2,898 results match your criteria Acta neurochirurgica. Supplement[Journal]


Management of Anaesthesia.

Acta Neurochir Suppl 2019;125:381-386

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

Surgical treatment of the craniovertebral junction (CVJ) requires excellent management by the anaesthetist. Patients undergoing this type of surgery have a wide range of concomitant diseases. Therefore, before proceeding to CVJ surgery, it is recommended to analyse the clinical aspects of the patient that could complicate the outcome of the surgical procedure. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_54
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http://dx.doi.org/10.1007/978-3-319-62515-7_54DOI Listing
January 2019
2 Reads

Intraoperative Neurophysiological Monitoring for Craniovertebral Junction Surgery.

Acta Neurochir Suppl 2019;125:369-380

Institute of Neurosurgery, University Hospital, Verona, Italy.

Craniovertebral junction (CVJ) surgery encompasses a wide spectrum of neurosurgical procedures ranging from transoral approaches for CVJ bone anomalies to surgery for intramedullary tumours. Intraoperative neurophysiological monitoring (IONM) has been increasingly used in recent years because of its ability to prevent neurological complications during surgery. In CVJ surgery the risk of neurological injuries is related first to the positioning of the patient and then to the surgical procedure. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_53DOI Listing
January 2019
3 Reads

Occipital Nerve Stimulation for Refractory Pain after Occipitocervical Fusion.

Acta Neurochir Suppl 2019;125:365-367

Department of Neurosurgery, Magna Graecia University of Catanzaro, Catanzaro, Italy.

Occipital nerve stimulation (ONS) is electric stimulation of the distal branches of the greater occipital nerve by cylindrical or paddle leads implanted in subcutaneous occipital tissue. This surgical option has emerged as a promising treatment for different types of disabling medical refractory headache and recently also for residual occipital and nuchal pain after previous occipitocervical fusion. The mechanisms of action have not yet been clearly explained: electrical stimulation of the occipital nerve has both peripheral and central effects on the nervous system, which may modulate nociception. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_52DOI Listing
January 2019
3 Reads

Complications of Halo Placement.

Acta Neurochir Suppl 2019;125:355-361

Department of Neurosurgery, AO Niguarda Ca'Granda Hospital, Milan, Italy.

Background: The halo vest is widely used throughout the world to manage craniovertebral and cervical instabilities. It can be used for postoperative immobilization or as an alternative to surgical fixation.

Method: In this paper we present some cases of severe complications from our own practice and review the literature on halo complications. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_51DOI Listing
January 2019
4 Reads

Extensive Spinal Epidural Abscesses Resolved with Minimally Invasive Surgery: Two Case Reports and Review of the Recent Literature.

Acta Neurochir Suppl 2019;125:345-353

Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy.

Purpose: An extensive spinal epidural abscess is a rare condition and causes significant morbidity and mortality. Few authors have described this uncommon entity, which requires early diagnosis and optimal treatment to avoid devastating complications. The purpose of this study was to evaluate a minimally invasive technique for treatment of an extensive spinal epidural abscess by describing two cases. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_50DOI Listing
January 2019
4 Reads

Management of Craniovertebral Junction Tuberculosis Presenting with Atlantoaxial Dislocation.

Acta Neurochir Suppl 2019;125:337-344

Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.

Tuberculosis (TB) rarely involves the craniovertebral junction (CVJ). Atlantoaxial dislocation (AAD) is one of the most commonly encountered lesions in craniocervical TB. The incidence of TB and its craniovertebral manifestation is increasing even in developed countries because of intercontinental migration and increased prevalence rates of immunosuppression conditions. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_49DOI Listing
January 2019
1 Read

Functional Outcome After Odontoid Fractures in the Elderly.

Acta Neurochir Suppl 2019;125:329-333

Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy.

