A Dual Approach for the Management of Complex Craniovertebral Junction Abnormalities: Endoscopic Endonasal Odontoidectomy and Posterior Decompression with Fusion
Background: Ventral brainstem compression secondary to complex craniovertebral junction abnormality is an infrequent cause of neurologic deterioration in pediatric patients. However, in cases of symptomatic, irreducible ventral compression, 360° decompression of the brainstem supported by posterior...
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Elsevier
2019-04-01
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Series: | World Neurosurgery: X |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2590139719300043 |
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doaj-92587ecebf344cfe9ef12affce37f62a |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Andrew F. Alalade Elizabeth Ogando-Rivas Jonathan Forbes Malte Ottenhausen Rafael Uribe-Cardenas Ibrahim Hussain Prakash Nair Kurt Lehner Harminder Singh Ashutosh Kacker Vijay K. Anand Roger Hartl Ali Baaj Theodore H. Schwartz Jeffrey P. Greenfield |
spellingShingle |
Andrew F. Alalade Elizabeth Ogando-Rivas Jonathan Forbes Malte Ottenhausen Rafael Uribe-Cardenas Ibrahim Hussain Prakash Nair Kurt Lehner Harminder Singh Ashutosh Kacker Vijay K. Anand Roger Hartl Ali Baaj Theodore H. Schwartz Jeffrey P. Greenfield A Dual Approach for the Management of Complex Craniovertebral Junction Abnormalities: Endoscopic Endonasal Odontoidectomy and Posterior Decompression with Fusion World Neurosurgery: X |
author_facet |
Andrew F. Alalade Elizabeth Ogando-Rivas Jonathan Forbes Malte Ottenhausen Rafael Uribe-Cardenas Ibrahim Hussain Prakash Nair Kurt Lehner Harminder Singh Ashutosh Kacker Vijay K. Anand Roger Hartl Ali Baaj Theodore H. Schwartz Jeffrey P. Greenfield |
author_sort |
Andrew F. Alalade |
title |
A Dual Approach for the Management of Complex Craniovertebral Junction Abnormalities: Endoscopic Endonasal Odontoidectomy and Posterior Decompression with Fusion |
title_short |
A Dual Approach for the Management of Complex Craniovertebral Junction Abnormalities: Endoscopic Endonasal Odontoidectomy and Posterior Decompression with Fusion |
title_full |
A Dual Approach for the Management of Complex Craniovertebral Junction Abnormalities: Endoscopic Endonasal Odontoidectomy and Posterior Decompression with Fusion |
title_fullStr |
A Dual Approach for the Management of Complex Craniovertebral Junction Abnormalities: Endoscopic Endonasal Odontoidectomy and Posterior Decompression with Fusion |
title_full_unstemmed |
A Dual Approach for the Management of Complex Craniovertebral Junction Abnormalities: Endoscopic Endonasal Odontoidectomy and Posterior Decompression with Fusion |
title_sort |
dual approach for the management of complex craniovertebral junction abnormalities: endoscopic endonasal odontoidectomy and posterior decompression with fusion |
publisher |
Elsevier |
series |
World Neurosurgery: X |
issn |
2590-1397 |
publishDate |
2019-04-01 |
description |
Background: Ventral brainstem compression secondary to complex craniovertebral junction abnormality is an infrequent cause of neurologic deterioration in pediatric patients. However, in cases of symptomatic, irreducible ventral compression, 360° decompression of the brainstem supported by posterior stabilization may provide the best opportunity for improvement in symptoms. More recently, the endoscopic endonasal corridor has been proposed as an alternative method of odontoidectomy associated with less morbidity. We report the largest single case series of pediatric patients using this dual-intervention surgical technique. The purpose of this study was to evaluate the surgical outcomes of pediatric patients who underwent posterior occipitocervical decompression and instrumentation followed by endoscopic endonasal odontoidectomy performed to relieve neurologic impingement involving the ventral brainstem and craniocervical junction. Methods: Between January 2011 and February 2017, 7 patients underwent posterior instrumented fusion followed by endonasal endoscopic odontoidectomy at our unit. Standardized clinical and radiological parameters were assessed before and after surgery. A univariate analysis was performed to assess clinical and radiologic improvement after surgery. Results: A total of 14 operations were performed on 7 pediatric patients. One patient had Ehlers-Danlos syndrome, 1 patient had a Chiari 1 malformation, and the remaining 5 patients had Chiari 1.5 malformations. Average extubation day was postoperative day 0.9. Average day of initiation of postoperative feeds was postoperative day 1.0. Conclusions: The combined endoscopic endonasal odontoidectomy and posterior decompression and fusion for complex craniovertebral compression is a safe and effective procedure that appears to be well tolerated in the pediatric population. Key words: Axis, Basilar invagination, Chiari, Endonasal, Endoscopic, Odontoidectomy, Pediatric |
