1
|
Park CK, Choi MK. Direct C1 posterior arch screws for reduction and osteosynthesis in the treatment of Jefferson fracture. Acta Neurochir (Wien) 2024; 166:31. [PMID: 38265602 DOI: 10.1007/s00701-024-05914-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/21/2023] [Indexed: 01/25/2024]
Abstract
The surgical treatment of Jefferson fractures generally involves solid fusion, which limits the range of motion of the upper cervical spine. Herein, we present a case of a Jefferson fracture that was surgically treated using direct C1 posterior arch screw reduction and osteosynthesis instead of fusion surgery. Postoperative computed tomography (CT) and plain radiography revealed that both C1 posterior arch screws were well positioned, and placing lag screws at the C1 level played a key role in fracture reduction. The present case highlights a surgical technique, which can preserve neck motion by using lag screws for reduction and osteosynthesis.
Collapse
Affiliation(s)
- Chang Kyu Park
- Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea
| | - Man Kyu Choi
- Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea.
| |
Collapse
|
2
|
Abstract
At present, the posterior cervical approach with open reduction and internal fixation (ORIF) remains a commonly effective treatment for unstable Atlas fracture. However, the inserted screws into the C1 lateral mass of some unstable atlas fracture are very difficult, so that the operation is forced to change into C0 to C2 fusion. In order to improve the successful rate of lateral mass screw placement, we introduced a method of fixing lateral mass with a towel clamp in posterior transpedicular fixation, and explore the efficacy and feasibility.Twenty-one consecutive patients with unstable atlas fracture were treated via this method from October 2012 to July 2017. All cases had neck pain and restricted motion of neck movement on admission. Electronic medical records and pre- and postoperative radiographs were reviewed. Screw and rod placement, bone fusion, and spinal cord integrity were assessed via long-term follow-up with anteroposterior and lateral radiographs and computed tomography. Follow-up included clinical assessment of neurological function, assessment of pain using the visual analog scale (VAS), and assessment of the activities of daily living using the neck disability index (NDI).The mean follow-up duration was 22.1 months (range: 12-54 months). No screw loosening or breakage, plate displacement, neurovascular injury, and severe complications occurred during follow-up. The mean operative time was 112.4 ± 14.9 min (range: 82-135 min), and mean blood loss was 386.2 ± 147.9 mL (range: 210-850 mL). One patient experienced continuous neck pain postoperatively, but this gradually disappeared with analgesic administration. At final follow-up, all patients had bone fusion, the VAS scores and NDI were significantly improved compared with preoperatively.Fixing the C1 lateral mass with a towel clamp during posterior transpedicular fixation for unstable atlas fracture appears to be a safe and reliable method, with the advantages of being a simple technique with few complications.
Collapse
Affiliation(s)
- Wei Guo
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
- Department of Spine Surgery, The First People's Hospital of Changde City, Hunan Province, P.R. China
| | - Yang Lin
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
| | - Jingwen Huang
- Department of Spine Surgery, The First People's Hospital of Changde City, Hunan Province, P.R. China
| | - Feng Hu
- Department of Spine Surgery, The First People's Hospital of Changde City, Hunan Province, P.R. China
| | - Zhou Ding
- Department of Spine Surgery, The First People's Hospital of Changde City, Hunan Province, P.R. China
| | - Zengming Xiao
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
| |
Collapse
|
3
|
Abstract
CASE A 47-year-old woman presented with an unstable C1 fracture after falling down several stairs. She was found to have a sagittal split fracture of the right C1 lateral mass extending into the posterior arch. The fracture was treated with a direct posterior osteosynthesis of C1 using lateral mass screws. CONCLUSION Surgical management of unstable C1 fractures has traditionally involved posterior fusion of C1 to C2 or fusion from the occiput to C2. These fusion procedures can be quite functionally limiting. Recently, direct osteosynthesis of C1 has been shown to be an effective, motion-preserving alternative.
