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craniocervical_injury

Craniocervical lesion

A article addresses the key features, clinical presentation, patterns of injury, indicated workup, and radiographic findings associated with craniocervical injuries in the pediatric population. It discusses nonsurgical and surgical management of pediatric cervical spine trauma, addressing when each is indicated, and the various techniques available to the pediatric neurosurgeon 1).

Case series

Two hundred twelve patients (mean age 47.9 years, 57.1% male) underwent transclival endoscopic endonasal approach (EEA) for lower clivus lesions. In addition to the lower clivus, resection involved the occipital condyle in 14.2% of patients, the foramen magnum in 16.5%, and the atlantooccipital joint (AO) in 1.4%. Quantification of condyle resection revealed complete resection in 3 cases, 75% resection in 8 cases, 50% resection in 6 cases, and 25% resection in 13 cases. Seven of these patients had EEA combined with an open, far lateral approach. In total, 7 patients required arthrodesis following EEA (3.3%), 4 of them after a combined approach. All patients who underwent arthrodesis had primary bone tumors such as chordoma, chondrosarcoma, or osteosarcoma (P = .022). Degree of condyle resection was a significant factor predisposing to occipitocervical instability (P = .001 and P < .001 for 75% and 100% condyle resection, respectively). Use of a combined approach was significantly associated with arthrodesis (P < .001).

EEA resection of the occipital condyles that results in greater than 75% condyle resection or EEA in combination with an open approach significantly increases the risk of AO instability and likely necessitates AO fixation 2).

1)
Goldstein HE, Anderson RC. Classification and Management of Pediatric Craniocervical Injuries. Neurosurg Clin N Am. 2017 Jan;28(1):73-90. doi: 10.1016/j.nec.2016.08.001. Review. PubMed PMID: 27886884.
2)
Kooshkabadi A, Choi PA, Koutourousiou M, Snyderman CH, Wang E, Fernandez-Miranda JC, Gardner PA. Atlanto-occipital Instability Following Endoscopic Endonasal Approach for Lower Clival Lesions: Experience With 212 Cases. Neurosurgery. 2015 Jul 31. [Epub ahead of print] PubMed PMID: 26237341.
craniocervical_injury.txt · Last modified: 2018/12/17 16:41 by administrador