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Posterior atlantoaxial facet joint reduction, fixation and fusion as revision surgery for failed suboccipital decompression in patients with basilar invagination and atlantoaxial dislocation: Operative nuances, challenges and outcomes.
Clin Neurol Neurosurg. 2020 07; 194:105793.CN

Abstract

OBJECTIVE

To report the technical nuances and clinical outcomes of posterior atlantoaxial facet joint reduction, fixation and fusion (AFRF) technique as a revision procedure for BI and AAD patients with failed suboccipital decompression and large occipital bone defect.

PATIENTS AND METHODS

We reviewed 32 patients with BI and AAD who were misdiagnosed as a simple Chiari malformation and received a suboccipital decompression surgery before admission. All patients underwent AFRF as a revision surgery. The separating, fusing, opacifying and false-coloring-volume rendering (SFOF-VR) technique was used to identify the course of the VA. Clinical and radiological outcomes were assessed after revision surgeries.

RESULTS

Clinical symptoms improved in all patients. The postoperative atlantodens interval, Wackenheim line and clivus-canal angle significantly improved (all P < 0.01). Intraoperative dural tear and cerebrospinal fluid leakage occurred in 3 patients and were managed by suture repair and lumbar drain. Abnormal VA was identified in 7 patients and no VA injury occurred with the aid of SFOF-VR technique. The average follow-up was 19.1 months and atlantoaxial bone fusion was confirmed in 31 patients.

CONCLUSION

For BI and AAD patients with failed suboccipital decompression, revision surgery is challenging. Occipitocervical fixation and posterior midline bone grafting are rather difficult due to the large occipital bone defect. The current study demonstrated that the posterior AFRF is a simple, safe and highly effective technique in revision surgery for such cases. For VA variations, the SFOF-VR technique is an effective tool to delineate the course VA.

Authors+Show Affiliations

Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China. Electronic address: xg_yu@aliyun.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32283470

Citation

Du, Yue-Qi, et al. "Posterior Atlantoaxial Facet Joint Reduction, Fixation and Fusion as Revision Surgery for Failed Suboccipital Decompression in Patients With Basilar Invagination and Atlantoaxial Dislocation: Operative Nuances, Challenges and Outcomes." Clinical Neurology and Neurosurgery, vol. 194, 2020, p. 105793.
Du YQ, Qiao GY, Yin YH, et al. Posterior atlantoaxial facet joint reduction, fixation and fusion as revision surgery for failed suboccipital decompression in patients with basilar invagination and atlantoaxial dislocation: Operative nuances, challenges and outcomes. Clin Neurol Neurosurg. 2020;194:105793.
Du, Y. Q., Qiao, G. Y., Yin, Y. H., Li, T., & Yu, X. G. (2020). Posterior atlantoaxial facet joint reduction, fixation and fusion as revision surgery for failed suboccipital decompression in patients with basilar invagination and atlantoaxial dislocation: Operative nuances, challenges and outcomes. Clinical Neurology and Neurosurgery, 194, 105793. https://doi.org/10.1016/j.clineuro.2020.105793
Du YQ, et al. Posterior Atlantoaxial Facet Joint Reduction, Fixation and Fusion as Revision Surgery for Failed Suboccipital Decompression in Patients With Basilar Invagination and Atlantoaxial Dislocation: Operative Nuances, Challenges and Outcomes. Clin Neurol Neurosurg. 2020;194:105793. PubMed PMID: 32283470.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Posterior atlantoaxial facet joint reduction, fixation and fusion as revision surgery for failed suboccipital decompression in patients with basilar invagination and atlantoaxial dislocation: Operative nuances, challenges and outcomes. AU - Du,Yue-Qi, AU - Qiao,Guang-Yu, AU - Yin,Yi-Heng, AU - Li,Teng, AU - Yu,Xin-Guang, Y1 - 2020/03/18/ PY - 2019/12/21/received PY - 2020/01/21/revised PY - 2020/03/16/accepted PY - 2020/4/14/pubmed PY - 2021/6/12/medline PY - 2020/4/14/entrez KW - Atlantoaxial dislocation KW - Atlantoaxial fixation and fusion KW - Basilar invagination KW - Revision surgery KW - Suboccipital decompression SP - 105793 EP - 105793 JF - Clinical neurology and neurosurgery JO - Clin Neurol Neurosurg VL - 194 N2 - OBJECTIVE: To report the technical nuances and clinical outcomes of posterior atlantoaxial facet joint reduction, fixation and fusion (AFRF) technique as a revision procedure for BI and AAD patients with failed suboccipital decompression and large occipital bone defect. PATIENTS AND METHODS: We reviewed 32 patients with BI and AAD who were misdiagnosed as a simple Chiari malformation and received a suboccipital decompression surgery before admission. All patients underwent AFRF as a revision surgery. The separating, fusing, opacifying and false-coloring-volume rendering (SFOF-VR) technique was used to identify the course of the VA. Clinical and radiological outcomes were assessed after revision surgeries. RESULTS: Clinical symptoms improved in all patients. The postoperative atlantodens interval, Wackenheim line and clivus-canal angle significantly improved (all P < 0.01). Intraoperative dural tear and cerebrospinal fluid leakage occurred in 3 patients and were managed by suture repair and lumbar drain. Abnormal VA was identified in 7 patients and no VA injury occurred with the aid of SFOF-VR technique. The average follow-up was 19.1 months and atlantoaxial bone fusion was confirmed in 31 patients. CONCLUSION: For BI and AAD patients with failed suboccipital decompression, revision surgery is challenging. Occipitocervical fixation and posterior midline bone grafting are rather difficult due to the large occipital bone defect. The current study demonstrated that the posterior AFRF is a simple, safe and highly effective technique in revision surgery for such cases. For VA variations, the SFOF-VR technique is an effective tool to delineate the course VA. SN - 1872-6968 UR - https://www.unboundmedicine.com/medline/citation/32283470/Posterior_atlantoaxial_facet_joint_reduction_fixation_and_fusion_as_revision_surgery_for_failed_suboccipital_decompression_in_patients_with_basilar_invagination_and_atlantoaxial_dislocation:_Operative_nuances_challenges_and_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0303-8467(20)30136-0 DB - PRIME DP - Unbound Medicine ER -