Surgical treatment for an uncommon headache: A gap of 4800 years

Abstract

Background Surgical management of headache due to anomalies in the cervical spine is uncommon, as most cases improve with drugs and/or physical therapy. Case We report two instances of a very uncommon congenital upper cervical spine anomaly due to the presence of a pseudoarthrosis between a unilateral paracondylar process in the base of the skull and an epitransverse process arising from the transverse apophysis (PCP/ETA). The first one corresponds to a male on whom an endoscopic guided puncture was performed, and the second to an adult male from the Neolithic period who showed two cranial trepanations together with the presence of morphine metabolites in both bones and dental calculus. Discussion We draw a parallel between the treatment of two individuals separated by a gap of more than 4800 years: contemporary direct vision of the false joint through a small endoscope, which provides an accurate puncture, and ancient double trepanation with clear signs of bone eburnation.

Post-auricular lump: CT diagnosis

“…If the process detaches and assimilates to the C1 transverse process instead, an epitransverse process is formed [3]. Our patient has an unusual variation where both paracondylar and epitransverse processes coexist [4]. In addition, to our knowledge, a multi-segmented appearance of two separate pseudo-articulations with the occipital bone and C1 transverse process has not been previously reported.…”

“…It may also present as an osseous lump (as in our patient) [2] or more frequently as an incidental imaging finding [10]. Compression of the adjacent vertebral artery and C1 nerve root may hypothetically lead to symptoms, but this has not been documented in previous case reports [2,4].…”