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Michael Karsy, Neal Moores, Faizi Siddiqi, Douglas L. Brockmeyer and Robert J. Bollo

cases of BSSMO for odontoidectomy have been reported in adult patients with juvenile rheumatoid arthritis, 13 Klippel-Feil syndrome, and congenital occipitocervical instability, 37 BSSMO has not been previously reported as a method to improve anterior access to the subaxial cervical spine in young children with cervical chin-on-chest deformities. Herein, we describe our surgical technique and present 5 pediatric cases with long-term follow-up, in which BSSMO was used to provide enhanced surgical access to the craniocervical junction and subaxial cervical spine

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Sarah T. Garber, Robert J. Bollo and Jay K. Riva-Cambrin

respiratory failure, hypotonia holochord laminectomy & biopsy stable disease at 3.5 yrs Arulrajah & Huisman, 2008 13 yrs headache, papilledema, neck pain C2–7 & intracranial biopsy hospice 3 yrs after diagnosis Matsuzaki et al., 2010 15 mos dysphagia, failure to thrive craniocervical junction–C6 STR stable disease at 64 mos Paraskevopoulos et al., 2011 12 yrs lt-sided motor/sensory deficits C2–7 >95% resection recurrence at 3 mos, death at 1 yr present study 11 yrs scoliosis, back pain T5–10 laminoplasty w

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Robert J. Bollo, Jay Riva-Cambrin, Meghan M. Brockmeyer and Douglas L. Brockmeyer

surgical management of patients with complex CMs. Conclusions We identified a specific profile of radiographic risk factors among patients with CM, present at the time of diagnosis, which are easily identified, reproducible among professionals, and significantly associated with the need for occipitocervical fusion in this study population. Patients with complex CMs with brainstem compression, anomalies of the craniocervical junction, or both, are identified by CM 1.5, basilar invagination, and CXA < 125°. This is a simple model that may be used to counsel patients

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Vijay M. Ravindra, Rajiv R. Iyer, Al-Wala Awad, Robert J. Bollo, Huirong Zhu and Douglas L. Brockmeyer

T he concept of global spinal alignment is central to the adult deformity literature. 1 Many studies have investigated cervical sagittal balance and its potential effect on spinopelvic alignment; 2–5 however, few, if any, studies have investigated the same relationships in either the pediatric or Chiari malformation (CM) populations. Emerging evidence from the pediatric literature demonstrates that a regional craniocervical junction (CCJ) metric, the clivoaxial angle (CXA), is an independent predictor of the need for delayed thoracolumbar fusion for scoliosis

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Steven W. Hwang, Loyola V. Gressot, Leonardo Rangel-Castilla, William E. Whitehead, Daniel J. Curry, Robert J. Bollo, Thomas G. Luerssen and Andrew Jea

internal fixation often permits stabilization without external immobilization, enables more rapid recovery and rehabilitation, and eliminates the risks associated with external orthoses. 39 Previously, pediatric spine surgeons were limited by a lack of appropriately sized instrumentation and, thus, either adapted adult-sized tools or used wiring techniques to stabilize the spine. 17 Recent developments in instrumentation and techniques for the craniocervical junction and subaxial cervical spine include occipital screws, C-1 lateral mass screws, C1–2 transarticular

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vertebroplasty has been described to be an effective procedure in adults. Anterior cervical approaches are much rare and no cases are reported in pediatrics. By delivering PMM inside the anterior and posterior elements of C2 through a combined approach, the tumor is embolized and the craniocervical junction remains stable. J Neurosurg Pediatr Journal of Neurosurgery: Pediatrics PED 1933-0707 1933