While several papers on mortality and the fusion rate in elderly patients treated surgically or non-surgically for odontoid fractures exist, little information is available on quality of life after treatment. The aim of treatment in these patients should not be fracture healing alone but also quality of life improvement.A literature search using PubMed identified seven papers including information on functional evaluation of 402 patients. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_48
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http://dx.doi.org/10.1007/978-3-319-62515-7_48DOI Listing
January 2019
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Learning Curve in Surgical Treatment of Odontoid Fixation for a Series of Type II C2 Fractures.

Acta Neurochir Suppl 2019;125:325-327

Neurosurgical Clinic, AOUP "Paolo Giaccone", PostGraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy.

The craniovertebral junction (CVJ) is a complex anatomical area upon which most of the motion of the upper cervical spine depends [1]. Because of its unique range of motion, the CVJ is subject to several types of traumatic injury; it has been shown that odontoid fractures are the most common ones in the general population and are the most common isolated spinal fractures [2]. Accounting for up to 18% of all cervical fractures, odontoid fractures are the most common ones in elderly patients [3], in whom they account for up to 60% of spinal cord injuries [4]. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_47DOI Listing
January 2019
2 Reads

Type II Odontoid Fracture: a case series highlighting the treatment strategies.

Acta Neurochir Suppl 2019;125:317-324

Neurosurgical Clinic, AOUP "Paolo Giaccone", PostGraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy.

Background: A type II odontoid fracture, if unstable, can cause spinal cord damage. In this case, it is essential to choose the correct treatment-but the issues of what the correct treatment is and which of the different surgical options is best are quite controversial. In this paper we present strategies for treatment of type II odontoid fracture. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_46DOI Listing
January 2019
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The Decision-Making Process in Traumatic Lesions of the Craniovertebral Junction: An Evidence-Based Approach? Part II.

Acta Neurochir Suppl 2019;125:313-316

Institute of Bio-imaging, Catholic University School of Medicine, Rome, Italy.

This paper is Part II of a two-part report. Part I of the report covered atlanto-occipital dislocation or dissociation, and isolated condylar fractures. This part of the report covers isolated and combination fractures of the atlas and axis. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_45DOI Listing
January 2019
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The Decision-Making Process in Traumatic Lesions of the Craniovertebral Junction: An Evidence-Based Approach? Part I.

Acta Neurochir Suppl 2019;125:309-311

Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.

Evidence-based medicine is a rather young concept, which entered the scientific literature in the early 1990s. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_44DOI Listing
January 2019
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Posttraumatic Anatomical Injuries of the Craniovertebral Junction and Treatment Implications: Part II.

Acta Neurochir Suppl 2019;125:303-307

Institute of Bio-imaging, Catholic University School of Medicine, Rome, Italy.

This paper is Part II of a two-part report. In Part I of the report, injuries of the occipital bone, atlanto-occipital dissociation and the atlanto-occipital joint space were discussed. This part of the report discusses atlantoaxial dislocation and fractures of the atlas and axis. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_43
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http://dx.doi.org/10.1007/978-3-319-62515-7_43DOI Listing
January 2019
2 Reads

Posttraumatic Anatomical Injuries of the Craniovertebral Junction and Treatment Implications: Part I.

Acta Neurochir Suppl 2019;125:297-302

Institute of Bio-imaging, Catholic University School of Medicine, Rome, Italy.

Please check the hierarchy of the section headings and correct if necessary. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_42
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http://dx.doi.org/10.1007/978-3-319-62515-7_42DOI Listing
January 2019
2 Reads

Odontoid Fusion.

Acta Neurochir Suppl 2019;125:289-294

Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.

Anterior odontoid screw fixation allows for the internal fixation of unstable odontoid fractures with low morbidity, good fusion rates, and preservation of the atlanto-axial range of motion when applied in appropriate clinical cases. Advances in surgical techniques have allowed for safer, more minimally invasive approaches that reduce the risk of injury to vital prevertebral structures and minimize soft tissue retraction. Moreover, improvements in surgical image guidance technology for spinal surgery that have been applied to odontoid screw placement have helped improve surgeon confidence about exact screw trajectories. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_41
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http://dx.doi.org/10.1007/978-3-319-62515-7_41DOI Listing
January 2019
2 Reads

Grisel's Syndrome: Non-traumatic Atlantoaxial Rotatory Subluxation-Report of Five Cases and Review of the Literature.

