Srpski arhiv za celokupno lekarstvo 2022 Volume 150, Issue 5-6, Pages: 351-353
https://doi.org/10.2298/SARH220203041Z
Full text ( 846 KB)
Occipitocervical fusion as treatment of instability in Chiari malformation
Zagorac Slaviša (University of Belgrade, Faculty of medicine, Belgrade, Serbia + University Clinical Center of Serbia, Clinic for Orthopedic Surgery and Traumatology, Belgrade, Serbia), slavisa.zagorac@gmail.com
Mijalčić Radovan (University of Belgrade, Faculty of medicine, Belgrade, Serbia + University Clinical Center of Serbia, Clinic for Neurosurgery, Belgrade, Serbia)
Vasić Miloš (University Clinical Center of Serbia, Clinic for Orthopedic Surgery and Traumatology, Belgrade, Serbia)
Dabetić Uroš (University Clinical Center of Serbia, Clinic for Orthopedic Surgery and Traumatology, Belgrade, Serbia)
Novaković Uroš (University Clinical Center of Serbia, Clinic for Orthopedic Surgery and Traumatology, Belgrade, Serbia)
Introduction. Occipitocervical (OC) fusion is a method for fixation of the OC junction when there is instability of that segment. Arnold Chiari malformation is a congenital disorder where cerebellar tonsils descend through the foramen magnum, which can lead to corticomedullar compression and formation of a syrinx. While treating this condition, for the purpose of decompression, the foramen magnum is expanded, which can potentially harm the stability of the OC junction. Case outline. We are presenting the case of a 16-year-old female who was surgically treated (suboccipital craniectomy and decompression) because of Arnold Chiari malformation type I. One-year post-op multislice computed tomography verified a slight enlargement of basion-axial and basion-dens intervals, with signs of spinal cord compression. Surgery was performed – OC fusion, canal decompression on C1 and C2 levels with a plate on occipital bone and screws placed in the third, fourth, and fifth cervical vertebra. Conclusion. OC fusion is a complex surgical procedure (vital neurovascular structures), but it is a reliable method for treatment of instability of the OC junction.
Keywords: occipitocervical instability, fusion, Arnold Chiari
Show references
Kukreja S, Ambekar S, Sin A, Nanda A. Occipitocervical Fusion Surgery: Review of Operative Techniques and Results. J Neurol Surg B Skull Base. 2015;76(5):331-9
Holly L, Batzdorf U. Chiari malformation and syringomyelia. J Neurosurg Spine. 2019;31(5):619-28.
Landridge B, Philips E, Choi D. Chiari Malformation Type 1: A Systematic Review of Natural History and Conservative Management. World Neurosurg. 2017;104:213-9.
Vinchon M. Surgery for Chiari 1 malformation: the Lille experience. Childs Nerv Syst. 2019;35(10):1875-80.
Fric R, Ringstad G, Eide P. [Chiari malformation type 1 - diagnosis and treatment]. Tidsskr Nor Laegeforen. 2019;139(10).
Chatterjee S, Shivhare P, Verma S. Chiari malformation and atlantoaxial instability: problems of co-existence. Childs Nerv Syst. 2019;35(10):1755-61.
Rocque B, Oakes W. Surgical Treatment of Chiari I Malformation. Neurosurg Clin N Am. 2015;26(4):527-31.
Joaquim A, Osorio J, Riew K. Occipitocervical Fixation: General Considerations and Surgical Technique. Global Spine J. 2020;10(5):647-56.
Ling FP, Chevillotte T, Leglise A, Thompson W, Bouthors C, Le Huec JC. Which parameters are relevant in sagittal balance analysis of the cervical spine? A literature review. Eur Spine J. 2018;27(Suppl 1):8-15.
Macki M, Hamilton T, Pawloski J, Chang V. Occipital fixation techniques and complications. J Spine Surg. 2020;6(1):145-55.
Izzo R, Popolizio T, Balzano RF, Simeone A, Gasparotti R, Scarabino T, et al. Imaging of cranio-cervical junction traumas. Eur J Radiol. 2020;127:108960.
Winegar CD, Lawrence JP, Friel BC, Fernandez C, Hong J, Maltenfort M, et al. A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine. 2010;13(1):5-16.
Elia C, Takayanagi A, Arvind V, Goodmanson R, von Glinski A, Pierre C, et al. Risk Factors Associated with 90-Day Readmissions Following Occipitocervical Fusion-A Nationwide Readmissions Database Study. World Neurosurg. 2021;147:e247-e254.
Zileli M, Akınturk N. Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up. Eur Spine J. 2022;31(2):311-26.
Ciaramitaro P, Massimi L, Bertuccio A, Solari A, Farinotti M, Peretta P, et al. Diagnosis and treatment of Chiari malformation and syringomyelia in adults: international consensus document. Neurol Sci. 2022;43(2):1327-42.
Asghar Ali Turabi MA, Pruthi N, Bhat D, Bhagavatula ID. Complex Chiari Malformation: Proposal of a New Set of Diagnostic Criteria and Outcomes After fusion Surgery. World Neurosurg. 2021;154:e677-e682.
Basaran R, Bozdogan C, Senol M, Gundogan D, Isik N. Longterm outcomes of surgical management in subtypes of Chiari malformation. Neurol Res. 2021;43(9):760-6.