Collapse
Affiliation(s)
- Jonathan C Yu
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | |
Collapse
|
4
|
Iacoangeli M, Nasi D, Colasanti R, Pan B, Re M, Di Rienzo A, di Somma L, Dobran M, Specchia N, Scerrati M. Endoscopic Endonasal Odontoidectomy with Anterior C1 Arch Preservation in Rheumatoid Arthritis: Long-Term Follow-Up and Further Technical Improvement by Anterior Endoscopic C1-C2 Screw Fixation and Fusion. World Neurosurg 2017; 107:820-9. [DOI: 10.1016/j.wneu.2017.08.063] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 08/06/2017] [Accepted: 08/10/2017] [Indexed: 12/19/2022]
|
5
|
Abstract
Most atlas fractures are the result of compression forces. They are often combined with fractures of the axis and especially with the odontoid process. Multiple classification systems for atlas fractures have been described. For an adequate diagnosis, a computed tomography is mandatory. To distinguish between stable and unstable atlas injury, it is necessary to evaluate the integrity of the transverse atlantal ligament (TAL) by magnetic resonance imaging and to classify the TAL lesion. Studies comparing conservative and operative management of unstable atlas fractures are unfortunately not available in the literature; neither are studies comparing different operative treatment strategies. Hence all treatment recommendations are based on low level evidence. Most of atlas fractures are stable and will be successfully managed by immobilization in a soft/hard collar. Unstable atlas fractures may be treated conservatively by halo-fixation, but nowadays more and more surgeons prefer surgery because of the potential discomfort and complications of halo-traction. Atlas fractures with a midsubstance ligamentous disruption of TAL or severe bony ligamentous avulsion can be treated by a C1/2 fusion. Unstable atlas fractures with moderate bony ligamentous avulsion may be treated by atlas osteosynthesis. Although the evidence for the different treatment strategies of atlas fractures is low, atlas osteosynthesis has the potential to change treatment philosophies. The reasons for this are described in this review.
Collapse
|
6
|
Iacoangeli M, Di Rienzo A, Colasanti R, Re M, Nasi D, Nocchi N, Alvaro L, di Somma L, Dobran M, Specchia N, Scerrati M. Endoscopic Transnasal Odontoidectomy With Anterior C1 Arch Preservation and Anterior Vertebral Column Reconstruction in Patients With Irreducible Bulbomedullary Compression by Complex Craniovertebral Junction Abnormalities: Operative Nuance. Oper Neurosurg (Hagerstown) 2016; 12:222-230. [DOI: 10.1227/neu.0000000000001330] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 03/14/2016] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND
During the past decades, the transoral transpharyngeal approach has been advocated as the standard route for the removal of odontoid causing an irreducible symptomatic neural compression. However, it may be potentially associated with a significant built-in morbidity because of the splitting of the soft palate for an adequate working angle, tracheostomy, and incision of the oral mucosa, causing exposure to a higher risk of infection by oral flora.
OBJECTIVE
To describe our experience with the minimally invasive pure endoscopic transnasal odontoidectomy in patients with bulbomedullary compression affected by complex anterior craniovertebral junction abnormalities.
METHODS
Five patients underwent a pure endoscopic neuronavigation-assisted transnasal odontoidectomy with anterior C1 arch preservation. Moreover, the anterior cervical spine column was reconstructed by filling the gap between the C1 arch and the residual C2 body with autologous/artificial bone. Neither tracheostomy nor enteral tube feeding were needed in any case.
RESULTS
A postoperative neurological improvement was observed in all patients. Postoperative imaging confirmed a satisfactory spinal cord decompression with cervical anterior column arthrodesis, and without evidence of instability at follow-up, so far.
CONCLUSION
The endoscopic transnasal approach seems to represent an efficient and safe alternative to the transoral route for the resection of odontoid process causing irreducible bulbomedullary compression. It provides a straightforward and minimally invasive natural surgical corridor to the anterior craniocervical junction, allowing a better working angle with preservation of spine biomechanics, while minimizing potential comorbidities.
