The Surgical Treatment Of The Craniocervical Junction Associated With Vertebral Vascular Malformations

ObjectiveA retrospective analysis of treatment methods and results of craniocervical junction malformation clinical cases associated vertebral vascular malformationsMethodsFrom July2008to August2011of The First Affiliated Hospital of Zhengzhou University,56patients with craniocervical junction malformations,which are21males and35females,age40±2.16years,in which5patients with vertebralvascular malformation.11cases of patients with atlantoaxial dislocation dislocation,10patients with basilar invagination,13cases of patients both have basilar invagination and atlantoaxial dislocation dislocation,5patients with free Odontoid process,25cases of patients with atlantooccipital fusion,18cases of patients with Chiari malformation,6patients with myelosyringosis o CT scan show C2pedicle and vertebral artery hole abnormalities underwent CTA, test results confirmed that the deformity of the vertebral artery, in order to avoid the C2pedicle screw injury, combined with one or both sides laminar screws,using the JOA score method for evaluating nerve function before surgery and after surgery, imaging studies assess bone fusion, measuring Medullary spinal cord of MRI.Results56patients were followed up from10days to36months,an average of19.6months, all patients have received bone healing,the symptom disappeared or almost disappeared37cases,11cases have significant improvement,2cases of slight improvement, preoperative JOA score was9.36±2.96, postoperative14.39±1.61(p<0.05),the overall improvement rate of0.76. Medullary spinal cord in the preoperative angle of129.82°±7.77°, postoperative angle was147.48°±5.27°(p<0.05), the9cases with deformity of the vertebral artery with satisfactive fixation position,and postoperative recovery was satisfactory. with head and neck rotation activities is significantly limited by internal fixation. The surgery did not occur spinal cord injury.Two cases of postoperative occur cerebrospinal fluid leakage,and one case of postoperative occur internal fixation infection. Central respiratory difficulty and central high fever happened of one case after3days, and she dead10days later because failure of many organ, multiple organ failure and death,all within a fixed no loosening of the fixation,loss, breakage phenomenon.Conclusion1.The satisfied effect.come from Selecting individualized surgical plan according to the specific type of malformations、clinical and imaging performance.2. It is necessary For patients with cervical2pedicle and vertebral artery hole deformity doing CTA。3.Combined with one or both axis lamina screws for the patients of vertebral artery malformation, the surgery safety is higher.