The subforaminal stenosis headache

Abstract

The clinical picture of the so-called subforaminal stenosis headache (Gutmann) and its surgical treatment (Roesner) have been presented. We have analyzed our findings in 119 patients and 55 operations. The clinical picture is characterized by increasing pain in the upper cervical and occipital region which in later stages may be accompanied also by other symptoms like disturbances of concentration, memory, libido, and potency, as well in some cases by symptoms similar to those of a secondary chronic myelopathy. The syndrome is caused by a subforaminal stenosis of the dural sac which regularly is compressed by the posterior atlas arch in connection with either morphological variations of the base of the skull or by static-functional deviations of the cranio-cervical region. The compression of the dural sac of the cranio-cervical region results in an impairment of its air chamber function, and additionally may disturb the connections between the intracranial and intraspinal venous plexus. By both factors the physiologically important smoothing function of the CSF space of the cranio-cervical region concerning intracranial pressure changes is disturbed. Treatment of choice is a laminectomy of the dorsal arch of the atlas and an osteoclastic dilatation of the foramen magnum but without opening of the dura. The results of this procedure are excellent.

Anomaly of Arch of Atlas – A Rare Cause of Symptomatic Canal Stenosis in Children

“…A review of the literature by the same authors made them conclude that the abnormalities of the posteri or arch are not always benign or symptomatic as previous ly believed. Presentation may be transient pain neck after trivial trauma and acute onset of neurologic deficits [1,3,[10][11][12][13]. Though rare, developmental canal stenosis as a cause of cervical myelopathy associated with spondylotic degeneration in the middle-aged above the level of C3 has been reported previously [14][15][16][17], Isolated Cl arch defect as a cause of high cord compression is not usually recog nized.…”

Anatomical Basis and Clinical Significance of Atlas Stenosis: a Systematic Review

“…The review delves into the numerous factors contributing to the compression of the spinal cord and dura mater, including ossification of ligaments, osteophytes, and other degenerative factors. The authors effectively communicate the potential outcomes of these com pressions, such as cervical myelopathy and circulation problems of cerebrospinal fluid, which engages in the pathomechanisms of the headache (4). The authors highlight the discrepancy between the prevalence of pain and the expression of other symptoms in patients with cervical myelopathy caused by C1 stenosis, providing valuable insights for physicians in diagnosing and treating this condition.…”