PMC4697203_01
Preoperative magnetic resonance imaging and computed tomography showing a complex craniovertebral junction malformation with basilar impression and radiological signs of myelopathy at C2 level
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Magnetic resonance imaging (MRI) and computed tomography (CT) scans showed a complex CVJ malformation with the basilar impression and radiological signs of myelopathy at the C2 level [Figure 1].
Preoperative dynamic cervical spine X-ray showing no instability of the craniovertebral junction ((a) static, (b) hyperextension, (c) hyperflexion)
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Furthermore, a dynamic cervical spine X-ray proved that there was no instability in flexion and extension movements of the CVJ [Figure 2].
Intraoperative endoscopic views: (a) C1 anterior arch upper portion drilling; the arrow points out the residual lateral part of the arch (b) final endoscopic view after the odontoidectomy is completed showing the spinal cord dura just behind the drilled portion of the dens (c) the white arrow indicates the dura
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The patient underwent a transnasal image-guided fully 3D endoscopic approach [Figure 3].
Dynamic X-ray with anterior atlas-dens interval and posterior atlas-dens interval performed before discharge showed no instability of the craniovertebral junction
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AADI and PADI remained stable after surgery, and the total C1-C2 overhang was no more than 7 mm, thus demonstrating no difference in CVJ motility compared with the preoperative radiographic pictures [Figure 4].
Postoperative dynamic computed tomography (b,c) and magnetic resonance (a) imaging demonstrated the achievement of a good spinal cord decompression
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Static (a) and dynamic (b,c) X-ray 18 months after discharge confirming that there was no instability of the craniovertebral junction
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