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Basilar Invagination: Case Report and Literature Review.
World Neurosurg. 2015 Jun; 83(6):1180.e7-11.WN

Abstract

BACKGROUND

Basilar invagination is a rare clinical condition characterized by upward protrusion of the odontoid process into the intracranial space, leading to bulbomedullary compression. It is often encountered in adults with rheumatoid arthritis. Transoral microscopic or endonasal endoscopic decompression may be pursued, with or without posterior fixation. We present a case of basilar invagination with C1-C2 autofusion and discuss an algorithm for choice of anterior versus posterior approaches.

CASE DESCRIPTION

A 47-year-old woman with rheumatoid arthritis presented with severe occipital and cervical pain, dysphagia, hoarseness, and arm paresthesias. Findings on magnetic resonance imaging revealed moderate cranial settling with the odontoid indenting the ventral medulla but no posterior compression. Computed tomography demonstrated bony fusion at C1-C2 without lateral sag. Given autofusion of C1-C2 in proper occipitocervical alignment and the absence of posterior compression, the patient underwent endoscopic endonasal odontoidectomy without further posterior fusion, with satisfactory resolution of symptoms.

CONCLUSION

Endoscopic endonasal odontoidectomy offers a safe and effective method for anterior decompression of basilar invagination. Preoperative assessment for existing posterior fusion, absence of posterior compression, and preservation of the anterior C1 ring during operative decompression help stratify the need for lone anterior approach versus a combined anterior and posterior treatment.

Authors+Show Affiliations

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.Department of Neurological Surgery, Oregon Health Sciences University, Portland, Oregon, USA.Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: idunn@partners.org.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

25701769

Citation

Chaudhry, Nauman S., et al. "Basilar Invagination: Case Report and Literature Review." World Neurosurgery, vol. 83, no. 6, 2015, pp. 1180.e7-11.
Chaudhry NS, Ozpinar A, Bi WL, et al. Basilar Invagination: Case Report and Literature Review. World Neurosurg. 2015;83(6):1180.e7-11.
Chaudhry, N. S., Ozpinar, A., Bi, W. L., Chavakula, V., Chi, J. H., & Dunn, I. F. (2015). Basilar Invagination: Case Report and Literature Review. World Neurosurgery, 83(6), e7-11. https://doi.org/10.1016/j.wneu.2015.02.007
Chaudhry NS, et al. Basilar Invagination: Case Report and Literature Review. World Neurosurg. 2015;83(6):1180.e7-11. PubMed PMID: 25701769.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Basilar Invagination: Case Report and Literature Review. AU - Chaudhry,Nauman S, AU - Ozpinar,Alp, AU - Bi,Wenya Linda, AU - Chavakula,Vamsidhar, AU - Chi,John H, AU - Dunn,Ian F, Y1 - 2015/02/18/ PY - 2014/12/27/received PY - 2015/02/12/accepted PY - 2015/2/22/entrez PY - 2015/2/24/pubmed PY - 2015/9/8/medline KW - Anterior odontoid decompression KW - Basilar invagination KW - Cervicomedullary junction compression KW - Endoscopic endonasal odontoidectomy KW - Posterior odontoid decompression SP - 1180.e7 EP - 11 JF - World neurosurgery JO - World Neurosurg VL - 83 IS - 6 N2 - BACKGROUND: Basilar invagination is a rare clinical condition characterized by upward protrusion of the odontoid process into the intracranial space, leading to bulbomedullary compression. It is often encountered in adults with rheumatoid arthritis. Transoral microscopic or endonasal endoscopic decompression may be pursued, with or without posterior fixation. We present a case of basilar invagination with C1-C2 autofusion and discuss an algorithm for choice of anterior versus posterior approaches. CASE DESCRIPTION: A 47-year-old woman with rheumatoid arthritis presented with severe occipital and cervical pain, dysphagia, hoarseness, and arm paresthesias. Findings on magnetic resonance imaging revealed moderate cranial settling with the odontoid indenting the ventral medulla but no posterior compression. Computed tomography demonstrated bony fusion at C1-C2 without lateral sag. Given autofusion of C1-C2 in proper occipitocervical alignment and the absence of posterior compression, the patient underwent endoscopic endonasal odontoidectomy without further posterior fusion, with satisfactory resolution of symptoms. CONCLUSION: Endoscopic endonasal odontoidectomy offers a safe and effective method for anterior decompression of basilar invagination. Preoperative assessment for existing posterior fusion, absence of posterior compression, and preservation of the anterior C1 ring during operative decompression help stratify the need for lone anterior approach versus a combined anterior and posterior treatment. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/25701769/Basilar_Invagination:_Case_Report_and_Literature_Review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(15)00084-4 DB - PRIME DP - Unbound Medicine ER -