thus, our measurement findings emphasize the importance of preoperative planning utilizing individual patient anatomy to ensure safe placement of occipital condyle screws for optimal outcomes.

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Posterior Fossa Epidural Hematomas: Rare but Serious Complication of Occipitocervical Fusion Surgery

Cited by 8 publications

References 12 publications

Surgical treatment for upper cervical deformity with atlantoaxial joint dislocation using individualized 3D printing occipitocervical fusion instrument

Surgical treatment for upper cervical deformity with atlantoaxial joint dislocation using individualized 3D printing occipitocervical fusion instrument

Features of diagnosis and surgical treatment of acute dislocation syndrome in patients with intracranial cystic meningiomas

Anatomical Parameters for Occipital Condyle Screws: An Analysis of 500 Condyles Using CT Scans

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