Surgical Results of Foramen Magnum Decompression for Chiari Type 1 Malformation associated with Syringomyelia:

基夫, 久保田; 利宏, 山内; 直勝, 佐伯; 晶, 山浦; 昌平, 南; 好則, 中田; 雅俊, 井上

doi:10.2531/spinalsurg.18.81

Cited by 14 publications

(18 citation statements)

References 8 publications

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“…Dorsal position of the dens causing spinal cord compression in dogs with CLM has been reported 1,11 and was detected in 66% of 64 dogs evaluated in a recent study. 50 In the present study, 104 of 274 (38.0%) dogs with CLM had DC. In another study, 38 females with Chiari malformation were more commonly affected with DA.…”

Section: Discussionsupporting

confidence: 44%

Morphometric features of the craniocervical junction region in dogs with suspected Chiari-like malformation determined by combined use of magnetic resonance imaging and computed tomography

Marino¹,

Loughin²,

Dewey³

et al. 2012

ajvr

115

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Section: Discussionsupporting

confidence: 44%

Morphometric features of the craniocervical junction region in dogs with suspected Chiari-like malformation determined by combined use of magnetic resonance imaging and computed tomography

Marino¹,

Loughin²,

Dewey³

et al. 2012

ajvr

115

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“…Neurological deficits were variably attributed to a CXA of less than 150° and 125° [3,14]. Kubota reported on a series of Chiari I malformation subjects, where the syringomyelia failed to resolve in those patients with a kyphotic CXA (<130°) [16].…”

Section: The Clival-axial Anglementioning

confidence: 99%

“…Extension of the craniocervical junction is employed to establish a CXA of >140°, which is associated with neurological improvement [3,5,7,11,4,16]. However, the subject should not be excessively extended, as this may cause "star gazing".…”

Section: Open Reductionmentioning

confidence: 99%

Optimizing Alignment Parameters During Craniocervical Stabilization and Fusion: A Technical Note

Henderson¹,

Rosenbaum²,

Narayanan³

et al. 2020

Cureus

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Proper craniocervical alignment during craniocervical reduction, stabilization, and fusion optimizes cerebrospinal fluid (CSF) flow through the foramen magnum, establishes the appropriate "gaze angle", avoids dysphagia and dyspnea, and, most importantly, normalizes the clival-axial angle (CXA) to reduce ventral brainstem compression. To illustrate the metrics of reduction that include CXA, posterior occipital cervical angle, orbital-axial or "gaze angle", and mandible-axial angle, we present a video illustration of a patient presenting with signs and symptoms of the cervical medullary syndrome along with concordant radiographic findings of craniocervical instability as identified on dynamic imaging and through assessment of the CXA, Harris, and Grabb-Oakes measurements.

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“…Van Gilder was the first to suggest that a CXA less than 150° may be associated with ventral cord compression [ 80 , 158 ]. Others reported that the kyphotic CXA in traumatic, developmental, heritable hypermobility, or degenerative conditions may cause deformation of the brainstem and upper-cervical spinal cord [ 18 , 65 , 83 , 99 , 147 ] and that there may be salutary consequences to the correction of the CXA [ 15 , 65 , 81 , 89 ]. Concurrent to the recognition of the kyphotic CXA and brainstem deformation, has been the growing understanding of mechanically induced neural injury [ 5 , 18 , 30 , 55 , 61 , 63 – 68 , 82 , 91 , 97 , 153 , 156 , 161 , 162 ].…”

Section: Introductionmentioning

confidence: 99%

Utility of the clivo-axial angle in assessing brainstem deformity: pilot study and literature review

et al. 2017

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There is growing recognition of the kyphotic clivo-axial angle (CXA) as an index of risk of brainstem deformity and craniocervical instability. This review of literature and prospective pilot study is the first to address the potential correlation between correction of the pathological CXA and postoperative clinical outcome. The CXA is a useful sentinel to alert the radiologist and surgeon to the possibility of brainstem deformity or instability. Ten adult subjects with ventral brainstem compression, radiographically manifest as a kyphotic CXA, underwent correction of deformity (normalization of the CXA) prior to fusion and occipito-cervical stabilization. The subjects were assessed preoperatively and at one, three, six, and twelve months after surgery, using established clinical metrics: the visual analog pain scale (VAS), American Spinal InjuryAssociation Impairment Scale (ASIA), Oswestry Neck Disability Index, SF 36, and Karnofsky Index. Parametric and non-parametric statistical tests were performed to correlate clinical outcome with CXA. No major complications were observed. Two patients showed pedicle screws adjacent to but not deforming the vertebral artery on post-operative CT scan. All clinical metrics showed statistically significant improvement. Mean CXA was normalized from 135.8° to 163.7°. Correction of abnormal CXA correlated with statistically significant clinical improvement in this cohort of patients. The study supports the thesis that the CXA maybe an important metric for predicting the risk of brainstem and upper spinal cord deformation. Further study is feasible and warranted.

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Surgical Results of Foramen Magnum Decompression for Chiari Type 1 Malformation associated with Syringomyelia:

Cited by 14 publications

References 8 publications

Morphometric features of the craniocervical junction region in dogs with suspected Chiari-like malformation determined by combined use of magnetic resonance imaging and computed tomography

Morphometric features of the craniocervical junction region in dogs with suspected Chiari-like malformation determined by combined use of magnetic resonance imaging and computed tomography

Optimizing Alignment Parameters During Craniocervical Stabilization and Fusion: A Technical Note

Utility of the clivo-axial angle in assessing brainstem deformity: pilot study and literature review

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