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Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis.
Acta Neurochir (Wien). 2020 07; 162(7):1553-1563.AN

Abstract

INTRODUCTION

Recently, a novel hypothesis has been proposed concerning the origin of craniovertebral junction (CVJ) abnormalities. Commonly found in patients with these entities, atlantoaxial instability has been suspected to cause both Chiari malformation type I and basilar invagination, which renders the tried and tested surgical decompression strategy ineffective. In turn, C1-2 fusion is proposed as a single solution for all CVJ abnormalities, and a revised definition of atlantoaxial instability sees patients both with and without radiographic evidence of instability undergo fusion, instead relying on the intraoperative assessment of the atlantoaxial joints to confirm instability.

METHODS

The authors conducted a comprehensive narrative review of literature and evidence covering this recently emerged hypothesis. The proposed pathomechanisms are discussed and contextualized with published literature.

CONCLUSION

The existing evidence is evaluated for supporting or opposing sole posterior C1-2 fusion in patients with CVJ abnormalities and compared with reported outcomes for conventional surgical strategies such as posterior fossa decompression, occipitocervical fusion, and anterior decompression. At present, there is insufficient evidence supporting the hypothesis of atlantoaxial instability being the common progenitor for CVJ abnormalities. Abolishing tried and tested surgical procedures in favor of a single universal approach would thus be unwarranted.

Authors+Show Affiliations

Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany. arthur.wagner@tum.de.Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany.Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

32504118

Citation

Wagner, Arthur, et al. "Chiari Malformation Type I and Basilar Invagination Originating From Atlantoaxial Instability: a Literature Review and Critical Analysis." Acta Neurochirurgica, vol. 162, no. 7, 2020, pp. 1553-1563.
Wagner A, Grassner L, Kögl N, et al. Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis. Acta Neurochir (Wien). 2020;162(7):1553-1563.
Wagner, A., Grassner, L., Kögl, N., Hartmann, S., Thomé, C., Wostrack, M., & Meyer, B. (2020). Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis. Acta Neurochirurgica, 162(7), 1553-1563. https://doi.org/10.1007/s00701-020-04429-z
Wagner A, et al. Chiari Malformation Type I and Basilar Invagination Originating From Atlantoaxial Instability: a Literature Review and Critical Analysis. Acta Neurochir (Wien). 2020;162(7):1553-1563. PubMed PMID: 32504118.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis. AU - Wagner,Arthur, AU - Grassner,Lukas, AU - Kögl,Nikolaus, AU - Hartmann,Sebastian, AU - Thomé,Claudius, AU - Wostrack,Maria, AU - Meyer,Bernhard, Y1 - 2020/06/06/ PY - 2020/04/14/received PY - 2020/05/22/accepted PY - 2020/6/7/pubmed PY - 2021/1/7/medline PY - 2020/6/7/entrez KW - Atlantoaxial fusion KW - Atlantoaxial instability KW - Basilar invagination KW - C1-2 fusion KW - Chiari malformation KW - Syringomyelia SP - 1553 EP - 1563 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 162 IS - 7 N2 - INTRODUCTION: Recently, a novel hypothesis has been proposed concerning the origin of craniovertebral junction (CVJ) abnormalities. Commonly found in patients with these entities, atlantoaxial instability has been suspected to cause both Chiari malformation type I and basilar invagination, which renders the tried and tested surgical decompression strategy ineffective. In turn, C1-2 fusion is proposed as a single solution for all CVJ abnormalities, and a revised definition of atlantoaxial instability sees patients both with and without radiographic evidence of instability undergo fusion, instead relying on the intraoperative assessment of the atlantoaxial joints to confirm instability. METHODS: The authors conducted a comprehensive narrative review of literature and evidence covering this recently emerged hypothesis. The proposed pathomechanisms are discussed and contextualized with published literature. CONCLUSION: The existing evidence is evaluated for supporting or opposing sole posterior C1-2 fusion in patients with CVJ abnormalities and compared with reported outcomes for conventional surgical strategies such as posterior fossa decompression, occipitocervical fusion, and anterior decompression. At present, there is insufficient evidence supporting the hypothesis of atlantoaxial instability being the common progenitor for CVJ abnormalities. Abolishing tried and tested surgical procedures in favor of a single universal approach would thus be unwarranted. SN - 0942-0940 UR - https://www.unboundmedicine.com/medline/citation/32504118/Chiari_malformation_type_I_and_basilar_invagination_originating_from_atlantoaxial_instability:_a_literature_review_and_critical_analysis_ L2 - https://dx.doi.org/10.1007/s00701-020-04429-z DB - PRIME DP - Unbound Medicine ER -