Basilar invagination: craniocervical instability treated with cervical traction and occipitocervical fixation

Case report

View More View Less
  • 1 Spinal Group, Neurosurgical Service, Hospital do Servidor Público Estadual de São Paulo;
  • 2 Spinal Group, Neurosurgical Service, Conjunto Hospitalar do Mandaqui; and
  • 3 Spinal Group, Neurosurgical Service, Faculdade de Ciências Medicas da Santa Casa de São Paulo, Brazil
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ The upward odontoid displacement observed in basilar invagination (BI) is generally associated with a horizontal clivus and craniocervical kyphosis, conditions that exert ventral compression at the spinomedullary junction. Ventral brainstem decompression by reduction or elimination of the odontoid invagination is part of the desired treatment. The authors describe a case of BI in an adult, who was effectively treated with the easy and safe reduction of odontoid invagination via cervical traction. Normalization of kyphosis at the craniovertebral junction and the vertical position of both a previously horizontal clivus and the cerebellar tentorium demonstrated that these conditions were not part of the original malformation but instead were caused by a reducible craniovertebral instability.

Abbreviations used in this paper:BI = basilar invagination; CJ = craniocervical junction; CM = Chiari malformation; CT = computed tomography; MR = magnetic resonance; PCF = posterior cranial fossa.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Ricardo Vieira Botelho, M.D., Ph.D., R. Haberbeck Brandão 68–122, Indianópolis, São Paulo, Brazil 04027040. email: bitbot@uol.com.br.
  • 1

    Friede RL, & Roessmann U: Chronic tonsillar herniation: an attempt at classifying chronic herniations at the foramen magnum. Acta Neuropathol 34:219235, 1976

    • Search Google Scholar
    • Export Citation
  • 2

    Goel A: Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine 1:281286, 2004

    • Search Google Scholar
    • Export Citation
  • 3

    Goel A, , Bhatjiwale M, & Desai K: Basilar invagination: a study based on 190 surgically treated patients. J Neurosurg 88:962968, 1998

  • 4

    Joseph V, & Rajshekhar V: Resolution of syringomyelia and basilar invagination after traction. Case illustration. J Neurosurg 98:3 Suppl 298, 2003

    • Search Google Scholar
    • Export Citation
  • 5

    Marin-Padilla M: Notochordal-basichondrocranium relationships: abnormalities in experimental axial skeletal (dysraphic) disorders. J Embryol Exp Morphol 53:1538, 1979

    • Search Google Scholar
    • Export Citation
  • 6

    Marin-Padilla M, & Marin-Padilla TM: Morphogenesis of experimentally induced Arnold–Chiari malformation. J Neurol Sci 50:2955, 1981

  • 7

    McRae DL, & Barnum AS: Occipitalization of the atlas. AJR Am J Roentgenol Radium Ther Nucl Med 70:2346, 1953

  • 8

    Menezes AH: Primary craniovertebral anomalies and the hind-brain herniation syndrome (Chiari I): data base analysis. Pediatr Neurosurg 23:260269, 1995

    • Search Google Scholar
    • Export Citation
  • 9

    Nishikawa M, , Sakamoto H, , Hakuba A, , Nakanishi N, & Inoue Y: Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa. J Neurosurg 86:4047, 1997

    • Search Google Scholar
    • Export Citation
  • 10

    Sahuquillo J, , Rubio E, , Poca MA, , Rovira A, , Rodriguez-Baeza A, & Cervera C: Posterior fossa reconstruction: a surgical technique for the treatment of Chiari I malformation and Chiari I/syringomyelia complex—preliminary results and magnetic resonance imaging quantitative assessment of hindbrain migration. Neurosurgery 35:874884, 1994

    • Search Google Scholar
    • Export Citation
  • 11

    Shukla R, , Nag D, , Gupta NN, & Lall BN: Congenital atlanto-axial dislocation: a clinical and radiological study. J Assoc Physicians India 32:697700, 1984

    • Search Google Scholar
    • Export Citation
  • 12

    Simsek S, , Yigitkanli K, , Belen D, & Bavbek M: Halo traction in basilar invagination: technical case report. Surg Neurol 66:311314, 2006

  • 13

    Tubbs RS, , Elton S, , Grabb P, , Dockery SE, , Bartolucci AA, & Oakes WJ: Analysis of the posterior fossa in children with the Chiari 0 malformation. Neurosurgery 48:10501055, 2001

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 632 302 14
Full Text Views 171 11 2
PDF Downloads 59 4 1
EPUB Downloads 0 0 0