Acta Neurochir Suppl 2019;125:279-288

, New York, USA.

Background: In children, when unresponsive neck rigidity and distress are observed after ear, nose and throat (ENT) surgical treatment or nasopharyngeal inflammation, Grisel's syndrome should be suspected. This is a rare syndrome involving non-traumatic rotatory subluxation of the atlantoaxial joint. Conservative management with external cervical orthoses and empirical antibiotic, muscle relaxant and analgesic therapy should be the first choice of treatment. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_40DOI Listing
January 2019
4 Reads

Realignment of Basilar Invagination by C1-C2 Joint Distraction: A Modified Approach to a Paradigm Shift.

Acta Neurochir Suppl 2019;125:273-277

Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy.

Background: Distraction of the C1-C2 joint and maintenance thereof by introduction of spacers into the articular cavity can successfully and durably reduce basilar invagination (BI). Thus, with the adjunct of instrumented fusion and decompression, BI-induced myelopathy can be efficiently treated with a one-stage posterior approach. This intervention is technically challenging, and in this paper we describe a procedural variation to facilitate the approach. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_39DOI Listing
January 2019
5 Reads

Insights into the Past and Future of Atlantoaxial Stabilization Techniques.

Acta Neurochir Suppl 2019;125:265-271

Alshafai Neurosurgical Academy (ANA), Toronto, ON, Canada.

Over the past century, atlantoaxial stabilization techniques have improved considerably. To our knowledge there has been a scarcity of articles published that focus specifically on the history of atlantoaxial stabilization. Examining the history of instrumentation allows us to evaluate the impact of early influences on current modern stabilization techniques. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_38DOI Listing
January 2019
2 Reads

Retro-odontoid Degenerative Pseudotumour Causing Spinal Cord Compression and Myelopathy: Current Evidence on the Role of Posterior C1-C2 Fixation in Treatment.

Acta Neurochir Suppl 2019;125:259-264

Department of Neurological Surgery, Policlinico "Gaspare Rodolico" University Hospital, Catania, Italy.

Background: A retro-odontoid pseudotumour compressing the spinal cord and causing myelopathy is often associated with an inflammatory condition such as rheumatoid arthritis. A degenerative non-inflammatory retro-odontoid pseudotumour responsible for clinically relevant spinal cord compression is a rare condition described in small clinical series and is likely associated with craniovertebral junction hypermobility or instability-like conditions. For several years, direct removal of the lesion through an anterior or lateral approach has been advocated as the best surgical option. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_37DOI Listing
January 2019
3 Reads

Wiring or Screwing at the Craniovertebral Junction in Childhood: Past and Present Personal Experience.

Acta Neurochir Suppl 2019;125:253-258

Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.

Background: Craniovertebral junction (CVJ) instrumentation and fusion in childhood are frequently performed with either sublaminar wires or screws in lateral masses, and both are considered quite safe procedures.

Methods: Our experience deals with 12 children: six (mean age 9.5 years) harbouring a congenital instability associated with Down's or Morquio's syndromes and primary os odontoideum; and six (mean age 11. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_36DOI Listing
January 2019
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Occipitocervical Fusion: An Updated Review.

Acta Neurochir Suppl 2019;125:247-252

Alshafai Neurosurgical Academy (ANA), Toronto, ON, Canada.

Occipitocervical fusion (OCF) is indicated for instability at the craniocervical junction (CCJ). Numerous surgical techniques, which evolved over 90 years, as well as unique anatomic and kinematic relationships of this region present a challenge to the neurosurgeon. The current standard involves internal rigid fixation by polyaxial screws in cervical spine, contoured rods and occipital plate. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_35
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http://dx.doi.org/10.1007/978-3-319-62515-7_35DOI Listing
January 2019
6 Reads

Occipitocervical Fusion.

