Atlantoaxial fixation for Chiari 1 formation in pediatric age-group patients: report of treatment in 33 patients.

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Atlantoaxial fixation for Chiari 1 formation in pediatric age-group patients: report of treatment in 33 patients.

World Neurosurg. 2017 Dec 30;:

Authors: Goel A, Gore S, Shah A, Dharurkar P, Vutha R, Patil A

Abstract
AIM: The role of atlantoaxial instability in the pathogenesis of Chiari 1 formation (Chiari formation) in pediatric age-group patients is evaluated.
MATERIAL AND METHODS: During the period January 2010 to June 2017, 33 pediatric age-group patients having Chiari formation were treated by atlantoaxial fixation. Twenty-four patients had basilar invagination and nine patients had no bone abnormality at the craniovertebral junction. Sixteen patients had syringomyelia and 9 patients had both basilar invagination and syringomyelia. On the basis of the type of facetal alignment and atlantoaxial instability, the patients were divided into 3 groups. Type 1 dislocation (13 patients) was anterior atlantoaxial instability wherein the facet of the atlas was dislocated anterior to the facet of the axis. Type 2 dislocation (5 patients) was posterior atlantoaxial instability wherein the facet of the atlas was dislocated posterior tothe facet of the axis. Type 3 dislocation (15 patients) was the absence of demonstrable facetal malalignment. Type 2 and 3 atlantoaxial facetal instability were labeled as "central" atlantoaxial dislocation. In 14 patients, dynamic images showed mobile and at-least partiallyreducible vertical atlantoaxial dislocation.
RESULTS: All patients were treated with atlantoaxial plate and screw fixation using techniques described in 1994 and 2004. Foramen magnum decompression or syrinx manipulation was not performed in any patient. Occipital bone and subaxial spinal elements were not included in the fixation construct. All patients had gratifying and sustained clinical improvement.
CONCLUSIONS: The outcome further confirms the cause-effect relationship of Chiari formation and atlantoaxial instability.

PMID: 29294396 [PubMed - as supplied by publisher]

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