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Retrospective case series. The aim of this study was to evaluate the clinical outcomes and effectiveness of using 3D printed implants in upper cervical spine and occipitocervical junction surgery. C2 primary tumor patients who required axial en bloc resection and other patients who required partial bone decompression using customized 3D printed implants or fixation devices for surgery were included. Evaluate the stability and surgical outcomes of 3D printed implants through perioperative and follow-up period. Five tumor patients underwent reconstruction using customized 3D printed artificial vertebral bodies, while another five patients with atlantoaxial joint dislocation underwent reduction and decompression using customized 3D printed internal fixation devices. The postoperative imaging results showed that the 3D printed structures had good immediate stability and had no signs of displacement or subsidence. Follow up showed that all five cases of vertebral body reconstruction had achieved fusion. Only one patient died one month after surgery due to infection and respiratory difficulties. Other patients showed excellent improvement in neurological function in follow up. The use of 3D printed implants in surgery involving the occipitocervical area is a feasible and reliable alternative choice. It is a valuable attempt for complex atlantoaxial dislocation that cannot be treated with conventional instruments. 3D printed implants can improve the safety and accuracy of surgery, provide good immediate stability, have a low incidence of subsidence, fewer related complications during the follow-up period. [ABSTRACT FROM AUTHOR]

Background: The management for craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) remains controversial and clinically challenging. We systemically summarized the clinical and angiographic outcomes of microsurgery, embolization, and conservative management. Methods: Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane, following PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management approaches, and clinical and angiographic outcomes. Results: We included 13 articles (166 patients). The weighted mean age was 58.9 years (95%CI: 53.2–64.5), 58.8 years (95%CI: 48.4–69.2), and 63.8 years (95%CI: 60.1–67.5), in microsurgery, embolization, and conservative groups respectively, with an overall male sex predominance (microsurgery [n = 51/77, 66.2%], embolization [n = 44/56, 78.6%], and conservative management [n = 6/8, 75.0%]). Patients were managed with microsurgery (n = 80/172, 46.5%), embolization (n = 79/172, 45.9%), and conservative treatment (n = 13/172, 7.6%). Foramen magnum was the most common location (microsurgery [n = 34/77, 44.2%], embolization [n = 31/56, 55.4%], and conservative treatment [n = 3/8, 37.5%]). Vertebral artery was the primary feeder (microsurgery [n = 58/84, 69.1%], embolization [n = 41/86, 47.6%], and conservative treatment [n = 4/7, 57.1%]). Complete fistula obliteration rates were 74.1% (95%CI:52.3–88.2%) in the microsurgery group and 54.9% (95%CI:30.7–77.0%) in the embolization group. Complications rates were 16.2% (95%CI:6.7–34.5%) in the embolization group, 11.6% (95%CI:3.8–30.4%) in the microsurgery group, and 7.7% (95%CI:1.1–39.1%) in the conservative group. Different rates of good clinical outcomes were observed [microsurgery: 66.4% (95%CI:48.1–80.8%), embolization: 51.9% (95%CI:30.8–72.4%), and conservative: 11.6% (95%CI:4.4–27.4%)]. Conclusions: In patients with CCJ-DAVFs, each management approach has its own merits based on the fistula and patient characteristics. [ABSTRACT FROM AUTHOR]

This study aims to discuss the identification of the C1 nerve root as an effective surgical approach to successfully locate the shunting point of craniocervical junction spinal dural arteriovenous fistula (CCJ-SDAVF) intraoperatively. This study included all patients with CCJ-SDAVF who underwent surgical treatment using the far-lateral transcondylar approach at a single institution from January 2017 to June 2023. Data on patient demographics, clinical and angiographic characteristics of CCJ-SDAVF, surgical details, and treatment outcomes were collected. Follow-up assessments were conducted for all patients until December 31, 2023. The study included a total of 7 patients, comprising 5 men(71.4%) and 2 women (28.6%), with an average age of 57.6 years. Among them, 4 patients (57.1%) developed diffuse subarachnoid hemorrhage(SAH), while 2 patients (28.6%) experienced progressive cervical myelopathy. The shunting points of all CCJ-SDAVFs, which exhibited engorged veins, were identified next to the C1 root. Complete obliteration of CCJ-SDAVFs was successfully achieved in all patients, as confirmed by postoperative angiography one month later. No recurrent CCJ-SDAVFs were observed two years after the operation. Among the patients, 5 (71.4%) experienced good functional recovery, as indicated by an mRS score ranging from 0 to 1, while the remaining 2 patients (28.6%) showed incomplete functional recovery. The surgical interruption of CCJ-SDAVFs is the preferred treatment option, given its high obliteration rate and favorable functional recovery outcomes. We advocate the identification of C1 spinal nerve root as a crucial surgical step to identify the shunting points of CCJ- SDAVFs. [ABSTRACT FROM AUTHOR]

