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Fryc GA, Godoy LDC, Kuo CL, Lurie AG. Prevalence of likely retro-odontoid pseudotumor in patients receiving dental CBCT examinations. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:301-309. [PMID: 38161086 DOI: 10.1016/j.oooo.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/25/2023] [Accepted: 11/04/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES We calculated the prevalence of unsuspected retro-odontoid pseudotumor (ROP) as detected in cone beam computed tomography (CBCT) examinations. Additionally, we examined patient age, sex, and presence and severity of cervical osteoarthritis (OA) as potential risk factors for ROP. STUDY DESIGN We retrospectively analyzed de-identified CBCT scans of 455 patients from the Division of Oral and Maxillofacial Radiology at the University of Connecticut School of Dental Medicine. Identification of likely ROP was completed through a likelihood scoring scale (1-4) due to the lack of magnetic resonance images. Severity of cervical OA was determined using 5 osteoarthritic features. An ordinal logistic regression model was used to link potential risk factors to ROP. RESULTS In total, 18 patients (3.9%) were classified with probable (11 patients [2.4%]) or definite (7 patients [1.5%]) likely ROP. Older age and the presence and severity of OA were significantly associated with higher ROP scores (P < .001). There was no significant association of ROP likelihood and patient sex (P = .637). An increase of 1 year of age increased the chance of a patient having a higher ROP likelihood score (P < .001). The age-adjusted chance of having a more severe ROP increased with moderate to severe OA (P ≤ .017). CONCLUSIONS Prevalence of likely ROP increases with age and OA but is not associated with sex. Individuals with moderate or severe OA are more likely to have ROP.
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Affiliation(s)
- Gosia Anna Fryc
- University of Connecticut School of Dental Medicine, Farmington, CT, USA.
| | - Lucas da Cunha Godoy
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
| | - Chia-Ling Kuo
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA; UConn Center of Aging, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Alan G Lurie
- Division of Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, Farmington, CT, USA
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Jamshidi AM, Govindarajan V, Levi AD. Transdural Approach for Resection of Craniovertebral Junction Cysts: Case Series. Neurosurgery 2023; 92:615-622. [PMID: 36512818 PMCID: PMC10158906 DOI: 10.1227/neu.0000000000002255] [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: 05/22/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Craniovertebral junction (CVJ) cysts, including retro-odontoid pseudotumors, are challenging pathologies to treat and manage effectively. Surgical intervention is indicated when these lesions result in progressive myelopathy, intractable pain, or instability. OBJECTIVE To present a case series of older patients who underwent successful resection retro-odontoid lesions using transdural approach. METHODS A single-center, retrospective observation study of older patients who underwent transdural resection of CVJ cysts at a single institution was performed. Summary demographic information, clinical presentation, perioperative and intraoperative imaging, and Nurick scores were collected and analyzed. RESULTS Eight patients were included (mean age [±SD] 75.88 ± 9.09 years). All patients presented with retro-odontoid lesions resulting in severe cervical stenosis, cord compression, and myelopathy. The mean duration of surgery was 226 ± 83.7 minutes. The average intraoperative blood loss was 181.2 cc. The average hospital stay was 4.5 days ± 1.3 (range, 3-7 days). The average follow-up time was 12.5 ± 9.5 months. No intraoperative complications were encountered. The Nurick classification score for myelopathy improved at the final postoperative examination (2.38 ± 1.06 vs 1 ± 1.07). Three patients demonstrated a pre-existing deformity prompting an instrumented fusion. Both computed tomography and MRI evidence of complete regression of retro-odontoid cyst were noted in all patients on the final follow-up. CONCLUSION Posterior cervical transdural approach for ventral lesions at the CVJ is a safe and effective means of treating older patients with progressive myelopathy. This technique provides immediate spinal cord decompression while limiting neurological complications commonly associated with open or endoscopic anterior transpharyngeal approaches.
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Affiliation(s)
- Aria M. Jamshidi
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Vaidya Govindarajan
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Alan D. Levi
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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Shin JJ, Kim KR, Shin J, Kang J, Lee HJ, Kim TW, Hong JT, Kim SW, Ha Y. Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study. Neurospine 2022; 19:1013-1025. [PMID: 36274194 PMCID: PMC9816592 DOI: 10.14245/ns.2244352.176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 04/27/2022] [Accepted: 10/03/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE This multicenter study compared radiological parameters and clinical outcomes between surgical and nonsurgical management and investigated treatment characteristics associated with the successful management of unstable atlas fractures. METHODS We retrospectively evaluated 53 consecutive patients with unstable atlas fracture who underwent halo-vest immobilization (HVI) or surgical fixation. Clinical outcomes were assessed using neck visual analogue scale and disability index. The radiological assessment included total lateral mass displacement (LMD) and the anterior atlantodental interval (AADI). RESULTS Thirty-two patients underwent surgical fixation and 21 received HVI (mean follow-up, 24.9 months). In the surgical fixation, but not in the HVI, LMD, and AADI showed statistically significant improvements at the last follow-up. The osseous healing rate and time-to-healing were 100% and 14.3 weeks with surgical fixation, compared with 71.43% and 20.0 weeks with HVI, respectively. Patients treated with HVI showed poorer neck pain and neck disability outcomes than those who received surgical treatment. LMD showed an association with osseous healing outcomes in nonoperative management. Clinical outcomes and osseous healing showed no significant differences according to Dickman's classification of transverse atlantal ligament injuries. CONCLUSION Surgical internal fixation had a higher fusion rate, shorter fracture healing time, more favorable clinical outcomes, and a more significant reduction in LMD and AADI compared to nonoperative management. The pitfalls of external immobilization are inadequate maintenance and a lower probability of reducing fractured lateral masses. Stabilization by surgical reduction with interconnected fixation proved to be a more practical management strategy than nonoperative treatment for unstable atlas fractures.
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Affiliation(s)
- Jun Jae Shin
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
| | - Kwang-Ryeol Kim
- Department of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University, College of Medicine, Incheon, Korea
| | - Joongkyum Shin
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University School of Medicine, Seoul, Korea,Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jiin Kang
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea,Corresponding Author Yoon Ha Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Tae Woo Kim
- Department of Neurosurgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sang-Woo Kim
- Department of Neurosurgery, Yeungnam University Medical Center, Daegu, Korea
| | - Yoon Ha
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea,POSTECH Biotech Center, Pohang University of Science and Technology, Pohang, Korea,Corresponding Author Yoon Ha Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
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Tanaka M, Ayhan S, Yamauchi T, Arataki S, Fujiwara Y, Kanemaru A, Masuda S, Torigoe K, Shiozaki Y. C1 laminoplasty and posterior atlantoaxial fusion for large retro-odontoid pseudotumor with Instability: A technical note. Interdisciplinary Neurosurgery 2022. [DOI: 10.1016/j.inat.2021.101478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Wang HB, Wang L, Zhang B, Chen F, Li S, Yang H, Zhou X, Ni B, Lu X, Guo Q. Cervical Myelopathy Due to Idiopathic Retroodontoid Pseudotumor. World Neurosurg 2022; 160:e256-e260. [DOI: 10.1016/j.wneu.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
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