Surgical Management Of Craniocervical Junction Malformation And Complication Correlated

Background and Objective:Craniocervical junction malformation mainly refers to the occipital and atlas, atlas and vertebral developmental anomalies, including Basilar invagination, Atlantooccipital fusion, Atlantoaxial subluxation, Klippel-Feil syndrome, Arnold-Chiari malformation.These malformations may occur independently or several simultaneously.The structural stability of occipital bone, atlas and axis maintain the stability of the craniocervical junction together with pertaining(?)muscles, ligaments, fascias as well as joint capsules. The clinical manifestations of the instability of the craniocervical junction appear when the function and structure of atlanto-occipital joint and antalto-axial joint are destroyed, and the cause or excess movement in physiological state. When the cerebrospinal fluid is also obstructed at the foramen magnum, syringomyelia is often acomplicating factor.ChiariⅠmalformation is a complication occurring readily in the presence of such bony anomalies. Among the many malformations of the craniocervical junction, Chiari typeⅠsyndrome and syringomyelia are worthy of reseasch because of their prevalence and the seriousness of their symptom. Patients who frequently present with neurologic symptoms and deficits need warrant surgical treatment to prevent progression. Untreated craniocervical instability is associated with a high morbidity and a significant mortality.A variety of surgical interventions have been recommended for patients with craniocervical junction malformation, while their results are also different. So far, there has not been an ideal treatment method for the disease.Methods:141 adult cases with craniocervical junction malformation selected from January 2007 to March 2011 were divided into A, B and C group. According to different clinical and radiographic examination. They were underwent suboccipital craniectomy or transoral-transpharyngeal odontoidectomy as well as autogenous bone grafting and occipitocervical fusion. All operations were performed by a single surgeon at a single institution. The clinical outcome was assessed by evaluation of postoperative signs and symptoms and magnetic resonance imaging of the craniocervical junction.Results:Bone fusion and improved hydrocephalus were clear on images 1 year after surgery, and the postoperative course has been good. The effectiveness of three groups are 88.4%,82.6%,80.3% respectively. According to different type selection of corresponding deformity operation mode is effective.Conclusion:1. Decompression and stability reconstitution should be paid equal attention to pressure in the surgical treatment.2. A proper surgical decompression and fixed mode should be defined from the clinical features of the spinal cord and the cranial nerves. Both static and dynamic MRI scans must be performed; in this way identification of the neural abnormalities (hydromyelia, Chiari, etc.) and of the osseous compression is possible.3. The treatment of hydrocephalus and syringomyelia should also be surgical treated fundamentally.The tonsillectomy,the cutting of the pseduomembrane and the dura closing are the ideal treatment for Chiari malformation with syringomyelia.4. The stability of the craniovertebral junction abnormalities reconstruction mainly depend on the osseous fusion 3 to 6 months after the operation, and titanium cable internal fixation may be a simple, efficient and economic fixed technology.