Collapse
Affiliation(s)
- Maurizio Iacoangeli
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Di Rienzo
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Roberto Colasanti
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Re
- Department of ENT Surgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Davide Nasi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Niccolò Nocchi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Lorenzo Alvaro
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Lucia di Somma
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Mauro Dobran
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Nicola Specchia
- Department of Orthopedic Surgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Scerrati
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| |
Collapse
|
7
|
Bednar DA, Almansoori KA. Solitary C1 Posterior Fixation for Unstable Isolated Atlas Fractures: Case Report and Systematic Review of the Literature. Global Spine J 2016; 6:375-82. [PMID: 27190741 PMCID: PMC4868582 DOI: 10.1055/s-0035-1564806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/19/2015] [Indexed: 11/11/2022] Open
Abstract
Study Design A systematic review of the literature. Objectives To review the published results to date of motion-preserving direct reconstruction of C1 ring fractures with combined coronal plane displacement of at least 7 mm (rule of Spence) and so at risk for Dickman type I or II disruption of the transverse atlantal ligament (TAL). Methods A structured literature review prompted by successful management of a typical case. Results To date only 65 such cases are reported and follow-up is almost uniformly short. Although reported clinical success is uniform, the case mix is heterogenous and confirmation/classification of ligamentous injury at baseline is often lacking. Conclusions Direct C1 stabilization shows promise as a "more selective" option in managing displaced atlas fractures with probable TAL disruption but cannot yet be recommended as a practice standard. Prospective clinical studies are indicated and should be structured so as to differentiate between Dickman type I and type II injuries of the TAL.
Collapse
Affiliation(s)
- Drew A. Bednar
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Address for correspondence Drew A. Bednar, MD c/o 414 Victoria Avenue North #M-9Hamilton, OntarioCanada L8L 5G8
| | - Khaled A. Almansoori
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
8
|
Re M, Iacoangeli M, Di Somma L, Alvaro L, Nasi D, Magliulo G, Gioacchini FM, Fradeani D, Scerrati M. Endoscopic endonasal approach to the craniocervical junction: the importance of anterior C1 arch preservation or its reconstruction. Acta Otorhinolaryngol Ital 2016; 36:107-18. [PMID: 27196075 PMCID: PMC4907157 DOI: 10.14639/0392-100x-647] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 10/19/2015] [Indexed: 12/02/2022]
Abstract
We report our experience with the endoscopic endonasal approaches (EEA) for different craniocervical junction (CCJ) disorders to analyse outcomes and demonstrate the importance and feasibility of anterior C1 arch preservation or its reconstruction. Between January 2009 and December 2013, 10 patients underwent an endoscopic endonasal approach for different CCJ pathologies at our Institution. In 8 patients we were able to preserve the anterior C1 arch, while in 2 post-traumatic cases we reconstructed it. The CCJ disorders included 4 cases of irreducible anterior bulbo-medullary compression secondary to rheumatoid arthritis or CCJ anomalies, 4 cases of inveterate fractures of C1 and/or C2 and 2 tumours. Pre- and postoperative neuroradiological evaluation was always obtained by magnetic resonance imaging (MRI), computed tomographic (CT) scanning and dynamic cranio-vertebral junction x-ray. Pre- and postoperative neurologic disability assessment was obtained by Ranawat classification for patients with rheumatoid arthritis and by Nurick classification for the others. At a mean follow-up of 31 months (range: 14-73 months), an improvement of at least one Ranawat or Nurick classification level was observed in 6 patients, while in another 4 patients neurological conditions were stable. Radiological follow-up revealed an adequate bulbo-medullary decompression in all patients and a regular bone fusion in cases of C1 and/or C2 fractures. In all patients spinal stability was preserved and none required subsequent posterior fixation. The endoscopic endonasal surgery provided adequate exposure and a low morbidity minimally invasive approach to the antero-medial located lesions of the CCJ, resulting in a safe, effective and well-tolerated procedure. This approach allowed preservation of the anterior C1 arch and the avoidance of a posterior fixation in all patients of this series, thus preserving the rotational movement at C0-C2 segment and reducing the risk of a subaxial instability development.
