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Francisco A. Ponce, Brendan D. Killory, Scott D. Wait, Nicholas Theodore and Curtis A. Dickman

-piecemeal resection, while the edges were folded away from the adjacent mediastinal vascular and visceral structures. Pleural boundaries were identified. When tumors extended into the foramen, traction on the foraminal component was avoided to prevent avulsion of the proximal thoracic nerve root, CSF leakage, or spinal cord injury. Unless the tumor extended intradurally, schwannomas that entered the foramen were removed without performing a laminectomy. Soft tumors were resected within the foramen and were shrunk with bipolar coagulation. The foramen was often widened by the

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Nicholas Theodore, M. Yashar S. Kalani and Volker K. H. Sonntag

group from the Barrow Neurological Institute further reported a novel technique for atlantooccipital fixation in which a novel transarticular screw method was used, and validated the biomechanical properties of this construct. 3 , 4 , 6 More recently, our group has reported a novel occipitoatlantal fusion construct for treatment of avulsion fractures of the foramen magnum, as well as a novel dual transarticular screw fixation technique for simultaneous fixation of occipitoatlantal and atlantoaxial dislocations. 5 , 9 In 2007 we reviewed our experience with

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Luis Perez-Orribo, Laura A. Snyder, Samuel Kalb, Ali M. Elhadi, Forrest Hsu, Anna G. U. S. Newcomb, Devika Malhotra, Neil R. Crawford and Nicholas Theodore

–869. Copyright Barrow Neurological Institute, Phoenix, Arizona. Published with permission. FIG. 2. Classification of injuries to the TAL: Type 1A (A) , Type IB (B) , Type IIA (C) , and Type IIB (D) . The TAL, when disrupted at the midportion (A) or at the insertion of the medial tubercle (B), cannot heal when treated only with external immobilization. Bony avulsions (C and D) have a good chance of healing when treated with external immobilization alone. From Dickman CA, Greene KA, Sonntag VKH: Injuries involving the transverse atlantal ligament: Classification

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Luis Perez-Orribo, Samuel Kalb, Laura A. Snyder, Forrest Hsu, Devika Malhotra, Richard D. Lefevre, Ali M. Elhadi, Anna G. U. S. Newcomb, Nicholas Theodore and Neil R. Crawford

of atlas fractures is based on whether the fractures occur in isolation or in combination with other cervical spine injuries and on the integrity of the TAL, which is best assessed using high-resolution MRI. 3 Isolated atlas fractures without injury to the TAL or those associated with bony avulsion of the medial tubercle should be followed for instability with flexion-extension radiography. Typically, the need for surgical fixation is determined by ligamentous impairment concomitant with the bony fracture. 9 Spence et al. studied the axial load of lateral mass