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Transnasal odontoid resection followed by posterior decompression and occipitocervical fusion in children with Chiari malformation Type I and ventral brainstem compression.
J Neurosurg Pediatr. 2010 Jun; 5(6):549-53.JN

Abstract

OBJECT

In rare cases, children with a Chiari malformation Type I (CM-I) suffer from concomitant, irreducible, ventral brainstem compression that may result in cranial neuropathies or brainstem dysfunction. In these circumstances, a 360 degrees decompression supplemented by posterior stabilization and fusion is required. In this report, the authors present the first experience with using an endoscopic transnasal corridor to accomplish ventral decompression in children with CM-I that is complicated by ventral brainstem compression.

METHODS

Two children presented with a combination of occipital headaches, swallowing dysfunction, myelopathy, and/or progressive scoliosis. Imaging studies demonstrated CM-I with severely retroflexed odontoid processes and ventral brainstem compression. Both patients underwent an endoscopic transnasal approach for ventral decompression, followed by posterior decompression, expansive duraplasty, and occipital-cervical fusion.

RESULTS

In both patients the endoscopic transnasal approach provided excellent ventral access to decompress the brainstem. When compared with the transoral approach, endoscopic transnasal access presents 4 potential advantages: 1) excellent prevertebral exposure in patients with small oral cavities; 2) a surgical corridor located above the hard palate to decompress rostral pathological entities more easily; 3) avoidance of the oral trauma and edema that follows oral retractor placement; and 4) avoidance of splitting the soft or hard palate in patients with oral-palatal dysfunction from ventral brainstem compression.

CONCLUSIONS

The endoscopic transnasal approach is atraumatic to the oral cavity, and offers a more superior region of exposure when compared with the standard transoral approach. Depending on their comfort level with endoscopic surgical techniques, pediatric neurosurgeons should consider this approach in children with pathological entities requiring ventral brainstem decompression.

Authors+Show Affiliations

Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York, New York, USA. tch12@columbia.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Comparative Study
Journal Article

Language

eng

PubMed ID

20515325

Citation

Hankinson, Todd C., et al. "Transnasal Odontoid Resection Followed By Posterior Decompression and Occipitocervical Fusion in Children With Chiari Malformation Type I and Ventral Brainstem Compression." Journal of Neurosurgery. Pediatrics, vol. 5, no. 6, 2010, pp. 549-53.
Hankinson TC, Grunstein E, Gardner P, et al. Transnasal odontoid resection followed by posterior decompression and occipitocervical fusion in children with Chiari malformation Type I and ventral brainstem compression. J Neurosurg Pediatr. 2010;5(6):549-53.
Hankinson, T. C., Grunstein, E., Gardner, P., Spinks, T. J., & Anderson, R. C. (2010). Transnasal odontoid resection followed by posterior decompression and occipitocervical fusion in children with Chiari malformation Type I and ventral brainstem compression. Journal of Neurosurgery. Pediatrics, 5(6), 549-53. https://doi.org/10.3171/2010.2.PEDS09362
Hankinson TC, et al. Transnasal Odontoid Resection Followed By Posterior Decompression and Occipitocervical Fusion in Children With Chiari Malformation Type I and Ventral Brainstem Compression. J Neurosurg Pediatr. 2010;5(6):549-53. PubMed PMID: 20515325.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transnasal odontoid resection followed by posterior decompression and occipitocervical fusion in children with Chiari malformation Type I and ventral brainstem compression. AU - Hankinson,Todd C, AU - Grunstein,Eli, AU - Gardner,Paul, AU - Spinks,Theodore J, AU - Anderson,Richard C E, PY - 2010/6/3/entrez PY - 2010/6/3/pubmed PY - 2010/6/19/medline SP - 549 EP - 53 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 5 IS - 6 N2 - OBJECT: In rare cases, children with a Chiari malformation Type I (CM-I) suffer from concomitant, irreducible, ventral brainstem compression that may result in cranial neuropathies or brainstem dysfunction. In these circumstances, a 360 degrees decompression supplemented by posterior stabilization and fusion is required. In this report, the authors present the first experience with using an endoscopic transnasal corridor to accomplish ventral decompression in children with CM-I that is complicated by ventral brainstem compression. METHODS: Two children presented with a combination of occipital headaches, swallowing dysfunction, myelopathy, and/or progressive scoliosis. Imaging studies demonstrated CM-I with severely retroflexed odontoid processes and ventral brainstem compression. Both patients underwent an endoscopic transnasal approach for ventral decompression, followed by posterior decompression, expansive duraplasty, and occipital-cervical fusion. RESULTS: In both patients the endoscopic transnasal approach provided excellent ventral access to decompress the brainstem. When compared with the transoral approach, endoscopic transnasal access presents 4 potential advantages: 1) excellent prevertebral exposure in patients with small oral cavities; 2) a surgical corridor located above the hard palate to decompress rostral pathological entities more easily; 3) avoidance of the oral trauma and edema that follows oral retractor placement; and 4) avoidance of splitting the soft or hard palate in patients with oral-palatal dysfunction from ventral brainstem compression. CONCLUSIONS: The endoscopic transnasal approach is atraumatic to the oral cavity, and offers a more superior region of exposure when compared with the standard transoral approach. Depending on their comfort level with endoscopic surgical techniques, pediatric neurosurgeons should consider this approach in children with pathological entities requiring ventral brainstem decompression. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/20515325/Transnasal_odontoid_resection_followed_by_posterior_decompression_and_occipitocervical_fusion_in_children_with_Chiari_malformation_Type_I_and_ventral_brainstem_compression_ L2 - https://thejns.org/doi/10.3171/2010.2.PEDS09362 DB - PRIME DP - Unbound Medicine ER -