Acta Neurochir Suppl 2019;125:243-245

Department of Neurosurgery, Magna Graecia University of Catanzaro, Catanzaro, Italy.

Occipitocervical fusion is a surgical technique in continuous evolution due to the innovation of devices, operative and instrumentation techniques. The aetiologies responsible for occipitocervical instability are trauma, neoplastic disease, metabolic disease or congenital disease. A variety of stabilization techniques are currently available depending on the type of patient and surgeon's experience. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_34DOI Listing
January 2019
10 Reads

Refinement of the Transoral Approach to Craniovertebral Junction Malformations.

Acta Neurochir Suppl 2019;125:235-240

Department of Neurosurgery, Tuscany School of Neurosurgery, University of Florence, Florence, Italy.

Background: The transoral approach provides the most direct surgical corridor for treatment of congenital bony abnormalities that exert irreducible ventral compression of the cervicomedullary junction. In this paper, based on our experience with the transoral approach over the past three decades, we briefly describe the surgical strategies and the operative nuances that allow effective decompression of the craniovertebral junction (CVJ) while minimizing postoperative morbidity.

Methods: The surgical strategy is dictated by the type and severity of the malformation. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_33DOI Listing
January 2019
1 Read

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

Acta Neurochir Suppl 2019;125:229-233

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

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. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_32DOI Listing
January 2019
2 Reads

The Endoscopic Endonasal Approach for Treatment of Craniovertebral Junction Pathologies: A Minimally Invasive but not Minimal-Risk Approach.

Acta Neurochir Suppl 2019;125:225-228

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

This paper has been edited for clarity, correctness and consistency with our house style. Please check it carefully to make sure the intended meaning has been preserved. If the intended meaning has been inadvertently altered by the editing changes, please make any corrections needed. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_31
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http://dx.doi.org/10.1007/978-3-319-62515-7_31DOI Listing
January 2019
2 Reads

Endoscopic Endonasal Approaches for Treatment of Craniovertebral Junction Tumours.

Acta Neurochir Suppl 2019;125:209-224

Head and Neck Surgery & Forensic Dissection Research Centre, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.

Tumours involving the craniovertebral junction (CVJ) are challenging because of their local invasiveness and high recurrence rates, as well as their proximity to critical neurovascular structures and the difficulty of reconstructing the resulting skull base defect at this site. Several surgical techniques are currently available to access these lesions, including the far lateral, extreme lateral, direct lateral, transcervical, transoral and transnasal approaches. In this paper, application of the endoscopic endonasal approach (EEA) in the treatment of CVJ tumours is analysed. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_30DOI Listing
January 2019
3 Reads

Endoscopic Endonasal Odontoidectomy and Posterior Fusion in a Single-Stage Surgery: Description of Surgical Technique and Outcome.

Acta Neurochir Suppl 2019;125:197-207

Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy.

This paper has been edited for clarity, correctness and consistency with our house style. Please check it carefully to make sure the intended meaning has been preserved. If the intended meaning has been inadvertently altered by the editing changes, please make any corrections needed. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_29DOI Listing
January 2019
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The Endonasal Endoscopic Approach to Pathologies of the Anterior Craniocervical Junction: Analytical Review of Cases Treated at Four European Neurosurgical Centres.

Acta Neurochir Suppl 2019;125:187-195

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

Supported by preliminary anatomical and clinical studies exploring the feasibility and usefulness of approaching many ventral pathologies of the craniocervical junction (CCJ) using the endoscopic endonasal approach, four European centres have joined forces to accumulate and share their growing surgical experience of this advanced technique. By describing the steps that led to the development and continuous refinement of this approach to the CCJ, this article delves deeply into an analysis of the cases operated on since 2010 at these four institutions, and discusses in detail the operative nuances that so far have allowed achievement of successful outcomes with excellent perioperative patient comfort and satisfactory long-term quality of life. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_28
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http://dx.doi.org/10.1007/978-3-319-62515-7_28DOI Listing
January 2019
3 Reads

Transoral Versus Transnasal Approach for Craniovertebral Junction Pathologies: Which Route Is Better?

