Goel Atul
Department of Neurosurgery, King Edward Memorial Hospital and Seth G. S. Medical College, Mumbai, India.
J Neurosurg Spine. 2004 Oct;1(3):281-6. doi: 10.3171/spi.2004.1.3.0281.
The author discusses the successful preliminary experience of treating selected cases of basilar invagination by performing atlantoaxial joint distraction, reduction of the basilar invagination, and direct lateral mass atlantoaxial plate/screw fixation.
Twenty-two patients with basilar invagination-in which the odontoid process invaginated into the foramen magnum and the tip of the odontoid process was above the Chamberlain, McRae foramen magnum, and Wackenheim clival lines-were selected to undergo surgery. In all patients fixed atlantoaxial dislocations were documented. The 16 male and six female patients ranged in age from 8 to 50 years. A history of trauma prior to the onset of symptoms was documented in 17 patients. Following surgery, the author observed minimal-to-significant reduction of basilar invagination and alteration in other craniospinal parameters resulting in restoration of alignment of the tip of the odontoid process and the clivus and the entire craniovertebral junction in all patients. In addition to neurological and radiological improvement, preoperative symptoms of torticollis resolved significantly in all patients. The minimum follow-up period was 12 months and the mean was 28 months.
Joint distraction and firm lateral mass fixation in selected cases of basilar invagination is a reasonable surgical treatment for reducing the basilar invagination, restoring craniospinal alignment, and establishing fixation of the atlantoaxial joint.
作者探讨通过寰枢关节撑开、寰枢关节复位及直接侧块寰枢椎钢板/螺钉固定治疗部分基底凹陷症病例的初步成功经验。
选取22例基底凹陷症患者，其齿状突陷入枕骨大孔，齿状突尖端高于张伯伦线、麦克雷枕骨大孔线及瓦肯海姆斜坡线，均接受手术治疗。所有患者均记录有固定性寰枢椎脱位。16例男性和6例女性患者，年龄8至50岁。17例患者有症状发作前的外伤史。术后，作者观察到所有患者的基底凹陷均有不同程度的减轻，其他颅颈参数也有改变，齿状突尖端与斜坡以及整个颅颈交界区恢复对线。除神经功能和影像学改善外，所有患者术前斜颈症状均显著缓解。最短随访期为12个月，平均为28个月。
对于部分基底凹陷症病例，关节撑开及牢固的侧块固定是一种合理的手术治疗方法，可减轻基底凹陷、恢复颅颈对线并实现寰枢关节固定。