Arteriovenous fistulas (AVFs) at the craniocervical junction (CCJ) are uncommon conditions with complex angioarchitecture. The objective of this study was to identify the angioarchitectural features of CCJ-AVF that were predictive of clinical presentation and neurological function. The study encompassed a total of 68 consecutive patients with CCJ-AVF at two neurosurgical centers between 2014 and 2022. Additionally, a systematic review was conducted, including 68 cases with detailed clinical data obtained via PubMed database spanning 1990 to 2022. Clinical and imaging data were collected and pooled together to analyze factors associated with subarachnoid hemorrhage (SAH), myelopathy, and modified Rankin scale (mRS) at presentation. The mean age of the patients was 54.5 ± 13.1 years, with 76.5% of them being male. The most common feeding arteries were V3-medial branches (33.1%), and drainage was frequently through the anterior or posterior spinal vein/perimedullary vein (72.8%). SAH was the most common presentation (49.3%), and an associated aneurysm was identified as a risk factor for SAH (adjusted OR, 7.44; 95%CI, 2.89–19.15). Anterior or posterior spinal vein/perimedullary vein (adjusted OR, 2.78; 95%CI, 1.00–7.72) and male gender (adjusted OR, 3.76; 95%CI, 1.23–11.53) were associated with higher risk for myelopathy. Myelopathy at presentation was an independent risk factor for unfavorable neurological status (adjusted OR per score, 4.73; 95%CI, 1.31–17.12) in untreated CCJ-AVF. The present study identifies risk factors associated with SAH, myelopathy, and unfavorable neurological status at presentation in patients with CCJ-AVF. These findings may help treatment decisions for these complex vascular malformations. [ABSTRACT FROM AUTHOR]

Fixed atlantoaxial dislocations are difficult to treat and there is no consensus in the treatment protocol. Unilateral enlargement of the atlas-axis facet complex in fixed atlantoaxial dislocations is a very rare condition. These pathologies are usually quite unstable and surgical treatment is necessary in unreductable cases. A 52-year-old woman with a diagnosis of irreducible-fixed rotatory atlantoaxial dislocation presented with acute onset of dizziness, loss of balance, and tetraparesis. She was under 8 years of conservative follow-up. Review of radiology revealed unilateral C2 superior facet hypertrophy compressing the medulla and obstructing the vertebral artery. To treat this condition, we have used a posterior midline approach and removed the lateral portions of the posterior rim of the foramen magnum and the assimilated posterior arch of C1. The V3 segments of the vertebral arteries were exposed bilaterally. The atlantoaxial joint complex on the left was hypertrophied compressing V3. We have removed hypertrophied lateral mass of the atlas and the hypertrophic superior articular facet of C2 for decompression. Patency of both vertebral arteries were checked intraoperatively by Doppler and indocyanine green angiography. We have fixated craniocervical junction on the same session. Patient was neurologically intact and she had confirmed fusion on the surgical site after three years of follow-up. This is a rare case of unilateral hypertrophy of the C2 superior articular facet in a fixed atlantoaxial rotatory dislocation. Progressive compression of medulla and the left vertebral artery leaded to clinical worsening of neurology in this case after 8 years of follow-up. Surgical treatment was necessary for neurological decompression and to establish stability. [ABSTRACT FROM AUTHOR]

The posterior condylar canals (PCCs) and posterior condylar emissary veins (PCEVs) are potential anatomical landmarks for surgical approaches through the lateral foramen magnum. We conducted computed tomography (CT) and microsurgical investigation of how PCCs and PCEVs can aid in planning and performing these approaches. We analyzed the microanatomy of PCCs and PCEVs using cadaveric specimens, dry skulls, and CT images. The recognition frequency and geometry of PCCs and PCEVs and their relationships with surrounding structures were evaluated. PCCs were identified in 36 of 50 sides in dry bones and 82 of 100 sides by CT. PCCs had a 3.5-mm mean diameter and a 6.8-mm mean canal length. We classified their courses into four types according to intracranial openings: the sigmoid sinus (SS) type, the jugular bulb (JB) type, the occipital sinus type, and the anterior condylar emissary vein type. In most cases, PCEV originated near the boundary between the SS and JB. PCCs and PCEVs can be useful anatomical landmarks to differentiate the transcondylar fossa approach from the transcondylar approach, thus preventing unnecessary injury of the atlantooccipital joint. They can also be used as landmarks when the jugular foramen (JF) and hypoglossal canal (HGC) are being exposed. The area anterior to the brain stem and the medial part of HGC can be accessed by removal of the lateral foramen magnum medial to PCC. JF and the lateral part of HGC can be accessed by removal of the skull base lateral to PCC without damaging the lateral rim of the foramen magnum. [ABSTRACT FROM AUTHOR]

Non-missile penetrating spinal cord injuries are uncommon, and involvement of the craniocervical junction is even less frequent. The author reports a case of 42-year-old male who presented with quadriparesis immediately following stab injury inflicted with a kitchen knife to the back of his neck. The knife was retained in the patient’s neck. Neurological examination revealed spastic paraplegia and severe weakness of the left upper limb and the right-hand grip, and sensory disturbance from C2 and downwards. In addition to these symptoms, cerebrospinal fluid (CSF) was leaking from the wound. Computerised tomography (CT) scan showed the blade passed through the spinal canal and its tip reached the odontoid peg. After retrieval of the knife, his quadriparesis recovered. The management and outcome of the patient are described. [ABSTRACT FROM AUTHOR]