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Atlantoaxial Fixation for Basilar Invagination without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Outcome Analysis of 63 Surgically Treated Cases.
World Neurosurg. 2017 Mar; 99:164-170.WN

Abstract

BACKGROUND

We discuss the rationale of surgical treatment of group B basilar invagination by atlantoaxial facet joint stabilization and segmental arthrodesis.

METHODS

From January 2010 to April 2016, 63 patients with group B basilar invagination were surgically treated. All patients had varying degree of myelopathy-related functional disability. Fifty-two patients had both Chiari malformation and syringomyelia. All patients were treated by atlantoaxial plate and screw fixation with the techniques described by us in 1994 and 2004. Foramen magnum decompression or syrinx manipulation was not carried out in any patient. Occipital bone and subaxial spinal elements were not included in the fixation construct.

RESULTS

Three patients died in the immediate postoperative phase. In the remaining patients, there was clinical improvement and no patient's neurologic function worsened after surgery. In 12 of 38 patients in whom postoperative magnetic resonance imaging was possible, at a follow-up of at least 3 months, there was reduction in the size of the syrinx.

CONCLUSIONS

The pathogenesis of basilar invagination in group B is related to atlantoaxial instability. The clinical outcome suggests that the surgical treatment in these cases should be directed toward atlantoaxial stabilization and aimed at segmental arthrodesis. Inclusion of the occipital bone in the fixation construct is not necessary. Foramen magnum decompression and procedures involving manipulation of Chiari malformation and syringomyelia are not necessary.

Authors+Show Affiliations

Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India; Lilavati Hospital and Research Centre, Bandra (E), Mumbai, India. Electronic address: atulgoel62@hotmail.com.Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

27890751

Citation

Goel, Atul, et al. "Atlantoaxial Fixation for Basilar Invagination Without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Outcome Analysis of 63 Surgically Treated Cases." World Neurosurgery, vol. 99, 2017, pp. 164-170.
Goel A, Sathe P, Shah A. Atlantoaxial Fixation for Basilar Invagination without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Outcome Analysis of 63 Surgically Treated Cases. World Neurosurg. 2017;99:164-170.
Goel, A., Sathe, P., & Shah, A. (2017). Atlantoaxial Fixation for Basilar Invagination without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Outcome Analysis of 63 Surgically Treated Cases. World Neurosurgery, 99, 164-170. https://doi.org/10.1016/j.wneu.2016.11.093
Goel A, Sathe P, Shah A. Atlantoaxial Fixation for Basilar Invagination Without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Outcome Analysis of 63 Surgically Treated Cases. World Neurosurg. 2017;99:164-170. PubMed PMID: 27890751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atlantoaxial Fixation for Basilar Invagination without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Outcome Analysis of 63 Surgically Treated Cases. AU - Goel,Atul, AU - Sathe,Prashant, AU - Shah,Abhidha, Y1 - 2016/11/24/ PY - 2016/09/04/received PY - 2016/11/15/revised PY - 2016/11/16/accepted PY - 2016/11/29/pubmed PY - 2017/9/21/medline PY - 2016/11/29/entrez KW - Atlantoaxial dislocation KW - Atlantoaxial fixation KW - Basilar invagination KW - Chiari malformation KW - Foramen magnum decompression KW - Syringomyelia SP - 164 EP - 170 JF - World neurosurgery JO - World Neurosurg VL - 99 N2 - BACKGROUND: We discuss the rationale of surgical treatment of group B basilar invagination by atlantoaxial facet joint stabilization and segmental arthrodesis. METHODS: From January 2010 to April 2016, 63 patients with group B basilar invagination were surgically treated. All patients had varying degree of myelopathy-related functional disability. Fifty-two patients had both Chiari malformation and syringomyelia. All patients were treated by atlantoaxial plate and screw fixation with the techniques described by us in 1994 and 2004. Foramen magnum decompression or syrinx manipulation was not carried out in any patient. Occipital bone and subaxial spinal elements were not included in the fixation construct. RESULTS: Three patients died in the immediate postoperative phase. In the remaining patients, there was clinical improvement and no patient's neurologic function worsened after surgery. In 12 of 38 patients in whom postoperative magnetic resonance imaging was possible, at a follow-up of at least 3 months, there was reduction in the size of the syrinx. CONCLUSIONS: The pathogenesis of basilar invagination in group B is related to atlantoaxial instability. The clinical outcome suggests that the surgical treatment in these cases should be directed toward atlantoaxial stabilization and aimed at segmental arthrodesis. Inclusion of the occipital bone in the fixation construct is not necessary. Foramen magnum decompression and procedures involving manipulation of Chiari malformation and syringomyelia are not necessary. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/27890751/Atlantoaxial_Fixation_for_Basilar_Invagination_without_Obvious_Atlantoaxial_Instability__Group_B_Basilar_Invagination_:_Outcome_Analysis_of_63_Surgically_Treated_Cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(16)31241-4 DB - PRIME DP - Unbound Medicine ER -