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Search Results: 1 - 10 of 1425 matches for " acesso suboccipital lateral "
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Varia es da extens o anterolateral do acesso suboccipital lateral: estudo anat mico
Silveira Roberto Leal,Gusm?o Sebasti?o
Arquivos de Neuro-Psiquiatria , 2002,
Abstract: Estudamos, em laboratório de microcirurgia, as extens es do acesso suboccipital lateral (ASOL) em sete pe as anat micas, com o objetivo de definir as extens es deste acesso necessárias à abordagem das les es da regi o anterolateral do forame magno e do forame jugular. As extens es (ressec o óssea) foram realizadas em cinco estágios progressivos: 1) craniectomia suboccipital retrossigmóidea (ASOL retrocondilar); 2) amplia o da craniectomia com remo o da metade posterior do c ndilo occipital (ASOL transcondilar parcial); 3)extens o lateral da blocagem do c ndilo occipital até abrir o canal do hipoglosso, seguida de ressec o do processo jugular e abertura do forame jugular (ASOL transcondilar parcial-transjugular); 4) brocagem completa do c ndilo occipital (ASOL transcondilar completo); 5) ASOL completo acrescido de retirada da massa lateral do atlas até identifica o do processo odontóide. Concluimos que as extens es do ASOL devem ser adaptadas à topografia da les o: o ASOL retrocondilar para as les es laterais ao forame magno, o ASOL transcondilar parcial para as anterolaterais, o ASOL transcondilar-transjugular para as les es da regi o do forame jugular, o ASOL transcondilar completo para as anteriores ao forame magno, e o transcondilar completo/trans-massa lateral do atlas para as les es extradurais da regi o anterior ao forame magno.
Varia??es da extens?o anterolateral do acesso suboccipital lateral: estudo anat?mico
Silveira, Roberto Leal;Gusm?o, Sebasti?o;
Arquivos de Neuro-Psiquiatria , 2002, DOI: 10.1590/S0004-282X2002000200013
Abstract: we studied the extensions of the lateral suboccipital approach (lsoa) in seven cadaver heads, in the microsurgical laboratory, in order to stablish the extensions necessary to approach the anterolateral area of the foramen magnum and the jugular foramen. the extensions (bone resection) were accomplished in five progressive steps: 1) suboccipital retrossigmoid craniectomy (lsoa retrocondylar); 2) extending the craniectomy with removal of half the occipital condyle (lsoa partial transcondylar); 3) extending the drilling of the occipital condyle to open the hypoglossal foramen, followed by removal of the jugular tubercle and opening the jugular foramen (lsoa transcondylar-transjugular); 4) complete drilling of the occipital condyle (lsoa complete transcondylar); 5) lsoa complete transcondylar plus removal of the atlas lateral mass up to the odontoid process (asol transcondylar-transjugular). we concluded that the extensions of lsoa should be adapted to the topography of the lesion: the lsoa retrocondylar for the lateral area of the foramen magnum; the lsoa partial transcondylar for the anterolateral portion; the lsoa transcondylar-transjugular to reach the jugular foramen; the lsoa complete transcondylar for the anterior part, and the lsoa complete transcondylar/translateral mass of the atlas for extradural lesions anterior to the foramen magnum.
Decompressive Craniectomy in Posterior Fossa Ischemic Stroke  [PDF]
Luciano Santana-Cabrera, Guillermo Pérez-Acosta, Cristina Rodríguez-Escot, Rosa Lorenzo-Torrent, Manuel Sánchez-Palacios
International Journal of Clinical Medicine (IJCM) , 2012, DOI: 10.4236/ijcm.2012.34059
Abstract: Ischemic damage produced in the posterior cerebral territory causes significant morbidity and urgently must be considered if the patient need a surgical attitude. Surgical decompression by suboccipital craniectomy seams to be effective to treat secondary edema due to cerebellar damage or in posterior fossa, when medical treatment is not able to control side effects. We report a clinical case of a patient with a subacute ischemic infarction in the vertebro-basilar territory, with perilesional edema, and a posterior fossa decompressive craniectomy (DC) was carried out.