Acta Neurochir Suppl 2019;125:181-186

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

Background: Several pathologies that affect the craniovertebral junction (CVJ) can be treated by means of a microsurgical transoral approach (TOA) or, alternatively, with an endoscopic endonasal approach (EEA), which is potentially able to overcome some complications associated with the former approach. In this paper, after discussing updates in the recent literature, to which we add our own surgical experience, we critically analyse these procedures with the aim of demonstrating that the TOA still deserves to be considered a viable alternative and that, in selected cases, it can even be considered superior to the EEA.

Methods: Our experience involves 25 anterior procedures in 24 paediatric and adult patients (18 TOA and seven EEA). Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_27DOI Listing
January 2019
3 Reads

The Extreme Lateral Approach to the Craniovertebral Junction: An Anatomical Study.

Acta Neurochir Suppl 2019;125:175-178

Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.

Background: The extreme lateral approach is a direct lateral approach which allows a good control of the entire length of the vertebral artery (VA), the jugular foramen, the lowest cranial nerves, and the jugular-sigmoid complex. Herein we try to exploit the variants of the approach and we identify indications, advantages, and disadvantages.

Methods: All phases of the study were conducted at the Institute of Public Health Section of Legal Medicine and Insurance of the University. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_26DOI Listing
January 2019
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Extreme Lateral Approach to the Craniovertebral Junction: An Update.

Acta Neurochir Suppl 2019;125:171-174

Alshafai Neurosurgical Academy (ANA), Toronto, ON, Canada.

Introduction: The term 'extreme lateral approach' (ELA) was first introduced by Sen and Sekhar relatively recently (in 1990). Its definition varies and remains controversial, but it generally entails more aggressive bony removal than the far lateral approach (FLA).

Goal: In this paper we review the relevant literature and weigh up the advantages and disadvantages of this approach. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_25DOI Listing
January 2019

Endoscope-Assisted Far Lateral Approach to the Craniovertebral Junction with Neuronavigation: A Cadaver Laboratory Experience.

Acta Neurochir Suppl 2019;125:165-169

Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.

The far lateral approach (FLA) is a technique performed nowadays to gain access to and remove intradural lesions located ventrolaterally to the brainstem and to the craniovertebral junction (CVJ). Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_24DOI Listing
January 2019

The Far Lateral Approach to the Craniovertebral Junction: An Update.

Acta Neurochir Suppl 2019;125:159-164

Department of Neurosurgery, Collegium Medicum Jagiellonian University, Alshafai Neurosurgical Academy (ANA), Kraków, Poland.

Introduction: Since 1972, when Hammon first described the far lateral approach (FLA) for treatment of vertebral artery aneurysms, it has undergone numerous modifications, including drilling of the occipital condyle, removal of the laminas of upper cervical vertebrae and so on. Also, the range of indications has increased exponentially.

Objective: In this paper we discuss state-of-the-art advances in the FLA, such as promising minimally invasive variants where an endoscope is used, and many others. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_23DOI Listing
January 2019

Compression Syndromes of the Vertebral Artery at the Craniocervical Junction.

Acta Neurochir Suppl 2019;125:151-158

Service de neurochirurgie, CHU, Strasbourg, France.

Compression syndromes of the vertebral artery that occur at the craniocervical junction are extremely rare causes of haemodynamic insufficiency of the posterior cerebral circulation. The aetiology of the compression syndrome may be a malformation, trauma, tumour, infection or degenerative pathology. This may lead to dynamic vertebral artery occlusion where the vessel courses around the atlas and the axis-the so-called V3 segment. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_22DOI Listing
January 2019
4 Reads

The High Cervical Anterolateral Retropharyngeal Approach.

