Tags

Type your tag names separated by a space and hit enter

Atlantoaxial Fixation for Chiari 1 Formation in Pediatric Age-Group Patients: Report of Treatment in 33 Patients.
World Neurosurg. 2018 Mar; 111:e668-e677.WN

Abstract

OBJECTIVE

The role of atlantoaxial instability in the pathogenesis of Chiari 1 formation (Chiari formation) in pediatric age-group patients is evaluated.

MATERIAL AND METHODS

During the period of January 2010 to June 2017, 33 pediatric patients having Chiari formation were treated with atlantoaxial fixation. Twenty-four patients had basilar invagination, and 9 patients had no bone abnormality at the craniovertebral junction. Sixteen patients had syringomyelia, and 9 patients had both basilar invagination and syringomyelia. Considering the type of facet alignment and atlantoaxial instability, the patients were divided into 3 groups. Type 1 dislocation (13 patients) was anterior atlantoaxial instability wherein the facet of the atlas was dislocated anterior to the facet of the axis. Type 2 dislocation (5 patients) was posterior atlantoaxial instability wherein the facet of the atlas was dislocated posterior to the facet of the axis. Type 3 dislocation (15 patients) was the absence of demonstrable facet malalignment. Type 2 and 3 atlantoaxial facet instability were labeled as central atlantoaxial dislocation. In 14 patients, dynamic images showed mobile and at least partially reducible vertical atlantoaxial dislocation.

RESULTS

All patients were treated with atlantoaxial plate and screw fixation using techniques described in 1994 and 2004. Foramen magnum decompression or syrinx manipulation was not performed in any patient. Occipital bone and subaxial spinal elements were not included in the fixation construct. All patients had gratifying and sustained clinical improvement.

CONCLUSIONS

The outcome further confirms the cause-effect relationship of Chiari formation and atlantoaxial instability.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29294396

Citation

Goel, Atul, et al. "Atlantoaxial Fixation for Chiari 1 Formation in Pediatric Age-Group Patients: Report of Treatment in 33 Patients." World Neurosurgery, vol. 111, 2018, pp. e668-e677.
Goel A, Gore S, Shah A, et al. Atlantoaxial Fixation for Chiari 1 Formation in Pediatric Age-Group Patients: Report of Treatment in 33 Patients. World Neurosurg. 2018;111:e668-e677.
Goel, A., Gore, S., Shah, A., Dharurkar, P., Vutha, R., & Patil, A. (2018). Atlantoaxial Fixation for Chiari 1 Formation in Pediatric Age-Group Patients: Report of Treatment in 33 Patients. World Neurosurgery, 111, e668-e677. https://doi.org/10.1016/j.wneu.2017.12.137
Goel A, et al. Atlantoaxial Fixation for Chiari 1 Formation in Pediatric Age-Group Patients: Report of Treatment in 33 Patients. World Neurosurg. 2018;111:e668-e677. PubMed PMID: 29294396.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atlantoaxial Fixation for Chiari 1 Formation in Pediatric Age-Group Patients: Report of Treatment in 33 Patients. AU - Goel,Atul, AU - Gore,Sandeep, AU - Shah,Abhidha, AU - Dharurkar,Pralhad, AU - Vutha,Ravikiran, AU - Patil,Abhinandan, Y1 - 2017/12/30/ PY - 2017/10/10/received PY - 2017/12/20/revised PY - 2017/12/21/accepted PY - 2018/1/3/pubmed PY - 2018/5/16/medline PY - 2018/1/3/entrez KW - Atlantoaxial instability KW - Chiari formation KW - Foramen magnum decompression KW - Syringomyelia SP - e668 EP - e677 JF - World neurosurgery JO - World Neurosurg VL - 111 N2 - OBJECTIVE: The role of atlantoaxial instability in the pathogenesis of Chiari 1 formation (Chiari formation) in pediatric age-group patients is evaluated. MATERIAL AND METHODS: During the period of January 2010 to June 2017, 33 pediatric patients having Chiari formation were treated with atlantoaxial fixation. Twenty-four patients had basilar invagination, and 9 patients had no bone abnormality at the craniovertebral junction. Sixteen patients had syringomyelia, and 9 patients had both basilar invagination and syringomyelia. Considering the type of facet alignment and atlantoaxial instability, the patients were divided into 3 groups. Type 1 dislocation (13 patients) was anterior atlantoaxial instability wherein the facet of the atlas was dislocated anterior to the facet of the axis. Type 2 dislocation (5 patients) was posterior atlantoaxial instability wherein the facet of the atlas was dislocated posterior to the facet of the axis. Type 3 dislocation (15 patients) was the absence of demonstrable facet malalignment. Type 2 and 3 atlantoaxial facet instability were labeled as central atlantoaxial dislocation. In 14 patients, dynamic images showed mobile and at least partially reducible vertical atlantoaxial dislocation. RESULTS: All patients were treated with atlantoaxial plate and screw fixation using techniques described in 1994 and 2004. Foramen magnum decompression or syrinx manipulation was not performed in any patient. Occipital bone and subaxial spinal elements were not included in the fixation construct. All patients had gratifying and sustained clinical improvement. CONCLUSIONS: The outcome further confirms the cause-effect relationship of Chiari formation and atlantoaxial instability. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/29294396/Atlantoaxial_Fixation_for_Chiari_1_Formation_in_Pediatric_Age_Group_Patients:_Report_of_Treatment_in_33_Patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(17)32253-2 DB - PRIME DP - Unbound Medicine ER -