The authors encountered a case involving difficult intubation during anesthesia for revision of cervical fixation angle in a 62-year-old woman, with a history of chronic rheumatoid arthritis, who experienced dysphagia...The authors encountered a case involving difficult intubation during anesthesia for revision of cervical fixation angle in a 62-year-old woman, with a history of chronic rheumatoid arthritis, who experienced dysphagia after initial posterior occipitocervical fusion to correct atlantoaxial subluxation. Two days after initial surgery, she developed trismus with neck flexion and dysphagia, and underwent revision surgery. General anesthesia was planned;however, tracheal intubation using the McGrath laryngoscope and bronchofiberscope was difficult, which prolonged anesthesia induction. Narrowing of the oral and pharyngeal cavities associated with overcorrection of the cervical spine was believed to be the reason for difficulty in manipulating the tracheal intubation devices. In posterior occipitocervical fusion, intraoperative evaluation of the occipito-second cervical vertebra (O-C2) angle is reported to be useful in preventing postoperative dyspnea and/or dysphagia, and avoids the need for revision of fixation angle. However, when revision surgery is needed, selection of airway management methods and tracheal intubation devices are important considerations because patients are likely to have restricted mobility in the cervical spine and narrowing of the oral and pharyngeal cavities.展开更多
At present,the common surgical procedures for the Chiari malformation typeⅠare comprised of posterior fossa decompression,duraplasty and tonsillectomy.Some neurosurgeons prefer these so called minimally invasive surg...At present,the common surgical procedures for the Chiari malformation typeⅠare comprised of posterior fossa decompression,duraplasty and tonsillectomy.Some neurosurgeons prefer these so called minimally invasive surgeries.However,there are still some failures for patients undergoing the above surgeries in clinical practice.Analyzing causes of many surgical failures,the author put forward the anatomical concept of occipitocervical dura angulation(ODA).The ODA is defined as the included angle between the cerebral dura mater and spinal dura mater at the posterior foramen magnum on the median sagittal plane.For Chiari malformation typeⅠwithout atlantoaxial instability,the selection of appropriate surgeries and accurate evaluation on the effect of the decompression can be realized after the comprehensive analysis both on the severity of tonsil herniation and the ODA.Tonsillectomy may be needed to add to posterior fossa decompression(PFD)and duraplasty for Chiari malformation typeⅠwith the ODA being the larger obtuse angle and/or the tonsil herniation to the level of arcus posterior atlantis.展开更多
Atlanto-occipital dislocation(AOD) is being increasingly recognized as a potentially survivable injury as a result of improved prehospital management of polytrauma patients and increased awareness of this entity, lead...Atlanto-occipital dislocation(AOD) is being increasingly recognized as a potentially survivable injury as a result of improved prehospital management of polytrauma patients and increased awareness of this entity, leading to earlier diagnosis and more aggressive treatment. However, despite overall improved outcomes, AOD is still associated with significant morbidity andmortality. The purpose of this paper is to review the biomechanical aspects, clinical features, radiologic criteria, and treatment strategies of AOD. Given that the diagnosis of AOD can be very challenging, a high degree of clinical suspicion is essential to ensure timely recognition and treatment, thus preventing neurological decline or death.展开更多
文摘The authors encountered a case involving difficult intubation during anesthesia for revision of cervical fixation angle in a 62-year-old woman, with a history of chronic rheumatoid arthritis, who experienced dysphagia after initial posterior occipitocervical fusion to correct atlantoaxial subluxation. Two days after initial surgery, she developed trismus with neck flexion and dysphagia, and underwent revision surgery. General anesthesia was planned;however, tracheal intubation using the McGrath laryngoscope and bronchofiberscope was difficult, which prolonged anesthesia induction. Narrowing of the oral and pharyngeal cavities associated with overcorrection of the cervical spine was believed to be the reason for difficulty in manipulating the tracheal intubation devices. In posterior occipitocervical fusion, intraoperative evaluation of the occipito-second cervical vertebra (O-C2) angle is reported to be useful in preventing postoperative dyspnea and/or dysphagia, and avoids the need for revision of fixation angle. However, when revision surgery is needed, selection of airway management methods and tracheal intubation devices are important considerations because patients are likely to have restricted mobility in the cervical spine and narrowing of the oral and pharyngeal cavities.
文摘At present,the common surgical procedures for the Chiari malformation typeⅠare comprised of posterior fossa decompression,duraplasty and tonsillectomy.Some neurosurgeons prefer these so called minimally invasive surgeries.However,there are still some failures for patients undergoing the above surgeries in clinical practice.Analyzing causes of many surgical failures,the author put forward the anatomical concept of occipitocervical dura angulation(ODA).The ODA is defined as the included angle between the cerebral dura mater and spinal dura mater at the posterior foramen magnum on the median sagittal plane.For Chiari malformation typeⅠwithout atlantoaxial instability,the selection of appropriate surgeries and accurate evaluation on the effect of the decompression can be realized after the comprehensive analysis both on the severity of tonsil herniation and the ODA.Tonsillectomy may be needed to add to posterior fossa decompression(PFD)and duraplasty for Chiari malformation typeⅠwith the ODA being the larger obtuse angle and/or the tonsil herniation to the level of arcus posterior atlantis.
文摘Atlanto-occipital dislocation(AOD) is being increasingly recognized as a potentially survivable injury as a result of improved prehospital management of polytrauma patients and increased awareness of this entity, leading to earlier diagnosis and more aggressive treatment. However, despite overall improved outcomes, AOD is still associated with significant morbidity andmortality. The purpose of this paper is to review the biomechanical aspects, clinical features, radiologic criteria, and treatment strategies of AOD. Given that the diagnosis of AOD can be very challenging, a high degree of clinical suspicion is essential to ensure timely recognition and treatment, thus preventing neurological decline or death.