Collapse
Affiliation(s)
- M Re
- Department of Otorhinolaryngology, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - M Iacoangeli
- Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - L Di Somma
- Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - L Alvaro
- Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - D Nasi
- Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - G Magliulo
- Organi di Senso Department, University ''la Sapienza'', Rome, Italy
| | - F M Gioacchini
- Department of Otorhinolaryngology, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - D Fradeani
- Department of Otorhinolaryngology, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - M Scerrati
- Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy
| |
Collapse
|
9
|
Iacoangeli M, Nocchi N, Nasi D, DI Rienzo A, Dobran M, Gladi M, Colasanti R, Alvaro L, Polonara G, Scerrati M. Minimally Invasive Supraorbital Key-hole Approach for the Treatment of Anterior Cranial Fossa Meningiomas. Neurol Med Chir (Tokyo) 2016; 56:180-5. [PMID: 26804334 PMCID: PMC4831943 DOI: 10.2176/nmc.oa.2015-0242] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The most important target of minimally invasive surgery is to obtain the best therapeutic effect with the least iatrogenic injury. In this background, a pivotal role in contemporary neurosurgery is played by the supraorbital key-hole approach proposed by Perneczky for anterior cranial base surgery. In this article, it is presented as a possible valid alternative to the traditional craniotomies in anterior cranial fossa meningiomas removal. From January 2008 to January 2012 at our department 56 patients underwent anterior cranial base meningiomas removal. Thirty-three patients were submitted to traditional approaches while 23 to supraorbital key-hole technique. A clinical and neuroradiological pre- and postoperative evaluation were performed, with attention to eventual complications, length of surgical procedure, and hospitalization. Compared to traditional approaches the supraorbital key-hole approach was associated neither to a greater range of postoperative complications nor to a longer surgical procedure and hospitalization while permitting the same lesion control. With this technique, minimization of brain exposition and manipulation with reduction of unwanted iatrogenic injuries, neurovascular structures preservation, and a better aesthetic result are possible. The supraorbital key-hole approach according to Perneckzy could represent a valid alternative to traditional approaches in anterior cranial base meningiomas surgery.
Collapse
Affiliation(s)
- Maurizio Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Zenga F, Marengo N, Pacca P, Pecorari G, Ducati A. C1 anterior arch preservation in transnasal odontoidectomy using three-dimensional endoscope: A case report. Surg Neurol Int 2015; 6:192. [PMID: 26759737 PMCID: PMC4697203 DOI: 10.4103/2152-7806.172696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/02/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The transoral ventral corridor is the most common approach used to reach the craniovertebral junction (CVJ). Over the last decade, many case reports have demonstrated the transnasal corridor to the odontoid peg represents a practicable route to remove the tip of the odontoid process. The biomechanical consequences of the traditional odontoidectomy led to the necessity of a cervical spine stabilization. Preserving the inferior portion of the C1 anterior arch should prevent instability. CASE DESCRIPTION This is the first report in which the technique to remove the tip of the odontoid while preserving the C1 anterior arch is described by means of a three-dimensional (3D) endoscope. A 53-year-old man underwent a transnasal 3D endoscopic approach because of a complex CVJ malformation. The upper-medial portion of the C1 anterior arch was removed preserving its continuity, and the odontoidectomy was performed. After surgery, a dynamic X-ray scan showed no difference in CVJ motility in comparison with the preoperative one. CONCLUSIONS The stereoscopic perception augmented the precision of the surgical gesture in the deep field. The importance of a 3D view relates to the depth of field, which a two-dimensional endoscopy cannot provide. This affects the preservation of the C1 anterior arch because of the presence of critical structures that are exposed to potential damage if not displayed.
Collapse
Affiliation(s)
- Francesco Zenga
- Department of Neurosciences, Molinette University Hospital, Via Cherasco 15, 10126 Torino, Italy
| | - Nicola Marengo
- Department of Neurosciences, Molinette University Hospital, Via Cherasco 15, 10126 Torino, Italy
| | - Paolo Pacca
- Department of Neurosciences, Molinette University Hospital, Via Cherasco 15, 10126 Torino, Italy
| | - Giancarlo Pecorari
- Department of Surgical Sciences, First ENT Division, Molinette University Hospital, Via Genova 3, 10126 Torino, Italy
| | - Alessandro Ducati
- Department of Neurosciences, Molinette University Hospital, Via Cherasco 15, 10126 Torino, Italy
| |
Collapse
|
11
|
Iacoangeli M, Di Rienzo A, di Somma LGM, Moriconi E, Alvaro L, Re M, Salvinelli F, Carassiti M, Scerrati M. Improving the endoscopic endonasal transclival approach: the importance of a precise layer by layer reconstruction. Br J Neurosurg 2013; 28:241-6. [PMID: 24011138 DOI: 10.3109/02688697.2013.835375] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND. The endoscopic endonasal transclival approach (EETCA) is a minimally-invasive technique allowing a direct route to the base of implant of clival lesions with reduced brain and neurovascular manipulation. On the other hand, it is associated with potentially severe complications related to the difficulties in reconstructing large skull base defects with a high risk of postoperative cerebrospinal fluid (CSF) leakage. The aim of this paper is to describe a precise layer by layer reconstruction in the EETCA including the suture of the mucosa as an additional reinforcing layer between cranial and nasal cavity in order to speed up the healing process and reduce the incidence of CSF leak. METHODS. This closure technique was applied to the last six cases of EETCA used for clival meningiomas (2), clival chordomas (2), clival metastasis (1), and craniopharyngioma with clival extension (1). RESULTS. After a mean follow-up of 6 months we had no one case of postoperative CSF leakage or infections. Seriated outpatient endoscopic endonasal controls showed a fast healing process of nasopharyngeal mucosa with less patient discomfort. CONCLUSIONS. Our preliminary experience confirms the importance of a precise reconstruction of all anatomical layers violated during the surgical approach, including the nasopharygeal mucosa.
