The role of occipital condyle and atlas anomalies on occipital cervical fusion outcomes in Chiari malformation type I with syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium-Reference-Cited by-同舟云学术

The role of occipital condyle and atlas anomalies on occipital cervical fusion outcomes in Chiari malformation type I with syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium

Published:2024-04-01 Issue: Volume: Page:1-9
ISSN:1933-0707
Container-title:Journal of Neurosurgery: Pediatrics
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Author:

Yahanda Alexander T.¹,Koueik Joyce²,Ackerman Laurie L.³,Adelson P. David⁴,Albert Gregory W.⁵,Aldana Philipp R.⁶,Alden Tord D.⁷,Anderson Richard C. E.⁸,Bauer David F.⁹,Bethel-Anderson Tammy¹,Bierbrauer Karin¹⁰,Brockmeyer Douglas L.¹¹,Chern Joshua J.¹²,Couture Daniel E.¹³,Daniels David J.¹⁴,Dlouhy Brian J.¹⁵,Durham Susan R.¹⁶,Ellenbogen Richard G.¹⁷,Eskandari Ramin¹⁸,Fuchs Herbert E.¹⁹,Grant Gerald A.¹⁹,Graupman Patrick C.²⁰,Greene Stephanie²¹,Greenfield Jeffrey P.²²,Gross Naina L.²³,Guillaume Daniel J.²⁴,Hankinson Todd C.²⁵,Heuer Gregory G.²⁶,Iantosca Mark²⁷,Iskandar Bermans J.²,Jackson Eric M.²⁸,Jallo George I.²⁹,Johnston James M.³⁰,Kaufman Bruce A.³¹,Keating Robert F.³²,Khan Nickalus R.³³,Krieger Mark D.¹⁶,Leonard Jeffrey R.³⁴,Maher Cormac O.³⁵,Mangano Francesco T.¹⁰,Martin Jonathan³⁶,McComb J. Gordon¹⁶,McEvoy Sean D.¹,Meehan Thanda¹,Menezes Arnold H.¹⁵,Muhlbauer Michael S.³³,O’Neill Brent R.²⁵,Olavarria Greg³⁷,Ragheb John³⁸,Selden Nathan R.³⁹,Shah Manish N.⁴⁰,Shannon Chevis N.⁴¹,Shimony Joshua S.⁴²,Smyth Matthew D.²⁹,Stone Scellig S. D.⁴³,Strahle Jennifer M.¹,Tamber Mandeep S.⁴⁴,Torner James C.¹⁵,Tuite Gerald F.²⁹,Tyler-Kabara Elizabeth C.⁴⁵,Wait Scott D.⁴⁶,Wellons John C.⁴⁰,Whitehead William E.⁹,Park Tae Sung¹,Limbrick David D.¹,Ahmed Raheel²

Affiliation:

1. Departments of Neurological Surgery and

2. Department of Neurological Surgery, University of Wisconsin at Madison, Wisconsin;

3. Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana;

4. Department of Neurosurgery, West Virginia University School, Morgantown, West Virginia;

5. Division of Neurosurgery, Arkansas Children’s Hospital, Little Rock, Arkansas;

6. Division of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida;

7. Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Illinois;

8. Neurosurgeons of New Jersey, Ridgewood, New Jersey;

9. Division of Pediatric Neurosurgery, Texas Children’s Hospital, Houston, Texas;

10. Division of Pediatric Neurosurgery, Cincinnati Children’s Medical Center, Cincinnati, Ohio;

11. Division of Pediatric Neurosurgery, Primary Children’s Hospital, Salt Lake City, Utah;

12. Division of Pediatric Neurosurgery, Children’s Healthcare of Atlanta University, Atlanta, Georgia;

13. Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina;

14. Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;

15. Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa;

16. Division of Pediatric Neurosurgery, Children’s Hospital of Los Angeles, USC Keck School of Medicine, Los Angeles, California;

17. Division of Pediatric Neurosurgery, Seattle Children’s Hospital, Seattle, Washington;

18. Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina;

19. Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina;

20. Division of Pediatric Neurosurgery, Gillette Children’s Hospital, St. Paul, Minnesota;

21. Divsion of Pediatric Neurosurgery, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;

22. Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York;

