Craniocervical junction fusions in patients with hindbrain herniation and syringohydromyelia

Albert J Fenoy; Arnold H Menezes; Kathleen A Fenoy

doi:10.3171/SPI/2008/9/7/001

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Craniocervical junction fusions in patients with hindbrain herniation and syringohydromyelia

Journal article

Peer reviewed

Craniocervical junction fusions in patients with hindbrain herniation and syringohydromyelia

Albert J Fenoy, Arnold H Menezes and Kathleen A Fenoy

Journal of neurosurgery. Spine, Vol.9(1), pp.1-9

07/2008

DOI: 10.3171/SPI/2008/9/7/001

PMID: 18590404

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Abstract

Patients with hindbrain herniation or the so-called Chiari malformation Type I (CM-I) and/or syringohydromyelia are treated with dorsal decompression alone; however, a small percentage of patients with other associated abnormalities require concomitant dorsal craniocervical junction (CCJ) fusion. The authors surveyed the indications for CCJ fusions in this population. A retrospective review of University of Iowa medical records and radiographs obtained between 1996 and 2005 was performed. Inclusion criteria encompassed patients with diagnoses of CM-I and/or syringohydromyelia requiring dorsal CCJ fusions, and others with CCJ abnormalities who had CM-I and/or syringohydromyelia. Two hundred thirty-four patients were identified, all of whom were symptomatic at presentation. Their ages ranged from 2.5 to 86 years; 33% of the patients were < 16 years of age. Patients were categorized as follows, with some being assigned to > 1 category: Group I, congenital or acquired CCJ abnormalities with reducible bone compression (25% of patients); Group II, previous anterior CCJ/upper brainstem decompression (44%); Group III, occipitocervical complex instability with CM-I and/or syringohydromyelia but without CCJ bone abnormalities requiring adjunctive posterior fossa decompression (26%); and Group IV, musculoligamentous instability, either from pathological states or from muscle dehiscence from repeated posterior fossa procedures (14%). Instrumentation was used in 96% of patients, with all 96% receiving semirigid fixation with titanium loop and sublaminar cables; all fusion constructs incorporated autologous bone. At last follow-up evaluation, fusion was radiographically complete in 97%, and symptom improvement was seen in 92%. Dorsal CCJ fusions are required in patients with CM-I and/or syringohydromyelia who have concomitant CCJ abnormalities (Groups I and II). A definite group (CM-I and/or syringohydromyelia) without bone abnormality exists (Groups III and IV). This may be due to muscle weakness secondary to a high syrinx.

Spinal Fusion - methods

Humans

Middle Aged

Arnold-Chiari Malformation - complications

Child, Preschool

Male

Rhombencephalon

Decompression, Surgical

Cervical Vertebrae - surgery

Magnetic Resonance Imaging

Arnold-Chiari Malformation - surgery

Syringomyelia - complications

Occipital Bone - surgery

Adolescent

Aged, 80 and over

Adult

Female

Aged

Retrospective Studies

Child

Syringomyelia - surgery

Details

Title: Subtitle: Craniocervical junction fusions in patients with hindbrain herniation and syringohydromyelia
Creators: Albert J Fenoy - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Arnold H Menezes
Kathleen A Fenoy
Resource Type: Journal article
Publication Details: Journal of neurosurgery. Spine, Vol.9(1), pp.1-9
DOI: 10.3171/SPI/2008/9/7/001
PMID: 18590404
NLM abbreviation: J Neurosurg Spine
ISSN: 1547-5654
eISSN: 1547-5646
Publisher: American Association of Neurological Surgeons; United States
Language: English
Date published: 07/2008
Academic Unit: Stead Family Department of Pediatrics; Neurosurgery; Otolaryngology
Record Identifier: 9984040385402771

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