Acta Neurochir Suppl 2019;125:147-149

Department of Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.

The first high cervical anterolateral retropharyngeal (HCALR) approach was reported by Stevenson et al. for a clivus chordoma in 1966. Anterior approaches to the spine have often been developed in response to problems presented by tuberculous spondylitis. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_21
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http://dx.doi.org/10.1007/978-3-319-62515-7_21DOI Listing
January 2019
4 Reads

Surgical Treatment of Chiari Malformation in Adults: Comparison of Surgical Techniques Described in the Literature and Our Experience.

Acta Neurochir Suppl 2019;125:139-143

Department of Neurosurgery, Policlinico "A. Gemelli", University "Cattolica", Rome, Italy.

This paper has been edited for clarity, correctness and consistency with our house style. Please check it carefully to make sure the intended meaning has been preserved. If the intended meaning has been inadvertently altered by the editing changes, please make any corrections needed. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_20DOI Listing
January 2019

Treatment of Holocord Syringomyelia-Chiari Complex by Posterior Fossa Decompression and a Syringosubarachnoid Shunt in a Single-Stage Single Approach.

Acta Neurochir Suppl 2019;125:133-138

Division of Neurosurgery, University of Messina, Messina, Italy.

Background: Posterior fossa decompression with expansive duraplasty is the first-line surgical approach for the treatment of symptomatic syringomyelia associated with Chiari malformation. Despite good decompression, the clinical failure rate is reported to be up to 26%. A syringosubarachnoid (S-S) shunt may be used as a secondary option. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_19
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http://dx.doi.org/10.1007/978-3-319-62515-7_19DOI Listing
January 2019
2 Reads

Surgical Treatment in Symptomatic Chiari Malformation Type I: A Series of 25 Adult Patients Treated with Cerebellar Tonsil Shrinkage.

Acta Neurochir Suppl 2019;125:125-131

Division of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy.

Background: The variety of symptoms and radiological findings in patients with Chiari malformation type I makes both the indication for surgery and the technical modality controversial. We report our 5-year experience, describing our technique and critically evaluating the clinical results.

Methods: Between 2012 and 2016, 25 patients (15 female and 10 male; mean age 39. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_18DOI Listing
January 2019

Bony Decompression for Chiari Malformation Type I: Long-Term Follow-Up.

Acta Neurochir Suppl 2019;125:119-124

Paediatric Neurosurgery, Agostino Gemelli Hospital Foundation, Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.

Background: Several surgical techniques are used for the management of Chiari malformation type I (CM-I). Bony posterior fossa decompression is considered a good option in children, though with a higher risk of requiring reoperation. However, there is not enough evidence from the series in the literature, which are often limited by inadequate follow-up. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_17DOI Listing
January 2019

The Relationship Between Basilar Invagination and Chiari Malformation Type I: A Narrative Review.

Acta Neurochir Suppl 2019;125:111-118

Department of Neurosurgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.

Basilar invagination (BI) and Chiari malformation type I CM-I) are the most common adult craniovertebral junction malformations, and they are frequently associated with each other and present synchronously. The relationship between BI and CM-I has remained incompletely understood, and the choice of surgical strategy has remained controversial. This brief review focuses on the different aspects of BI and CM-I, and further discusses the relationship between these two concomitant pathologies on the basis of the concepts proposed over the last three decades. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_16
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http://dx.doi.org/10.1007/978-3-319-62515-7_16DOI Listing
January 2019
15 Reads

Atlantoaxial Fixation for Treatment of Chiari Formation and Syringomyelia with No Craniovertebral Bone Anomaly: Report of an Experience with 57 Cases.

Acta Neurochir Suppl 2019;125:101-110

Department of Neurosurgery, KEM Hospital and Seth GS Medical College, Mumbai, India.

Aim: In this paper we evaluate the role of atlantoaxial instability in the pathogenesis of Chiari formation type I and the role of atlantoaxial stabilization for treatment of this condition in cases with no obvious bone malformation in the region of the craniovertebral junction.