url |
http://www.sciencedirect.com/science/article/pii/S2590139719300043 |
work_keys_str_mv |
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doaj-92587ecebf344cfe9ef12affce37f62a2020-11-25T01:37:52ZengElsevierWorld Neurosurgery: X2590-13972019-04-012A Dual Approach for the Management of Complex Craniovertebral Junction Abnormalities: Endoscopic Endonasal Odontoidectomy and Posterior Decompression with FusionAndrew F. Alalade0Elizabeth Ogando-Rivas1Jonathan Forbes2Malte Ottenhausen3Rafael Uribe-Cardenas4Ibrahim Hussain5Prakash Nair6Kurt Lehner7Harminder Singh8Ashutosh Kacker9Vijay K. Anand10Roger Hartl11Ali Baaj12Theodore H. Schwartz13Jeffrey P. Greenfield14Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USA; Department of Neurosurgery, The Walton Centre, Liverpool, United Kingdom; To whom correspondence should be addressed: Andrew F. Alalade, M.B.B.S.Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USADepartment of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USADepartment of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USADepartment of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USADepartment of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USADepartment of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USAZucker School of Medicine, Hofstra-Northwell Health School of Medicine, New York, USADepartment of Neurosurgery, Stanford University Medical Center, Stanford, California, USADepartment of Otolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USADepartment of Otolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USADepartment of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USADepartment of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USADepartment of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USA; Department of Otolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USA; Department of Neuroscience, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USADepartment of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USABackground: Ventral brainstem compression secondary to complex craniovertebral junction abnormality is an infrequent cause of neurologic deterioration in pediatric patients. However, in cases of symptomatic, irreducible ventral compression, 360° decompression of the brainstem supported by posterior stabilization may provide the best opportunity for improvement in symptoms. More recently, the endoscopic endonasal corridor has been proposed as an alternative method of odontoidectomy associated with less morbidity. We report the largest single case series of pediatric patients using this dual-intervention surgical technique. The purpose of this study was to evaluate the surgical outcomes of pediatric patients who underwent posterior occipitocervical decompression and instrumentation followed by endoscopic endonasal odontoidectomy performed to relieve neurologic impingement involving the ventral brainstem and craniocervical junction. Methods: Between January 2011 and February 2017, 7 patients underwent posterior instrumented fusion followed by endonasal endoscopic odontoidectomy at our unit. Standardized clinical and radiological parameters were assessed before and after surgery. A univariate analysis was performed to assess clinical and radiologic improvement after surgery. Results: A total of 14 operations were performed on 7 pediatric patients. One patient had Ehlers-Danlos syndrome, 1 patient had a Chiari 1 malformation, and the remaining 5 patients had Chiari 1.5 malformations. Average extubation day was postoperative day 0.9. Average day of initiation of postoperative feeds was postoperative day 1.0. Conclusions: The combined endoscopic endonasal odontoidectomy and posterior decompression and fusion for complex craniovertebral compression is a safe and effective procedure that appears to be well tolerated in the pediatric population. Key words: Axis, Basilar invagination, Chiari, Endonasal, Endoscopic, Odontoidectomy, Pediatrichttp://www.sciencedirect.com/science/article/pii/S2590139719300043 |