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PubMed1979

An alternate method for posterior fixation in anterior and inferior atlanto-axial dislocation.

A modification of common methods is described for fixation of anterior and inferior atlanto-axial dislocation (AAD and IAD). In AAD a wire is passed around the atlas arch and knotted around the spinous process of the axis in a way that a figure 8 arrangement is achieved as seen in the lateral view. In IAD a wire is passed through holes in the occiput and knotted around the spinous process of the axis. A rectangular bone graft is inserted between the occiput and the spinous process of the axis, thus preventing further inferior dislocation. In both methods methyl methacrylate and bone grafts are as a rule added for further long-time stabilization. The methods have been used in 15 cases of AAD and in three cases of IAD. On radiologic examination with attention focused on the immediate postoperative fixation the follow-up time has been three months. The long-time results of fixation have been recorded with a follow-up time of six years. The fixation proved to be satisfactory in 14 patients with AAD and in the three patients with IAD. The clinical results were good in the 14 patients with AAD and in the three with IAD.

Adolescent↗
PubMed1979

The posteriorly tilted dens. A normal variation mimicking a fractured dens.

The normal dens occasionally can be posteriorly tilted and in such cases, can mimic a fractured, posteriorly tilted, dens. Differentiation of the two conditions depends on: [1] knowledge that this normal variation of the dens occurs, and [2] demonstrating that no fracture exists. In many cases, this latter determination can be accomplished on plain films, but in other cases, laminography is required.

Axis, Cervical Vertebra↗
PubMed1981

Atlanto-axial instability in children with Down syndrome.

One hundred fifty-eight patients with Down syndrome underwent roentgenologic examinations of the cervical spine in neutral position, in hyperflexion, and in hyperextension. Fifteen children with Down syndrome were found to have a distance between the joint surfaces of 5 mm and more. The majority of these children were asymptomatic, one child displayed hyperactive deep tendon reflexes and two children were symptomatic and underwent surgery.

Adolescent↗
PubMed1983

Precision resection of intra-axial CNS lesions by CT-based stereotactic craniotomy and computer monitored CO2 laser.

This report describes an open stereotactic technique by which a tumour volume reconstructed in stereotactic space from CT data is removed by stereotactic CO2 laser vaporization. The position of the laser beam in relation to the tumour outlines is monitored by computer and displayed to the surgeon on a graphics display terminal in the operating room. Twenty-six (26) of these procedures have been performed on twenty-four (24) patients with deep-seated intra-axial neoplasms (23) and arteriovenous malformation (1). Post-operative CT scanning revealed no evidence of contrast enhancing lesions in nineteen (19) patients while a small amount of residual tumour was noted in five (5) patients post-operatively. This method has proven itself valuable for maintaining three-dimensional surgical orientation for the resection of intra-axial neoplasms from neurologically important areas.

Adult↗
PubMed1983

Craniocervical malformations.

This short survey summarises the important craniocervical dysplasias, the malformations accompanying primary neuroectodermal and secondary lesions of the neural structures and their coverings, and complex malformations. The interpretation, classification and the identification of the static and/or dynamic biomechanical pathogenesis is a prerequisite for the correct diagnosis and for assessing the indications for and the choice of any operation to be adopted.

Axis, Cervical Vertebra↗
PubMed1983

Computer-tomographic investigations in malformations of the occipito-cervical junction.

The diagnosis of occipito-cervical dysplasias has been improved markedly by computer-tomography. Two millimetre transverse cuts with sagittal and coronal reconstructions are necessary. Based on nine cases with nearly all types of malformations it is shown that even complex osseous (mesodermal) malformations and dysplasias as well as isolated or combined neuroectodermal dysplasic or secondary compressive lesions of the medulla oblongata and cord can be detected. Transverse and AP diameters of the foramen magnum and spinal canal and the classical lines and angles can be measured. This time-consuming procedure will give more information than the classical radiological methods and avoid myelographic and cisternal examinations. Its disadvantages are the impossibility of dynamic functional studies and the length of the procedure.

Adolescent↗
PubMed1983

Transoral operations for craniospinal malformations.

The transoral approach to the lower third of the clivus and to the ventral aspect of the upper cervical spine is used in craniospinal malformations with or without dislocation as well as in basilar aneurysms, ventrally situated cranio-spinal tumours, fractures of the odontoid process, and in rheumatoid arthritis compressing the spinal cord. In consideration of the literature and ten personal cases the indications and techniques of the transoral approach in craniospinal malformations are discussed. According to our own experiences and those of other authors it is possible to expose the lower clivus and the cervical spine down to C2 by a midline incision of the pharyngeal wall using a mouth retractor and oral intubation. Splitting of the soft palate or resection of the hard palate are not necessary, a tracheotomy should be performed only in exceptional cases. In congenital craniospinal malformations without dislocation or instability causing a ventral compression of the spinal cord, for instance by the odontoid process, the transoral decompression is preferable to dorsal decompressing operations. In cases of pure instability without any space-occupying lesion the transoral and posterior approach are possible in order to perform a fusion. The last one seems more advantageous in these cases. In craniospinal malformations with dislocation causing a ventral and dorsal narrowing of the spinal canal, apart from the decompression a stabilization has to be achieved. In these usually complex malformations individual treatment is necessary. According to the rare cases in the literature and to our own experience a primary anterior decompression, followed by a most careful posterior stabilization seems to produce the most favourable results.

Adult↗
PubMed1983

Indications and technique for the operative treatment of hypoplastic deformities of the odontoid process.

On the basis of four typical cases of congenital hypoplastic deformities of the odontoid process the clinical significance, symptoms, diagnosis and the indications for operative treatment of the malformations are described. It is further shown that these malformations lead to clinical manifestations only when associated with a primarily existing, or a later acquired inadequacy of the ligaments with movement-induced changes in the position of the atlas. The operative treatment recommended involves a special technique for a bilateral dorsal fixation with tibial grafts. By this operative technique a substantial or even completely stable fixation of the atlas can be achieved, in the acute phase by the stability of the tibial grafts and in the long term by the bony fusion which occurs.

Adult↗
PubMed1994

Congenital malformations of the craniovertebral junction: classification and surgical treatment.

The clinical, radiological and surgical findings of 56 patients with congenital malformations of the craniovertebral junction who underwent surgical intervention in the Department of Neurosurgery, Hacettepe University Medical School were reviewed. The anomalies were classified according to their embryonic origin. Forty-two cases of the series were major abnormalities formed by the combination of more than one germ layer.

Adolescent↗
PubMed1978

Fractures of the axis caused by hanging.

Prerequisities for fractures of the neural arch of the axis in the region of the isthmus (hangman's fracture) during hanging are considered to be a long drop and a submental knot. A case is presented showing that hangman's fracture arising in hanging can result from stretching of the neck combined with anteroflexion of the head.

Adult↗
PubMed1988

A contribution to the anatomic basis of the transoral approach to the atlas and axis.

The transoral approach (Fang and Ong 1962) allows direct free exposure of the atlas and axis. However, a morphologic description of certain structures at risk corresponding to the views at operation has so far been lacking. The present study is intended to fill this gap by giving the surgeon a transoral view of the peripharyngeal structures. This is a further instance of how classical gross anatomy needs to be continuously rediscovered in the light of clinical activities.

Axis, Cervical Vertebra↗