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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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Bassel Zebian, Florence Rosie Avila Hogg, Richard Zhiming Fu, Ramanan Sivakumaran and Simon Stapleton

pathological yawning. Presentation was acute in the first case and more chronic in the second. Imaging showed brainstem edema in combination with CM-I. Both patients underwent foramen magnum decompression, which resulted in complete cessation of the excessive yawning. Given the role of the brainstem in yawning, we believe that medullary compression at the craniocervical junction and ensuing edema were implicated in this curious symptomatology. Case Reports Case 1 History and Examination A 12-year-old girl whose twin sister had undergone foramen magnum

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Hung T. Wen, Albert L. Rhoton Jr., Toshiro Katsuta and Evandro de Oliveira

) dissection of the muscles along the posterolateral aspect of the craniocervical junction to permit an adequate lateral approach while reducing the depth of the surgical field; 2) early identification of the vertebral artery (VA) either above the posterior arch of the atlas or in its ascending course between the transverse processes of the atlas and axis; 3) a suboccipital craniectomy or craniotomy with removal of at least one-half of the posterior arch of the atlas; and 4) removal of the posterior portion of the occipital condyle to allow a more lateral approach. The

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Craniocervical abnormalities

A comprehensive surgical approach

Arnold H. Menezes, John C. VanGilder, Carl J. Graf and Dennis E. McDonnell

. TABLE 1 Clinical summary of 17 patients treated for craniocervical junction abnormalities * Case No. Age (yrs), Sex Clinical Presentation Radiological Findings Treatment Results 1 12, F juvenile rheumatoid arthritis age 6 yrs; slurred speech; spastic quadriparesis; neurogenic bladder for 3 yrs polyarticular rheumatoid involvement; severe atlantoaxial subluxation; CM compression, reducible in extension halo cast in extension; posterior fusion C1–2 recovered 2 7, M occipital headaches; neck stiffness 1 yr

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Meng Huang, David D. Gonda, Valentina Briceño, Sandi K. Lam, Thomas G. Luerssen and Andrew Jea

U pper airway obstruction leading to dyspnea and dysphagia is not uncommon after cervical spine surgery. The most common cause for this complication is pharyngeal edema. 1 , 11 , 13 , 14 However, it is not widely recognized that occipitocervical fusion with the craniocervical junction in overflexion may cause upper airway obstruction. There are limited reports in the Japanese-language literature 9 , 14 and even fewer English-language studies 1 , 6 focusing on adult patients and documenting this rare but life-threatening complication. To the best of

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Patrick J. Reid and Paul J. Holman

craniocervical junction due to intraarticular corticosteroid injection. Making a clinical diagnosis of an SEA with or without associated osteomyelitis can be difficult in the setting of acute and chronic neck pain. The clinical triad of back or neck pain, fever, and neurological deficit may not always be present and depends on the stage of the infection. The clinical course has been classified into four stages: spinal ache, root pain, weakness, and paralysis. 11 In patients who present for interventional spinal procedures, this diagnostic dilemma is amplified because many

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Tsung-Ming Su, Ching-Hsiao Cheng, Wu-Fu Chen and Shih-Wei Hsu

examination revealed a bruise over the occipital scalp and sluggishly reactive pupils. The anterior fontanel was not bulging. Laboratory examination demonstrated no bleeding tendency. A brain CT scan showed diffuse subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), and dilation of the ventricular system. There was a hyperdense lesion in the right craniocervical junction. Two days later, MRI revealed diffuse SAH, IVH, and variable stages of subdural hematoma (SDH) in bilateral occipital and left temporal subdural spaces. A partially thrombosed aneurysm was

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Stefan Grossauer, Katharina Koeck and Giles H. Vince

features of the CM with tonsillar herniation below the foramen magnum and associated extensive cervicothoracic syringomyelia. Right: Postoperative image demonstrating reestablished CSF flow at the craniocervical junction and significant reduction in syringomyelia a few weeks after the operation. Operation The patient was positioned prone with her head slightly flexed after induction of general anesthesia. After making a midline skin incision from inion to C-2, we dissected the paraspinal muscles from the bone and harvested pericranium for later duraplasty. A

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Matthew J. McGirt, Frank J. Attenello, Daniel M. Sciubba, Ziya L. Gokaslan and Jean-Paul Wolinsky

compression and stabilization of the craniocervical junction are needed to prevent progression of deficits in children afflicted with this disease. 5 , 6 , 8 , 13 , 14 , 17 , 18 , 27 , 29 , 32–34 , 39 , 40 , 42 , 43 , 46 Currently, the standard direct approach to this area is through the transoral–transpharyngeal approach. 5 , 13 , 14 , 18 , 29 , 32–34 , 39 , 40 , 43 , 46 If added exposure is required, then a transmandibular route 6 , 8 , 17 , 27 , 42 or Le Fort osteotomies 2 , 7 , 26 can be used. Refinements in surgical technique have improved the morbidity and

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Allan J. Belzberg and Bruce I. Tranmer

✓ Traumatic atlanto-occipital dislocation is most often fatal. Consequently, there are only scattered case reports of patients surviving this injury, and treatment modalities are anecdotal and varied. The case of an 18-year-old woman who suffered an anterior atlanto-occipital dislocation as the result of a motor-vehicle accident is presented. Rigid posterior fixation and complete reduction of the dislocation were achieved using an anatomically contoured steel loop secured to the occiput and cervical vertebrae. The addition of cancellous bone to the graft afforded long-term stability. This operative treatment provided anatomical realignment of the dislocation and allowed early mobilization of the patient with the use of aggressive rehabilitation. Previously reported cases of patients surviving anterior atlanto-occipital dislocation are reviewed. The use of cervical traction, halo bracing, and operative stabilization is discussed.