Abstract
Introduction
This study aimed to highlight that atlantoaxial rotatory fixation (AARF) can be related to neurosurgery procedures in children, with an afterward demonstration of good results after halo-gravity traction and C1–C2 stabilization using the Harms technique.
Case description
To the best of our knowledge, this is the first case to report a 4-year-old boy who presented with AARF after a posterior fossa craniotomy to treat a cerebellar astrocytoma. At our medical facility, AARF was diagnosed using plain radiography and computed tomography imaging. The patient was treated with continuous cranial traction for 14 days. Initially, we detected that the patient had no C1 posterior arch or C2 spinous process; therefore, the best option was to perform the Harms technique. Postoperatively, the patient was placed in a cervical collar for 4 weeks. At the 4-year postoperative follow-up, the patient was doing well and had not developed any complications.
Conclusion
Herein, we report a case in which AARF can be developed after neurosurgical procedure. Surgical techniques used for atlantoaxial subluxation should be carefully selected. In our case, the Harms technique after cranial traction was an excellent option for correcting and stabilizing the abnormal neck position. However, further studies are required to determine the best technique to use in the pediatric population.
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Vinicius de Meldau Benites: Conceptualization, writing the original draft, data acquisition, editing, and reviewing. Marcos Devanir Silva da Costa: Review and editing. Sergio Cavalheiro: Supervision, review, and editing.
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The study was approved by the Research Ethics Committee of the Universidade Federal de São Paulo, São Paulo, Brazil. Informed consent was obtained from all the guardians.
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de Meldau Benites, V., da Costa, M.D.S. & Cavalheiro, S. Posterior C1–C2 fusion for atlantoaxial rotatory fixation after posterior fossa craniotomy in a 4-year old: a case report. Childs Nerv Syst 39, 1647–1651 (2023). https://doi.org/10.1007/s00381-023-05862-y
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DOI: https://doi.org/10.1007/s00381-023-05862-y