经后路寰枢椎侧块螺钉固定联合枕下减压治疗Arnold-Chiari畸形合并寰枢关节脱位
POSTERIOR ATLANTOAXIAL LATERAL MASS SCREW FIXATION AND SUBOCCIPITAL DECOMPRESSION FOR TREATMENT OF Arnold-Chiari MALFORMATION ASSOCIATED WITH ATLANTOAXIAL DISLOCATION

冯文献,李力,徐绪昌,刘继东,杨扬,焦云琦
- , 2016, DOI: 10.7507/1002-1892.20160289
Abstract: 目的探讨经后路寰枢椎侧块螺钉固定联合枕下减压治疗Arnold-Chiari畸形合并寰枢关节脱位的疗效。 方法2012年9月-2015年11月,收治17例Arnold-Chiari畸形合并寰枢关节脱位患者,均行经寰枢椎侧块螺钉固定+枕下减压扩大硬脑膜修补+植骨融合术治疗。男10例,女7例;年龄35~65岁,平均51.4岁。病程14个月~15年,平均7.4年。Arnold-Chiari畸形分型:Ⅰ型13例,Ⅱ型3例,Ⅲ~Ⅳ型1例。存在中上颈神经根刺激和压迫症状12例,枕大孔综合征11例,小脑受压症状6例,脊髓空洞症10例。 结果1例术后第3天拔除引流管后出现脑脊液切口漏,腰大池引流7 d后切口愈合良好,脑脊液漏消失。其余患者切口均Ⅰ期愈合,无手术早期并发症发生。患者均获随访,随访时间6个月~2年,平均18.4个月。患者神经功能障碍均有不同程度改善,术后6个月日本骨科协会(JOA)评分为(16.12±1.11)分,较术前的(11.76±2.01)分明显提高,比较差异有统计学意义( t=13.596, P=0.000);脊髓及延髓受压改善。X线片复查示,术后6个月内植骨均达融合。10例合并脊髓空洞者6个月复查MRI显示3例空洞消失,6例空洞变小,1例无明显变化。 结论寰枢椎侧块螺钉固定联合枕下减压扩大硬脑膜修补术治疗Arnold-Chiari畸形合并寰枢关节脱位可获得良好疗效。
ObjectiveTo evaluate the effectiveness of the posterior atlantoaxial lateral mass screw fixation and suboccipital decompression in the treatment of Arnold-Chiari malformation associated with atlantoaxial joint dislocation. MethodsBetween September 2012 and November 2015, 17 cases of Arnold-Chiari malformation associated with atlantoaxial dislocation were treated by the posterior atlantoaxial lateral mass screw fixation and suboccipital decompression and expansion to repair the dura mater and bone graft fusion. There were 10 males and 7 females, aged 35-65 years (mean, 51.4 years). The disease duration was 14 months to 15 years with an average of 7.4 years. According to Arnold-Chiari malformation classification, 13 cases were rated as type I, 3 cases as type II, and 1 case as type III-IV. Cervical nerve root stimulation and compression symptoms were observed in 12 cases, occipital foramen syndrome in 11 cases, cerebellar compression symptoms in 6 cases, and syringomyelia in 10 cases. ResultsPrimary healing of incision was obtained in the other patients except 1 patient who had postoperative cerebrospinal fluid leakage after removal of drainage tube at 3 days after operation, which was cured after 7 days. All patients were followed up 6 months to 2 years, with an average of 18.4 months. The neurological dysfunction was improved in different degrees after operation. The Japanese Orthopedic Association (JOA) score was significantly increased to 16.12±1.11 at 6 months from preoperative 11.76±2.01 ( t=13.596, P=0.000); compression of spinal cord and medulla was improved. X-ray examination showed bone graft fusion at 6 months after operation. In 10 patients with spinal cord cavity, MRI showed empty disappearance in 3 cases, empty cavity lessening in 6 cases, and no obvious change in 1 case at 6 months. ConclusionAtlantoaxial lateral mass screw fixation and suboccipital decompression and expansion to repair the dura mater can obtain good effectiveness in the treatment
Malformación de Chiari tipo I: evolución postoperatoria a dos a?os. Análisis de 10 casos
Alvarez-Betancourt,L.; García-Rentaría,J. A.; López-Ortega,S.J.; Caldera-Duarte,A.;
Neurocirugía , 2005, DOI: 10.4321/S1130-14732005000100005
Abstract: objective to describe the clinical and radiological evolution of ten patients with chiari i malformation (cim), treated surgically. method. ten patients with chiari i malformation underwent suboccipital craniectomy, laminectomy of c1 and dural patch grafting. all of them were followed for at least two years. a magnetic resonance imaging was performed 6 months after surgery. clinical preoperative evolution and time of installation, results of mri and clinical postoperative evolution were correlated. results. in postoperative clinical evolution, we noted an important improvement in sensitive function, decrease of the syringohydromielia and partial improvement of cerebellar functions. improvement of the motor alteration was less marked. during the two years after treatment the muscular atrophy did not change. conclusions. chiari i malformation is a congenital disease with many clinical manifestations which usually increase with time. a suitable diagnostic studies as well as an appropriate treatment are needed to improve the neurological results.
