1Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai; and.
2Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, India.
Neurosurg Focus. 2023 Mar;54(3):E13. doi: 10.3171/2022.12.FOCUS22634.
The authors reviewed their scientific publications and updated their clinical material obtained over the last 12 years for cases of central or axial atlantoaxial dislocation (CAAD) identified in the presence of craniovertebral musculoskeletal and/or neural alteration(s). The management implications of diagnosing and treating CAAD are highlighted.
During a 12-year period, CAAD was diagnosed in 393 patients with craniovertebral junction-related musculoskeletal and neural alterations who underwent atlantoaxial fixation. No bone decompression was done. All CAAD-related craniovertebral junction structural changes were identified to have a naturally protective role. Hence, in this paper the term "craniovertebral alterations" is used for "craniovertebral junction anomalies" and the term "Chiari formation" is used instead of the commonly used term "Chiari malformation."
The major radiological diagnosis was determined either singly or in cohort with one or more of other so-called pathological entities that included Chiari formation (367 cases), syringomyelia with Chiari (306 cases), idiopathic syringomyelia (12 cases), type B basilar invagination (147 cases), bifid arch of the atlas (9 cases), assimilation of the atlas (119 cases), C2-3 fusion (65 cases), Klippel-Feil alteration (4 cases), and dorsal kyphoscoliosis (15 cases). The follow-up period ranged from 6 to 155 months. Clinical improvement was observed in all patients.
Understanding and treating CAAD may have significant implications in the surgical treatment of a number of clinical entities. The gratifying clinical outcomes obtained in patients after atlantoaxial fixation, without any type of decompression involving bone or soft-tissue resection, consolidate the concept that atlantoaxial instability has a defining role in the pathogenesis.
作者回顾了他们的科学出版物，并更新了过去 12 年来在存在颅颈骨骼肌肉和/或神经改变的情况下获得的关于正中或轴向寰枢关节脱位（CAAD）的临床资料。强调了诊断和治疗 CAAD 的管理意义。
在 12 年期间，对 393 例颅颈关节相关骨骼肌肉和神经改变的患者进行了寰枢关节固定，诊断为 CAAD。未进行骨减压。所有与 CAAD 相关的颅颈关节结构变化都被认为具有自然保护作用。因此，在本文中，术语“颅颈改变”用于“颅颈关节异常”，术语“Chiari 形成”用于替代常用的“Chiari 畸形”。
主要的影像学诊断要么单独确定，要么与一个或多个其他所谓的病理实体共同确定，这些实体包括 Chiari 形成（367 例）、Chiari 伴脊髓空洞症（306 例）、特发性脊髓空洞症（12 例）、B 型基底凹陷症（147 例）、寰椎弓裂（9 例）、寰椎融合（119 例）、C2-3 融合（65 例）、Klippel-Feil 改变（4 例）和背侧脊柱后凸（15 例）。随访时间为 6 至 155 个月。所有患者的临床状况均得到改善。
理解和治疗 CAAD 可能对许多临床实体的手术治疗具有重要意义。在寰枢关节固定后，所有患者均获得了令人满意的临床结果，无需进行任何涉及骨或软组织切除的减压，这巩固了寰枢关节不稳定在发病机制中具有决定性作用的概念。
