Retropharyngeal Pseudomeningocele after Atlanto-occipital Dislocation: Report of Two Cases

Naso, William B.; Curé, Joel K.; Cuddy, Brian G.

doi:10.1097/00006123-199706000-00033

Cited by 40 publications

(23 citation statements)

References 5 publications

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“…The most common complication in our patients was the development of hydrocephalus. This complication has been described in previous case reports 23,45 . All patients with hydrocephalus in our series were treated with a ventriculoperitoneal shunt.…”

Section: Discussionsupporting

confidence: 70%

Traumatic Atlanto-Occipital Dislocation in Children

Astur

Klimo

Sawyer

et al. 2013

The Journal of Bone & Joint Surgery

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Section: Discussionsupporting

confidence: 70%

Traumatic Atlanto-Occipital Dislocation in Children

Astur

Klimo

Sawyer

et al. 2013

The Journal of Bone & Joint Surgery

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“…When present they have been described in varying anatomical locations such as retropharyngeal 1,2,3 , posterolateral 4 and intracanalicular 5 No Observation trauma and have been described in association with atlanto-odontoid dislocation and hydrocephalus 3,6 . Thus far only five reports appear to be available from the literature [1][2][3][4]7 with an additional case with questionable trauma at onset 8 . Probably secondary to the nature and severity of the underlying trauma, all retropharyngeal pseudomeningoceles have been reported in patients with neurological deficits.…”

Section: Discussionmentioning

confidence: 99%

“…Most cases have been associated in patients with atlanto-occipital dislocation and hydrocephalus 1,2,3,4 .…”

Section: Introductionmentioning

confidence: 99%

Traumatic Retropharyngeal Pseudomeningocele with Atlanto-Occipital Dislocation in a Neurologically Intact Patient

et al. 2007

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Traumatic retropharyngeal pseudomeningoceles occur rarely, are associated with severe trauma, and have been reported in patients with significant neurologic deficits at presentation. We report the rare occurrence of a pseudomeningocele following a high-speed motor vehicle accident. Neurological examination showed the patient to be briskly following commands, with intact cranial nerve, motor, and sensory function. CT/MR imaging showed subarachnoid hemorrhage involving the interpeduncular cistern, a clivus fracture, a right occipital condyle fracture, an atlanto-occipital subluxation, aortic arch transection (stable and contained on CT angiogram), multiple rib fractures on the right side with associated pneumothorax, hemothorax and pulmonary contusions. His cervical spine was stabilized in a halo. He was subsequently managed in the intensive care unit and remained neurologically intact. A repeat MRI showed the interval development of a 2×1.5 cm pseudomeningocele at the craniocervical junction medial to the left occipital condyle communicating with the left anterolateral aspect of the spinal canal. Traumatic pseudomeningoceles are associated with large deceleration forces at the time of injury and are usually associated with significant neurologic deficits at presentation. However, they can arise and give rise to symptoms in a delayed fashion in trauma patients who are neurologically intact at initial presentation.

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“…Complete retention is sometimes impossible due to interposition of fragments or ligamentous structures. Conservative treatment with extension or halo-fixator as further management is recommended in children and in the case of little instability of AOD [2,28,49,56,63,73,83,84,93]; however, from the aforementioned literature it is not evident how much instability may be tolerated. In children, a fibrous ankylosis is expected after months of conservative treatment [49,56,83,93].…”

Section: Discussionmentioning

confidence: 99%

Atlanto-occipital dislocation: four case reports of survival in adults and review of the literature

Labler

Eid

Platz

et al. 2004

European Spine Journal

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IntroductionFractures and dislocations of the cranio-cervical junction represent one-third of all injuries to the cervical spine. They are usually caused by high-energy trauma such as traffic accident or fall from a great height [3, 9]. Atlantooccipital dislocation (AOD), because of its accompanying injuries to the brain stem and lesions to the vascular structures of the neck, is mostly a lethal injury [11,32,98]. The diagnosis is often overlooked [74]. Recognition of AOD and therapeutic procedures are hampered by the frequent combination of AOD with traumatic brain injury and/or polytrauma. In this article four adult patients with AOD are presented and two showed a long-term survival and were surgically treated. Case reports Case 1A 22-year-old man fell 12 m from a roof, was unconscious and had a Glasgow Coma Scale (GCS) of three points for an unknown time. Cardiac arrest and apnea occurred after arrival of the rescue team. Following successful resuscitation and intubation, the patient was transferred to the emergency ward of the University Hospital of Zurich without relaxation or sedation. The GCS was unchanged, pupillary light reactions and vital signs were normal. Except for a generalized brain edema in the computed tomography (CT) scan of the head, there were no pathological findings in the clinical and radiological work-up. After insertion of a subdural catheter for intracranial pressure (ICP) monitoring, the patient was transferred to the intensive care unit (ICU). On the first posttraumatic day, clinical neurological examination showed bilateral cranial Abstract Traumatic atlanto-occipital dislocation (AOD) is a rare cervical spine injury and in most cases fatal. Consequently, relatively few case reports of adult patients surviving this injury appeared in the literature. We retrospectively report four patients who survived AOD injury and were treated at our institution. A young man fell from height and a woman was injured in a traffic accident. Both patients survived the injury but died later in the hospital. The third patient had a motorcycle accident and survived with incomplete paraplegia. The last patient, a man involved in a working accident, survived without neurological deficit of the upper extremities. Rigid posterior fixation and complete reduction of the dislocation were applied in last two cases using Cervifix together with a cancellous bone grafting. Previously reported cases of patients surviving AOD are reviewed, and clinical features and operative stabilisation procedures are discussed.

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Retropharyngeal Pseudomeningocele after Atlanto-occipital Dislocation: Report of Two Cases

Cited by 40 publications

References 5 publications

Traumatic Atlanto-Occipital Dislocation in Children

Traumatic Atlanto-Occipital Dislocation in Children

Traumatic Retropharyngeal Pseudomeningocele with Atlanto-Occipital Dislocation in a Neurologically Intact Patient

Atlanto-occipital dislocation: four case reports of survival in adults and review of the literature

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