Collapse
Affiliation(s)
- Maurizio Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital , Ancona , Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Iacoangeli M, Gladi M, Alvaro L, Di Rienzo A, Specchia N, Scerrati M. Endoscopic endonasal odontoidectomy with anterior C1 arch preservation in elderly patients affected by rheumatoid arthritis. Spine J 2013; 13:542-8. [PMID: 23453575 DOI: 10.1016/j.spinee.2013.01.043] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 09/27/2012] [Accepted: 01/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Rheumatoid arthritis is the most common inflammatory disease involving the spine with predilection for the craniovertebral segment. Surgery is usually reserved to patients with symptomatic craniovertebral junction (CVJ) instability, basilar invagination, or upper spinal cord compression by rheumatoid pannus. Anterior approaches are indicated in cases of irreducible ventral bulbo-medullary compression. Classically performed through the transoral approach, the exposure of this region can be now achieved by a minimally invasive endonasal endoscopic approach (EEA). PURPOSE The aim of this article is to demonstrate the feasibility of performing an odontoidectomy and a rheumatoid pannus removal by a minimally invasive EEA, preserving the anterior C1 arch continuity and avoiding a posterior fixation procedure. STUDY DESIGN Technical description and cohort report. METHODS We report three cases of elderly patients with a long history of rheumatoid arthritis and irreducible anterior bulbo-medullary compression secondary to basilar invagination and/or rheumatoid pannus. Anterior decompression was achieved by an endonasal image-guided fully endoscopic approach. RESULTS Neurological improvement and adequate bulbo-medullary decompression were obtained in all cases. The anterior C1 arch continuity was preserved, and none of the patients required a subsequent posterior fixation. CONCLUSIONS Anterior decompression by a minimally invasive EEA could represent an innovative option for the treatment of irreducible ventral CVJ lesions in elderly patients with rheumatoid arthritis. This approach permits the preservation of the anterior C1 arch and the avoidance of a posterior fixation, thus preserving the rotational movement at C0-C2 segment and reducing the risk of a subaxial instability development.
Collapse
Affiliation(s)
- Maurizio Iacoangeli
- Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy.
| | | | | | | | | | | |
Collapse
|
13
|
Iacoangeli M, Di Rienzo A, Re M, Alvaro L, Nocchi N, Gladi M, De Nicola M, Scerrati M. Endoscopic endonasal approach for the treatment of a large clival giant cell tumor complicated by an intraoperative internal carotid artery rupture. Cancer Manag Res 2013; 5:21-4. [PMID: 23403482 PMCID: PMC3565560 DOI: 10.2147/cmar.s38768] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Giant cell tumors (GCTs) are primary bone neoplasms that rarely involve the skull base. These lesions are usually locally aggressive and require complete removal, including the surrounding apparently healthy bone, to provide the best chance of cure. GCTs, as well as other lesions located in the clivus, can nowadays be treated by a minimally invasive fully endoscopic extended endonasal approach. This approach ensures a more direct route to the craniovertebral junction than other possible approaches (transfacial, extended lateral, and posterolateral approaches). The case reported is a clival GCT operated on by an extended endonasal approach that provides another contribution on how to address one of the most feared complications attributed to this approach: a massive bleed due to an internal carotid artery injury.
Collapse
Affiliation(s)
- Maurizio Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy
| | | | | | | | | | | | | | | |
Collapse
|