Materials, Methods And Results: During the period from January 2010 to July 2016, we identified 57 cases of Chiari formation where there was no bone malformation or evidence of craniovertebral junction instability that could be diagnosed on the basis of an abnormal increase in the atlantodental interval on dynamic imaging. Forty-eight of these patients had syringomyelia. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_15DOI Listing
January 2019
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The Role of Arachnoid Veils in Chiari Malformation Associated with Syringomyelia.

Acta Neurochir Suppl 2019;125:97-99

Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.

Chiari malformation type I (CM-I), or hindbrain herniation syndrome, has traditionally been defined as a dislocation of the cerebellar tonsils 5 mm or more below the foramen magnum on sagittal magnetic resonance imaging (MRI) [1, 2]. An association of this anomaly with syringomyelia is observed in 45-68% of patients [3, 4]. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_14DOI Listing
January 2019

Chiari Malformations.

Acta Neurochir Suppl 2019;125:89-95

Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy.

Background: Chiari malformations (CM) represent a group of anomalies characterized by descent of the cerebellar tonsils or vermis into the cervical spinal canal. These malformations can be associated with abnormalities such as hydrocephalus, spina bifida, hydromyelia, syringomyelia, curvature of the spine (kyphosis and scoliosis) and tethered cord syndrome. Hereditary syndromes and other disorders that affect growth and bone formation-such as craniosynostosis, Ehlers-Danlos syndromes and Klippel-Feil syndrome-can also be associated with CM. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_13
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http://dx.doi.org/10.1007/978-3-319-62515-7_13DOI Listing
January 2019
13 Reads

The Craniovertebral Junction in Rheumatoid Arthritis: State of the Art.

Acta Neurochir Suppl 2019;125:79-86

Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Palermo, Italy.

Rheumatoid arthritis (RA) is a chronic inflammatory disorder, characterized by polyarticular inflammation causing progressive joint damage and disability. The mechanisms underlying its pathogenesis involve activation of innate and adaptive immunity, microvascular endothelial cell activation, and inflammatory infiltration of lymphocytes and monocytes into the synovium. Spinal involvement in RA is not typical; when it occurs, the main radiological features are (1) atlantoaxial subluxation (AAS), which is the most typical form of cervical spine involvement; (2) cranial settling-also known as basilar impression, atlantoaxial impaction or superior migration of the odontoid-which is the most severe form of associated spinal instability; and (3) subaxial subluxation. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_12DOI Listing
January 2019
4 Reads

Role of Subaxial Spinal and Atlantoaxial Instability in Multisegmental Cervical Spondylotic Myelopathy.

Authors:
Atul Goel

Acta Neurochir Suppl 2019;125:71-78

Department of Neurosurgery, Seth GS Medical College and KEM Hospital, Mumbai, India.

Aim: In this paper the role of atlantoaxial and multilevel subaxial spinal instability as the primary nodal point of the pathogenesis of degenerative cervical spinal disease-related myelopathy, and the focus of surgical treatment for it, is evaluated.

Materials And Methods: The series analyses the treatment of 73 patients with single or multilevel degenerative cervical spinal disease by fixation of the involved spinal segment(s) alone, aimed at arthrodesis. No bone decompression or disc/osteophyte resection was done. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_11DOI Listing
January 2019
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Ossification of the Posterior Longitudinal Ligament: Analysis of the Role of Craniovertebral and Spinal Instability.

Authors:
Atul Goel

Acta Neurochir Suppl 2019;125:63-70

Department of Neurosurgery, Seth GS Medical College and KEM Hospital, Mumbai, India.

