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A Staged Approach for Surgical Management of Basilar Invagination.
Irina Joitescu1, Aymeric Amelot2, Guillaume Lot3
1Department of Neurosurgery, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre , France.
Operative Neurosurgery (Hagerstown, Md.)
|June 13, 2024
Summary
Surgical management of basilar invagination (BI) involves tailored approaches. Posterior decompression and fusion are for atlanto-axial instability, while anterior decompression addresses irreducible compression. Foramen magnum decompression alone minimizes morbidity in other BI cases.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Basilar invagination (BI) presents complex challenges in craniovertebral junction (CVJ) management.
- Surgical options range from decompression to fusion, necessitating a strategic approach.
Purpose of the Study:
- To examine indications and outcomes of surgical strategies for basilar invagination (BI).
- To develop a staged algorithm for managing BI based on patient-specific factors.
Main Methods:
- Retrospective cohort study across two neurosurgical centers.
- Inclusion criteria: BI defined by dens tip position relative to Chamberlain line.
- Assessment of CVJ anomalies and C1-C2 stability using dynamic CT scans.
Main Results:
- 30 BI patients studied with a mean follow-up of 56 months.
- Posterior decompression/fusion for atlanto-axial instability (n=8).
- Anterior decompression for irreducible anterior compression/cranial nerve deficits (n=9).
- Foramen magnum decompression for posterior signs without instability (n=13).
- Complications higher with combined procedures; reinterventions more likely with posterior decompression alone.
Conclusions:
- Patient selection is critical for optimal basilar invagination (BI) surgical outcomes.
- Combined approaches reserved for irreducible, symptomatic anterior compression.
- Fusion indicated only for clear atlanto-axial instability.
- Foramen magnum decompression alone is effective for select BI patients, minimizing morbidity.
