Surgical Treatment of C2 Odontoid Process Intussusception in Combination with Type I Chiari Malformation

Abstract

Type I Chiari malformation is often accompanied by congenital developmental abnormalities such as platybasia, basilar impression and C2 odontoid process retroflexion that may cause anterior compression of brainstem structures and upper cervical segments of spinal cord. Formerly the conventional method was posterior decompression even in presence of anterior brainstem compression. This article presents on a kinetic example the tactics of one-step treatment of patients with type I Chiari malformation accompanied by basilar impression and C2 odontoid process retroflexion via transoral approach only that was used for both decompression and C1-C2 segment anterior stabilization. Surgical intervention enabled to achieve the decompression of brainstem structures and upper cervical segments of spinal cord, normalization liquor dynamics and subsequent redislocation of cerebellar tonsils to normal position (above the Chamberlain line).