• Journal of Korean Neurosurgical Society
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• v.42 no.5
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• pp.406-409
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• 2007

Craniovertebral junction (CVJ) tuberculosis is a rare disease, potentially causing severe instability and neurological deficits. The authors present a case of CVJ tuberculosis with atlantoaxial dislocation and retropharyngeal abscess in a 28-year-old man with neck pain and quadriparesis. Radiological evaluations showed a widespread extradural lesion around the clivus, C1, and C2. Two stage operations with transoral decompression and posterior occipitocervical fusion were performed. The pathological findings confirmed the diagnosis of tuberculosis. Treatment options in CVJ tuberculosis are controversial without well-defined guidelines. But radical operation (anterior decompression and posterior fusion and fixation) is necessary in patient with neurological deficit due to cord compression, extensive bone destruction, and instability or dislocation. The diagnosis and treatment options are discussed.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.402-406
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• 2000

The term 'craniovertebral junction' refers to the occipital bone that surrounds the foramen magnum and the atlas and the axis vertebrae. A wide variety of congenital, developmental, and acquired anomalies exist at the craniovertebral junction. The authors present a rare case of the congenital anomaly of the craniovertebral junction consisting of atlantal hypoplasia, atlantal assimilation, and basilar invagination in a 58-year-old male. An occiput-C2 arthrodesis was performed. The clinical and imaging features are described, and the embryology and etiology of this anomaly are discussed.

• Neurospine
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• v.15 no.4
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• pp.323-328
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• 2018

The author reviews the various types of cervical fusion that are associated with instability of the craniovertebral junction. Assimilation of the atlas, C2-3 fusion, the Klippel-Feil abnormality, and pancervical fusion are amongst the more common types of bone abnormalities. It is conceptualised that these types of cervical fusion are not related to any kind of embryological dysgenesis or fault, but instead emerge due to longstanding muscle spasms of the neck in response to atlantoaxial instability. Such bone fusions could be secondary protective responses to longstanding atlantoaxial instability.

• Journal of Korean Neurosurgical Society
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• v.48 no.1
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• pp.37-45
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• 2010

Objective : Craniovertebral junction (CVJ) consists of the occipital bone that surrounds the foramen magnum, the atlas and the axis vertebrae. The mortality and morbidity is high for irreducible CVJ lesion with cervico-medullary compression. In a clinical retrospective study, the authors reviewed clinical and radiographic results of occipitocervical fusion using a various methods in 32 patients with CVJ instability. Methods : Thirty-two CVJ lesions (18 male and 14 female) were treated in our department for 12 years. Instability resulted from trauma (14 cases), rheumatoid arthritis (8 cases), assimilation of atlas (4 cases), tumor (2 cases), basilar invagination (2 cases) and miscellaneous (2 cases). Thirty-two patients were internally fixed with 7 anterior and posterior decompression with occipitocervical fusion, 15 posterior decompression and occipitocervical fusion with wire-rod, 5 C1-2 transarticular screw fixation, and 5 C1 lateral mass-C2 transpedicular screw. Outcome (mean follow-up period, 38 months) was based on clinical and radiographic review. The clinical outcome was assessed by Japanese Orthopedic Association (JOA) score. Results : Nine neurologically intact patients remained same after surgery. Among 23 patients with cervical myelopathy, clinical improvement was noted in 18 cases (78.3%). One patient died 2 months after the surgery because of pneumonia and sepsis. Fusion was achieved in 27 patients (93%) at last follow-up. No patient developed evidence of new, recurrent, or progressive instability. Conclusion : The authors conclude that early occipitocervical fusion to be recommended in case of reducible CVJ lesion and the appropriate decompression and occipitocervical fusion are recommended in case of irreducible craniovertebral junction lesion.

• Korean Journal of Bronchoesophagology
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• v.14 no.2
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• pp.64-69
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• 2008

Craniovertebral junction (CVJ) tuberculosis is a rare disease, and potentially fatal due to the risk of atlantoaxial dislocation. The disease usually accompanies a retropharyngeal cold abscess, which can cause subsequential otolaryngologic symptoms such asdysphagia, odynophagia, or airway obstruction. Such a patient must be handled with great care to avoid a disaster. The disease is diagnosed with microbiological or other laboratory tests on the pus collected through puncture and aspiration, which will need otolaryngologic skills. For treatment, otolaryngologists play an important role by doing incision and drainage of the retropharyngeal abscess, or by attending the transoral vertebra surgery as partners with spine surgeons who will manage the CVJ lesions and ensure the craniocervical stability.

