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Case Reports
. 2024 Jun 20;16(6):e62754.
doi: 10.7759/cureus.62754. eCollection 2024 Jun.

A Transoral Approach to Decompression Odontoidectomy With Posterior Wiring and Fusion for Pediatric Platybasia With Chiari Malformation

Nur Aidurra Zainudin  1 , Mohd Hisam Muhamad Ariffin  2
Affiliations
Case Reports

A Transoral Approach to Decompression Odontoidectomy With Posterior Wiring and Fusion for Pediatric Platybasia With Chiari Malformation

Nur Aidurra Zainudin et al. Cureus. .

Abstract

Basilar invagination in a Chiari malformation associated with osteogenesis imperfecta in the pediatric population is a rare entity. We report a case of a seven-year-old female who presented with sudden-onset bilateral spastic quadriplegia and evidence of a basilar invagination on MRI. She underwent emergency decompression of the impinging odontoid via transoral approach followed by posterior wiring and fusion of the C1 and C2 vertebrae. Imaging modalities such as dynamic CT and MRI play a major role in delineating any craniovertebral anomalies and neural impingement not easily identified in plain radiographs. Understanding the complex craniovertebral junction (CVJ) anatomy and the possible causes of such deformities is vital for ensuring proper diagnosis and management of these patients.

Keywords: atlantoaxial; basilar; chiari; craniovertebral; invagination; osteogenesis.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT cervical in flexion (A) and extension (B) sagittal view on admission shows the widening of the spinal canal on extension
CT: computed tomography
Figure 2
Figure 2. Craniometric lines and angles measured in the patient
The Chamberlain line (blue line) joins the posterior margin of the hard palate to the opisthion. The tip of the dens is seen pressing into the brainstem. In normal patients, the tip of the dens should not exceed 5 mm above this line. Welcher basal angle (red line): the angle between the lines drawn from nasion to tuberculum sellae and tuberculum sellae to basion. The angle measured is 150 degrees, indicating a platybasia, as normal values range from 125 to 143 degrees
Figure 3
Figure 3. MRI showing the downward displacement of the cerebellum below the McRae line (yellow) indicating a Chiari malformation
MRI: magnetic resonance imaging
Figure 4
Figure 4. Surgery-related images of the patient
(A) Patient position on Jackson operating table. (B) Visualized odontoid. (C) Remnant of odontoid after decompression. (D) Visualized transverse alar ligament
Figure 5
Figure 5. Image intensifier lateral and anteroposterior images of tubular retractor placement inside the oral cavity
(A) The 90 mm tubular retractor placed directly onto the C1 anterior arch through the oral cavity in the lateral view of the image intensifier. (B) Placement of tubular retractor in anteroposterior view
Figure 6
Figure 6. Patient images
(A) On the first day of presentation. (B, C) Three weeks post-surgery
Figure 7
Figure 7. Patient at three months post-surgery
Figure 8
Figure 8. CT scan sagittal and coronal image at three months post-surgery shows a widening of the spinal canal
CT: computed tomography
Figure 9
Figure 9. Patient’s neck range of motion at six months post-surgery
(A, B) Neck range of motion in lateral flexion. (C, D) Lateral rotation. (E) Forward flexion. (F) Extension. (G, H) Neutral position
See this image and copyright information in PMC

References

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