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Stability-Sparing Endoscopic Endonasal Odontoidectomy in a Malformative Craniovertebral Junction: Case Report and Biomechanical Considerations.
Acta Neurochir Suppl. 2019; 125:229-233.AN

Abstract

BACKGROUND

The craniovertebral junction (CVJ) is often involved in a wide range of congenital, developmental and acquired pathologies that can create bony and ligamentous instability or cause direct compression on the medulla and cervical spine cord, resulting in significant impairment. Atlas assimilation is the most common malformation in the CVJ and can be frequently associated with basilar invagination (BI) and Chiari malformation (CM) type I. Posterior atlas assimilation more frequently leads to BI type II with a mass effect on neural structures but usually no signs of biomechanical instability. Operative approaches to the CVJ have undergone a remarkable evolution and can be divided into ventral, lateral and dorsal ones. In this kind of surgery, it is vital to detect and eventually treat any CVJ instability.

CASE DESCRIPTION

We present a case of CVJ malformation comprising assimilation of the posterior arch of the atlas, BI type II and CM, treated by endoscopic endonasal odontoidectomy and partial clivus removal to spare CVJ stability.

CONCLUSION

Neurological and biomechanical analysis of all CVJ malformations permits stratification and selection of those cases that can be managed by simple, direct, minimally invasive decompression with no need for surgical fusion.

Authors+Show Affiliations

Neurosurgical Unit, Surgical Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. mat.vitali@virgilio.it.Department of Otorhinolaryngology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.Neurosurgical Unit, Surgical Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. Neurosurgery, Department of Clinical Surgical, Diagnostic and Paediatric Sciences, Università degli Studi di Pavia, Pavia, Italy.Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy.Neurosurgical Unit, Surgical Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.Neurosurgical Unit, Surgical Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30610326

Citation

Vitali, Matteo, et al. "Stability-Sparing Endoscopic Endonasal Odontoidectomy in a Malformative Craniovertebral Junction: Case Report and Biomechanical Considerations." Acta Neurochirurgica. Supplement, vol. 125, 2019, pp. 229-233.
Vitali M, Canevari FR, Cattalani A, et al. Stability-Sparing Endoscopic Endonasal Odontoidectomy in a Malformative Craniovertebral Junction: Case Report and Biomechanical Considerations. Acta Neurochir Suppl. 2019;125:229-233.
Vitali, M., Canevari, F. R., Cattalani, A., Somma, T., Grasso, V. M., & Barbanera, A. (2019). Stability-Sparing Endoscopic Endonasal Odontoidectomy in a Malformative Craniovertebral Junction: Case Report and Biomechanical Considerations. Acta Neurochirurgica. Supplement, 125, 229-233. https://doi.org/10.1007/978-3-319-62515-7_32
Vitali M, et al. Stability-Sparing Endoscopic Endonasal Odontoidectomy in a Malformative Craniovertebral Junction: Case Report and Biomechanical Considerations. Acta Neurochir Suppl. 2019;125:229-233. PubMed PMID: 30610326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stability-Sparing Endoscopic Endonasal Odontoidectomy in a Malformative Craniovertebral Junction: Case Report and Biomechanical Considerations. AU - Vitali,Matteo, AU - Canevari,Frank Rikki, AU - Cattalani,Andrea, AU - Somma,Teresa, AU - Grasso,Vincenzo Maria, AU - Barbanera,Andrea, PY - 2019/1/6/entrez PY - 2019/1/6/pubmed PY - 2019/8/23/medline KW - Atlas assimilation KW - Basilar invagination KW - Chiari I malformation KW - Cranio-cervical malformation KW - Cranio-vertebral junction KW - Endoscopic endonasal odontoidectomy SP - 229 EP - 233 JF - Acta neurochirurgica. Supplement JO - Acta Neurochir. Suppl. VL - 125 N2 - BACKGROUND: The craniovertebral junction (CVJ) is often involved in a wide range of congenital, developmental and acquired pathologies that can create bony and ligamentous instability or cause direct compression on the medulla and cervical spine cord, resulting in significant impairment. Atlas assimilation is the most common malformation in the CVJ and can be frequently associated with basilar invagination (BI) and Chiari malformation (CM) type I. Posterior atlas assimilation more frequently leads to BI type II with a mass effect on neural structures but usually no signs of biomechanical instability. Operative approaches to the CVJ have undergone a remarkable evolution and can be divided into ventral, lateral and dorsal ones. In this kind of surgery, it is vital to detect and eventually treat any CVJ instability. CASE DESCRIPTION: We present a case of CVJ malformation comprising assimilation of the posterior arch of the atlas, BI type II and CM, treated by endoscopic endonasal odontoidectomy and partial clivus removal to spare CVJ stability. CONCLUSION: Neurological and biomechanical analysis of all CVJ malformations permits stratification and selection of those cases that can be managed by simple, direct, minimally invasive decompression with no need for surgical fusion. SN - 0065-1419 UR - https://www.unboundmedicine.com/medline/citation/30610326/Stability_Sparing_Endoscopic_Endonasal_Odontoidectomy_in_a_Malformative_Craniovertebral_Junction:_Case_Report_and_Biomechanical_Considerations_ L2 - https://medlineplus.gov/chiarimalformation.html DB - PRIME DP - Unbound Medicine ER -