One-Stage Anteroposterior Extensive Atlantoaxial Osteotomy Correction With 16 Months Follow-up: Technical Case Report

Patients with severe thoracic or lumbar deformities can achieve satisfactory correction through appropriate osteotomies. However, patients with multiple craniocervical malformations commonly undergo conservative or finite surgical therapy mainly because of the involvement of the vertebral artery. Anterior oral meningocele is an extremely rare pathology that has not been previously reported. Here, we provide the first report of complex craniocervical anomalies combined with oral meningocele treated with a 1-stage anteroposterior atlantoaxial osteotomy correction surgery, with outcomes after 16 mo follow-up.

A 10-yr-old boy presented with recurrent dyspnea, cyanosis, and progressive torticollis. Imaging studies revealed complicated bony abnormalities accompanied by an anterior oral meningocele. A 1-stage extensive atlantoaxial osteotomy through anterior and posterior approaches was performed with an innovatively designed vertebral artery exclusion technique. Lumbar cistern drainage and ceftazidime were used to address the leakage of cerebrospinal fluid and intracranial infection.

The satisfactory outcome demonstrates the feasibility of extensive atlantoaxial osteotomy via a vertebral artery exclusion technique that might also be applicable to osteotomy in segments of C3-C6.