Comparación del tratamiento de la malformación de Chiari tipo I mediante craniectomía suboccipital y resección del arco posterior de C1 con o sin duroplastia
Alamar,M.; Teixidor,P.; Colet,S.; Mu?oz,J.; Cladellas,J.M; Hostalot,C.; García-Armengol,R.; Bescós,A.; Cardiel,I.; Fiallos,M.; Florensa,R.;
Neurocirugía , 2008, DOI: 10.4321/S1130-14732008000300003
Abstract: there are various surgical approaches to treat chiari i malformation. in spite of the good clinical results that are reported with most of them, there is still controversy about the optimal treatment of this patology. objective. to compare the clinical and radiological results of surgical treatment of the chiari i malformation with suboccipital craniectomy, posterior arch of c1 resection with or without dural graft, analyzing clinical and radiological findings and describing the complications. material and methods. retrospectively clinical cases series of patients who underwent chiari i malformation surgery between 1998 and 2006 in the hospital germans trias i pujol in badalona. the inclusion criteria consisted in: patients older than 18 years, who have had surgery in our hospital, detailed neurological examination before and after surgery (calculating the edss scale punctuation), craniospinal magnetic resonance imaging before and after surgery and minimal follow up period of 6 months. the election of the surgical approach was left to the discretion of the main surgeon. patients were divided in two groups depending of the surgical technique: group a (with dural graft) and group b (without dural graft). to evaluate the morphological results in both groups, measurements of the position of the fastigium above a basal line in the midsagittal t1 weighted magnetic resonance images were obtained. in patients with syringomyelia, siringoto-cord ratio was measured before and after surgery. to evaluate the clinical results, neurological examination was recorded in both groups before and after surgery. results. the mean age of group a patients was 47 (±12.89) years, and of group b was 38,3 (±7.77) years. mean follow up period was 2,48 (±2.44) years in group a and 4,2 (±4.46) in group b. creation of an artifitial cisterna magna was observed en 35,7% of group a patients and only in 3.5% of group b patients (p=0.022). in 8 patients front group a, 8 patients (28.6%) an upward migra
Suboccipital craniectomy with or without duraplasty: what is the best choice in patients with Chiari type 1 malformation?
Romero, Flávio Ramalho;Pereira, Clemente Augusto de Brito;
Arquivos de Neuro-Psiquiatria , 2010, DOI: 10.1590/S0004-282X2010000400027
Abstract: the best surgical treatment for chiari malformation is unclear, especially in patients with syringomyelia. we reviewed the records of 16 patients who underwent suboccipital craniectomy at our institution between 2005 and 2008. of the six patients who did not undergo duraplasty, four showed improvement postoperatively. two patients without syringomyelia showed improvement postoperatively. of the four patients with syringomyelia, three showed improvement, including two with a decrease in the cavity size. one patient showed improvement in symptoms but the syringomyelia was unchanged. the cavity size increased in the one patient who did not show improvement. among the 10 patients who underwent duraplasty, improvements were noted in four of the five patients without syringomyelia and in all of the five with syringomyelia. there is a suggestion that patients with syringomyelia may have a higher likelihood of improvement after undergoing duraplasty.