23. Warren Clinic Pediatric Neurosurgery, Saint Francis Health System, Tulsa, Oklahoma;

24. Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota;

25. Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania;

26. Division of Pediatric Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania;

27. Division of Pediatric Neurosurgery, Penn State Health Children’s Hospital, Hershey, Pennsylvania;

28. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;

29. Division of Neurosurgery, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida;

30. Department of Neurosurgery, University of Alabama at Birmingham, Alabama;

31. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin;

32. Department of Neurosurgery, Children’s National Medical Center, Washington, DC;

33. Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee;

34. Division of Pediatric Neurosurgery, Nationwide Children’s Hospital, Columbus, Ohio;

35. Department of Neurosurgery, Stanford University, Palo Alto, California;

36. Department of Neurosurgery, Connecticut Children’s Hospital, Hartford, Connecticut;

37. Division of Pediatric Neurosurgery, Arnold Palmer Hospital for Children, Orlando, Florida;

38. Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida;

39. Department of Neurological Surgery and Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon;

40. Division of Pediatric Neurosurgery, McGovern Medical School, Houston, Texas;

41. American Society for Reproductive Medicine, Birmingham, Alabama;

42. Radiology, Washington University School of Medicine, St. Louis, Missouri;

43. Division of Pediatric Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts;

44. Division of Neurosurgery, The University of British Columbia, Vancouver, British Columbia, Canada;

45. Department of Neurosurgery, Dell Medical School, Austin, Texas; and

46. Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina

Abstract

OBJECTIVE Congenital anomalies of the atlanto-occipital articulation may be present in patients with Chiari malformation type I (CM-I). However, it is unclear how these anomalies affect the biomechanical stability of the craniovertebral junction (CVJ) and whether they are associated with an increased incidence of occipitocervical fusion (OCF) following posterior fossa decompression (PFD). The objective of this study was to determine the prevalence of condylar hypoplasia and atlas anomalies in children with CM-I and syringomyelia. The authors also investigated the predictive contribution of these anomalies to the occurrence of OCF following PFD (PFD+OCF). METHODS The authors analyzed the prevalence of condylar hypoplasia and atlas arch anomalies for patients in the Park-Reeves Syringomyelia Research Consortium database who underwent PFD+OCF. Condylar hypoplasia was defined by an atlanto-occipital joint axis angle (AOJAA) ≥ 130°. Atlas assimilation and arch anomalies were identified on presurgical radiographic imaging. This PFD+OCF cohort was compared with a control cohort of patients who underwent PFD alone. The control group was matched to the PFD+OCF cohort according to age, sex, and duration of symptoms at a 2:1 ratio. RESULTS Clinical features and radiographic atlanto-occipital joint parameters were compared between 19 patients in the PFD+OCF cohort and 38 patients in the PFD-only cohort. Demographic data were not significantly different between cohorts (p > 0.05). The mean AOJAA was significantly higher in the PFD+OCF group than in the PFD group (144° ± 12° vs 127° ± 6°, p < 0.0001). In the PFD+OCF group, atlas assimilation and atlas arch anomalies were identified in 10 (53%) and 5 (26%) patients, respectively. These anomalies were absent (n = 0) in the PFD group (p < 0.001). Multivariate regression analysis identified the following 3 CVJ radiographic variables that were predictive of OCF occurrence after PFD: AOJAA ≥ 130° (p = 0.01), clivoaxial angle < 125° (p = 0.02), and occipital condyle–C2 sagittal vertical alignment (C–C2SVA) ≥ 5 mm (p = 0.01). A predictive model based on these 3 factors accurately predicted OCF following PFD (C-statistic 0.95). CONCLUSIONS The authors’ results indicate that the occipital condyle–atlas joint complex might affect the biomechanical integrity of the CVJ in children with CM-I and syringomyelia. They describe the role of the AOJAA metric as an independent predictive factor for occurrence of OCF following PFD. Preoperative identification of these skeletal abnormalities may be used to guide surgical planning and treatment of patients with complex CM-I and coexistent osseous pathology.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Link

https://thejns.org/downloadpdf/journals/j-neurosurg-pediatr/aop/article-10.3171-2024.1.PEDS23229/article-10.3171-2024.1.PEDS23229.xml

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