Background: This paper reviews an experience of surgically treating ossification of the posterior longitudinal ligament (OPLL) with fixation of the involved spinal segments alone, without resorting to any bony or soft tissue decompression or attempts at direct resection of the OPLL. While in the early part of the experience, stabilization of only the involved subaxial cervical spinal segments was done, in the later part of the experience, atlantoaxial fixation was included in the multisegmental spinal fixation construct. This treatment is based on the understanding that spinal instability that includes atlantoaxial instability forms the nodal point of the pathogenesis and development of OPLL, and maturation of the presenting clinical symptoms. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_10DOI Listing
January 2019

Atlantoaxial Instability: Evolving Understanding.

Authors:
Atul Goel

Acta Neurochir Suppl 2019;125:59-62

Department of Neurosurgery, King Edward VII Memorial Hospital and Seth GS Medical College, Mumbai, India.

The atlantoaxial joint is the most mobile joint in the body. The physical architecture of the joint is characterized by a uniformly round and approximately flat surface, which allows a wide range of unobstructed movements. The standing human posture and lifelong heartbeat like uninterrupted activity of the atlantoaxial joint, and its ability to facilitate saying both 'yes' and 'no' necessarily requires smooth and 'fluid' movements that are supported by strong yet supple ligaments. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_9DOI Listing
January 2019

Transoral Approach to the Craniovertebral Junction: A Neuronavigated Cadaver Study.

Acta Neurochir Suppl 2019;125:51-55

Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.

More than 100 years after the first description by Kanavel of a transoral-transpharyngeal approach to remove a bullet impacted between the atlas and the clivus [1], the transoral approach (TOA) still represents the 'gold standard' for surgical treatment of a variety of conditions resulting in anterior craniocervical compression and myelopathy [2, 3]. Nevertheless, some concerns-such as the need for a temporary tracheostomy and a postoperative nasogastric tube, and the increased risk of infection resulting from possible bacterial contamination and nasopharyngeal incompetence [4-6]-led to the introduction of the endoscopic endonasal approach (EEA) by Kassam et al. [7] in 2005. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_8
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http://dx.doi.org/10.1007/978-3-319-62515-7_8DOI Listing
January 2019
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Ventral Brainstem Anatomy: An Endoscopic Transoral Perspective.

Acta Neurochir Suppl 2019;125:45-50

Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Federico II University of Naples, Naples, Italy.

In recent years the use of the endoscope through the transclival route has gained new attention as a minimally invasive operative method to successfully treat numerous clival pathologies such as chordomas, meningiomas, haemangiopericytomas, enterogenous and epidermoid cysts, and metastasis(Cappabianca et al. Neurosurgery 55:933-940, 2004; Cappabianca et al. Childs Nerv Syst 20:796-801, 2004; Cappabianca et al. Read More

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January 2019

Endonasal and Transoral Approaches to the Craniovertebral Junction: A Quantitative Anatomical Study.

Acta Neurochir Suppl 2019;125:37-44

Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.

Background: The endoscopic endonasal approach has recently been added to the surgical armamentarium to access the anterior craniovertebral junction (CVJ). Comparative analyses with the transoral approach are scarce. The aim of this study was to provide a quantitative anatomical analysis of both approaches. Read More

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http://link.springer.com/10.1007/978-3-319-62515-7_6
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http://dx.doi.org/10.1007/978-3-319-62515-7_6DOI Listing
January 2019
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The Endoscopic Endonasal Approach to Craniovertebral Junction Pathologies: Surgical Skills and Anatomical Study.

Acta Neurochir Suppl 2019;125:25-36

Division of Neurosurgery, Department of Neurosciences, University of Turin, Turin, Italy.

Introduction: Surgical anterior decompression is the treatment of choice for symptomatic irreducible ventral craniovertebral junction (CVJ) compression. Along with the classic transoral approach, the endoscopic endonasal approach has evolved and is gaining growing success.

Materials And Methods: In this work we discuss the surgical technique, give a complete step-by-step description of dissection of the craniovertebral junction and report a specific case of endoscopic endonasal odontoidectomy with use of a high-definition (HD) three-dimensional (3D) endoscope. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_5DOI Listing
January 2019
5 Reads