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Related Concept Videos

Sutures of the Skull01:22

Sutures of the Skull

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The human skull is composed of several bones that come together to protect the brain and support the structures of the face. The junctions where these bones meet are called sutures.
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
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Cranial Bones: Superior and Posterior View01:14

Cranial Bones: Superior and Posterior View

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The superior view of the cranium shows the frontal and paired parietal bones.
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...
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Related Experiment Video

Updated: Mar 12, 2026

Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
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Craniovertebral junction anomalies: When is resurgery required?

Pavaman Sindgikar1, Kuntal Kanti Das1, Jayesh Sardhara1

  • 1Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Neurology India
|November 15, 2016
PubMed
Summary

Resurgery for craniovertebral junction abnormalities is often due to dorsal causes like implant issues or infections, with ventral causes including persistent myelopathy requiring transoral decompression. Factors like scoliosis increase reoperation rates.

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Spinal Surgery

Background:

  • Craniovertebral junction (CVJ) abnormalities can lead to high cervical myelopathy.
  • Inadequate decompression, torticollis, scoliosis, implant issues, and surgical site infections may necessitate resurgery.
  • CVJ abnormalities include atlantoaxial dislocation (AAD), basilar invagination (BI), and Chiari malformation (CM).

Purpose of the Study:

  • To investigate the etiopathogenesis of resurgery in patients with craniovertebral junction abnormalities.
  • To identify factors contributing to failed primary surgical outcomes in CVJ anomalies.

Main Methods:

  • Retrospective study of 414 operated cases of CVJ anomalies at a tertiary care institute.
  • Analysis of clinical and radiological data, and operative records for 55 patients who underwent resurgery.
  • Inclusion criteria: failed primary procedure, construct failure, infection, or wound dehiscence; exclusion: pure CM without bony anomalies.

Main Results:

  • 137 procedures were performed in 55 patients (13%).
  • Causes of resurgery were predominantly dorsal (59.8%, implant factors/wound infections) versus ventral (40.2%, decompression/wound complications).
  • Factors like scoliosis, torticollis, and asymmetric joints increased reexploration; occipitocervical fusion was more prone to construct loosening than C1-2 fusion.

Conclusions:

  • Persistent myelopathy after distraction with posterior fusion (PF) may require transoral surgery (TOD), especially with spinal deformities.
  • Single-stage transoral decompression plus posterior fusion (TOD+PF) increases infection risk.
  • Chronic sinus tracts often indicate deeper infection treatable by implant removal.