• Journal of Korean Neurosurgical Society
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• v.48 no.2
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• pp.139-144
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• 2010

Objective : We report our surgical experience in the treatment of 16 consecutive patients with benign craniovertebral junction (CVJ) tumor, observed from 2003 to 2008 at our department. Methods : We had treated 6 foramen magnum meningiomas, 6 cervicomedullary hemangioblastomas, 1 accessory nerve schwannoma, 1 hypoglossal nerve schwannoma, 1 C2 root schwannoma, and 1 cavernous hemangioma. Clinical results were evaluated by Karnofsky Performance Scale (KPS) and all patients underwent preoperative neuroradiological evaluation with computed tomography (CT) and magnetic resonance image (MRI). Angiography was performed in 15 patients and preoperative embolization was done in 2 patients. Results : Five far-lateral, 1 supracondylar and 10 midline suboccipital approaches were performed. Gross total removal was achieved in 15 cases (94%) and subtotal removal in 1 patient (6%). None of the patients required occipitocervical fusion. Radiological follow-up showed no recurrence in cases totally removed. Postoperative decrease of KPS scores was recorded in only 1 patient. The treatment of cervicomedullary solid hemangioblastoma presented particular issues : by preoperative embolization, we removed tumor totally without an excessive bleeding or brainstem injury. In one of foramen magnum meningioma, we carried out subtotal removal due to hard tumor consistency and encasement of neurovascular structures. Conclusion : The choice of surgical approaches and the extent of bone resection should be defined according to the location and size of individual tumors. Moreover, we emphasize that preoperative neuroradiological evaluations on presumptive tumor type could be helpful to the surgeon in tailoring the technique and providing the required exposure for different lesions, without unnecessary surgical steps.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.379-388
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• 2000

Objective : Although transoral transpharyngeal approach is a very useful method for the lesions of craniovertebral junction, it is not frequently used because of anatomical unfamilarity, risk of cerebrospinal fluid(CSF) leakage, and resultant postoperative meningitis. To evaluate the usefulness of transoral transpharyngeal approach for various lesions of craniovertebral junction, clinical characteristics and the results of this approach are investigated. Methods : Transoral transpharyngeal approaches were performed in eight cases between 1996 and 1999. Among them, there were three basilar invaginations due to congenital anomalies, two odontoid type I fractures, two atlantoaxial dislocations, and one pseudotumor. Surgical methods included five cases of anterior decompression and posterior fusion, two anterior approaches for decompression and one transoral approach for biopsy. Results : This procedure allowed immediate clinical improvement in all cases. In seven patients with preoperative motor deficit showed a progressive neurological improvement. The follow-up plain x-rays demonstrated successful bony fusion in all patients. Only one patient suffered from postoperative wound dehiscence, but she completely recovered after wound revision. There was no complication of postoperative CSF leakages. Conclusions : Transoral transpharyngeal approach for the ventral lesions of craniovertebral junction, can be used as a relatively simple and effective method.

• Journal of Korean Neurosurgical Society
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• v.57 no.4
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• pp.311-313
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• 2015

Chiari type I malformation is a tonsillar herniation more than 3 mm from the level of foramen magnum, with or without concurrent syringomyelia. Different surgical treatments have been developed for syringomyelia secondary to Chiari's malformations: craniovertebral decompression with or without plugging of the obex, syringo-subarachnoid, syringo-peritoneal, and theco-peritoneal shunt placement. Shunt placement procedures are useful for neurologically symptomatic large-sized syrinx. In this paper, authors define the first successful treatment of a patient with syringomyelia due to Chiari type I malformation using a pre-defined new technique of syringo-subarachnoid-peritoneal shunt with T-tube system.

• Journal of Korean Neurosurgical Society
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• v.57 no.4
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• pp.276-282
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• 2015

Objective : The purpose of this study was to investigate morphological change at the craniovertebral junction (CVJ) region using computed tomography. Methods : A total of 238 patients were included in this study, and mean age was $47.8{\pm}21.3months$. Spinal canal diameter, Power's ratio, McRae line, antero-posterior C1 ring height, atlantoaxial joint space, C2 growth, epidural space from the dens (M-PB-C2) and longitudinal distance (basion to C2 lower margin, B-C2) were measured. The mean value of each parameter was assessed for individual age groups. The cohorts were then divided into three larger age groups : infancy (I) (${\leq}2years$), very early (VE) childhood (2-5 years) and early (E) childhood ($5{\geq}years$). Results : Spinal canal diameter increased with age; however, this value did not increase with statistical significance after VE age. A significant age-related difference was found for all C2 body and odontoid parameters (p<0.05). Mean McRae line was 8.5, 8, and 7.5 mm in the I, VE, and E groups, respectively. The M-PB-C2 line showed up-and-down dynamic change during early pediatric periods. Conclusion : Expansion of the spinal canal was restricted to the very early childhood period (less than 5 years) in the CVJ region; however, the C2 body and odontoid process increased continuously with age. The above results induced a dynamic change in the M-PB-C2 line. Although C2 longitudinal growth continued with age, the McRae line showed relatively little change.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.309-316
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• 2000

Objective :The transoral approach allows direct view of the ventral craniovertebral junction and provides useful management of the various lesions of this area. We present a step by step guide to the performance of the transoral excision of the odontoid process in the cadaveric model. Methods : Ten cadaver heads were used in fixed or unfixed state. We describe the relevant surgical anatomy in the cadaveric dissection and surgical technique of transoral transpharyngeal odontoidectomy. Results : The surgical procedure of transoral odontoidectomy was categorized by six steps；soft palate, posterior pharyngeal wall, muscular structures, osseous structures, odontoid process and ligaments, cruciate ligament and dura. Conclusion : With anatomical knowledge of these regions neurosurgeons can deal with wide variety of lesions in the ventral craniovertebral junction.