Malformación de Chiari y siringomielia: experiencia 2000-2008
Domitrovic,Luis; Gandarillas,Bladimir; Clar,Flavia; Carrasco,Edgar; Jalón,Pablo; Mezzadri,Juan José;
Revista argentina de neurocirug?-a , 2009,
Abstract: objetive. to describe the postoperative outcome of patients with chiari malformation (cm) and/or syringomyelia (sm). methods. the clinical records of patients with cm and sm, treated from 2000 to 2008, were retrospectively reviewed. data about sex, age, previous history, admission symptoms, magnetic resonance imaging (mri), treatment modalities, outcome (odom′s scale) and postoperative complications were collected. results. we treated 17 patients (1 varón, 16 mujeres); mean age: 39 years old (10-66). the admission symptoms were: pain in 11 cases, cerebellum/brain stem in 4 cases and spinal cord in 14 cases. diagnosis was made by mri: cm type i with sm 9 cases, cm i without sm 6 cases, cm type ii with sm 1 case and idiopathic sm 1 case. mc ii had myelomeningocele and ventricular shunting surgery at 3 months old. in 15 cases we performed a suboccipital craniectomy with duraplasty and c1 posterior arch resection (n:12) or c1-c2 posterior arch resection (n:3). one case had surgery at another institution and 1 case was not operated because symptoms did not progressed. sm persisted in 4 of the operated cases; in 3 of them a syringopleural shunting (sps) was performed. in the idiopathic sm a sps was also performed, but it became obstructed 3 months later. complications were: meningitis 1 case, csf fistula 1 case and meningitis + csf fistula 1case. in cm outcome after 1 year was: excellent-good in 13 cases, fair in 1 case and poor in 2 cases. conclusion. in patients with cm and/or sm, postoperative clinical outcome was excellent-good in 13/16 cases.
Suboccipital segment of the vertebral artery: A cadaveric study
Muralimohan S,Pande Anil,Vasudevan M,Ramamurthi Ravi
Neurology India , 2009,
Abstract: Objective: To study the course, relationships, branches and possible anomalies of the vertebral artery in the suboccipital region in adult Indian cadavers. Materials and Methods: Twenty-one suboccipital segment vertebral artery specimens from embalmed, Indian adult cadavers were dissected and studied. Dissection was performed using microsurgical instruments and was carried out from the skin up to the vertebral artery in layers. The course, relationships and the branches of the vertebral artery were studied and measurements were taken using Vernier calipers. The readings obtained were corroborated with the measurements derived from the digital images using a computer. Observations: All the vertebral arteries had a tortuous course and were covered with rich venous plexuses. None of the specimens had an anomalous course. The artery was divided into a vertical segment (Vv) between C2 and C1 vertebra and a horizontal segment (Vh) from the C1 transverse foramina to its dural entry. The mean diameter of the artery was 4.8mm. The shortest distance of Vv segment from the dural tube was 16.1mm, and the distance from the C2 ganglion was 7.2mm. The average length of the Vv segment was 15mm and the average length of the Vh segment was 35.6mm. The average of the shortest distance between the vertebral artery and the midline was 13.4mm. Conclusion: The vertebral artery has a tortuous course and is prone to accidental iatrogenic injury, which can result in devastating neurological sequelae depending on contralateral vertebral artery flow. A thorough anatomical knowledge of this segment is essential for the surgeon who intends to operate in this area.
Bony reconstruction by reposition of bony chips in suboccipital craniectomy
Chowdhury Forhad,Haque Raziul,Islam Shafiqul,Sarkar Mainul
Neurology India , 2010,
Abstract: In suboccipital craniectomy where the bone is not repositioned, there may be a significant cosmetic defect due to lack of skull bone in the suboccipital region. It may accompanied by sensory symptoms, including pain. To prevent any cosmetic defect and sensory symptoms we repositioned the bone chips at the craniectomy site in 42 suboccipital craniectomies before the closure of the scalp. At a mean follow-up of 22 months (range: 5-44 months), two patients complained of mild discomfort in the healed wound or of occasional local pain. One patient complained of mild itching at the site. In two patients, bone chips were accumulated at the lower part of the suboccipital craniectomy and failed to form a uniform bone cover at the operated site. In one patient, all bone chips were reabsorbed and there was no bone at the operated site. There was pseudomeningocele formation in one patient. In the rest of the cases there was satisfactory bone coverage at the operated site, both clinically and radiologically. The wound sites were aesthetically acceptable in 40 cases. Our study suggests that in the majority of cases where suboccipital craniotomy is not possible or not done, repositioning of the bone chips at the craniectomy site is associated with satisfactory aesthetic and functional outcome and formation of bone coverage at the operated site.
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