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Odontoid process and clival regeneration with Chiari malformation worsening after transoral decompression: an unexpected and previously unreported cause of “accordion phenomenon”

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Abstract

Purpose

Transoral odontoidectomy followed by occipito-cervical fixation is a widely used approach to relieve ventral compressions at the craniovertebral junction (CVJ). Despite the large amount of literature on this approach and its complications, no previous reports of odontoid process and clival regeneration following transoral odontoidectomy are present in the English literature.

Methods

We report the case of odontoid process and clival regeneration following transoral odontoidectomy.

Results

A 7-year-old boy presented with symptoms of brainstem and upper cervical spinal cord compression due to a complex malformation at the CVJ including a basilar invagination with Chiari malformation. A successful transoral microsurgical endoscopic-assisted odontoidectomy extended to the clivus was performed along with occipito cervical instrumentation and fusion. Clinical and radiological resolution of the CVJ compression was evident up to 2 years post-op, when the child had a relapse of some of the presenting symptoms and the follow-up CT and MRI scans showed a quite complete regrowth of the odontoid process, clival partial regeneration and recurrence of preoperative Chiari malformation.

Conclusions

Besides the need of an accurate complete resection of the periosteum, which apparently was incompletely performed in our case, our experience suggests the need of resection of the odontoid down to the dentocentral synchondrosis and an accurate lateral removal of the bone surrounding the anterior tubercle of the Clivus is advised when an anterior CVJ decompression is required in children presenting a still evident synchondrosis at neuroradiological investigation.

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Acknowledgments

No funding was obtained for the present paper.

Conflict of interest

None of the authors has any potential conflict of interest.

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Authors and Affiliations

  1. Institute of Neurosurgery, Policlinico Gemelli, Catholic University School of Medicine, Largo A. Gemelli 8, 00168, Rome, Italy

    Massimiliano Visocchi, Gianluca Trevisi, Gianpiero Tamburrini & Massimo Caldarelli

  2. Institute of Neurosurgery, Policlinico Giaccone, University of Palermo, Palermo, Italy

    Domenico Gerardo Iacopino

  3. Division of Neurosurgery, Department of Neurosciences, Policlinico “G. Rodolico” University Hospital, Catania, Italy

    Giuseppe M. V. Barbagallo

Authors
  1. Massimiliano Visocchi
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  2. Gianluca Trevisi
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  3. Domenico Gerardo Iacopino
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  4. Gianpiero Tamburrini
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  5. Massimo Caldarelli
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  6. Giuseppe M. V. Barbagallo
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Correspondence to Massimiliano Visocchi.

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Visocchi, M., Trevisi, G., Iacopino, D.G. et al. Odontoid process and clival regeneration with Chiari malformation worsening after transoral decompression: an unexpected and previously unreported cause of “accordion phenomenon”. Eur Spine J 24 (Suppl 4), 564–568 (2015). https://doi.org/10.1007/s00586-014-3720-1

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  • DOI: https://doi.org/10.1007/s00586-014-3720-1

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