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New Trends in Craniovertebral Junction Surgery pp 229–233Cite as

Stability-Sparing Endoscopic Endonasal Odontoidectomy in a Malformative Craniovertebral Junction: Case Report and Biomechanical Considerations

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Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 125))

Abstract

Background: The craniovertebral junction (CVJ) is often involved in a wide range of congenital, developmental and acquired pathologies that can create bony and ligamentous instability or cause direct compression on the medulla and cervical spine cord, resulting in significant impairment. Atlas assimilation is the most common malformation in the CVJ and can be frequently associated with basilar invagination (BI) and Chiari malformation (CM) type I. Posterior atlas assimilation more frequently leads to BI type II with a mass effect on neural structures but usually no signs of biomechanical instability. Operative approaches to the CVJ have undergone a remarkable evolution and can be divided into ventral, lateral and dorsal ones. In this kind of surgery, it is vital to detect and eventually treat any CVJ instability.

Case Description: We present a case of CVJ malformation comprising assimilation of the posterior arch of the atlas, BI type II and CM, treated by endoscopic endonasal odontoidectomy and partial clivus removal to spare CVJ stability.

Conclusion: Neurological and biomechanical analysis of all CVJ malformations permits stratification and selection of those cases that can be managed by simple, direct, minimally invasive decompression with no need for surgical fusion.

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Abbreviations

3D:

Three-dimensional

BI:

Basilar invagination

CM:

Chiari malformation

CSF:

Cerebro-spinal fluid

CT:

Computed tomography

CTA:

Computed tomography angiography

CVJ:

Craniovertebral junction

EEG:

Electroencephalography

MRI:

Magnetic resonance imaging

NPL:

Nasopalatine line

PL:

Palatine line

RX:

Radiography

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Competing Interests

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Neurosurgical Unit, Surgical Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

    Matteo Vitali, Andrea Cattalani, Vincenzo Maria Grasso & Andrea Barbanera

  2. Department of Otorhinolaryngology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

    Frank Rikki Canevari

  3. Neurosurgery, Department of Clinical Surgical, Diagnostic and Paediatric Sciences, Università degli Studi di Pavia, Pavia, Italy

    Andrea Cattalani

  4. Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy

    Teresa Somma

Authors
  1. Matteo Vitali
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  2. Frank Rikki Canevari
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  3. Andrea Cattalani
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  4. Teresa Somma
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  5. Vincenzo Maria Grasso
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  6. Andrea Barbanera
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Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Institute of Neurosurgery, Rome, Italy

    Massimiliano Visocchi

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Vitali, M., Canevari, F.R., Cattalani, A., Somma, T., Grasso, V.M., Barbanera, A. (2019). Stability-Sparing Endoscopic Endonasal Odontoidectomy in a Malformative Craniovertebral Junction: Case Report and Biomechanical Considerations. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_32

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  • DOI: https://doi.org/10.1007/978-3-319-62515-7_32

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62514-0

  • Online ISBN: 978-3-319-62515-7

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