Individualized Treatment of Complex Craniovertebral Junction Abnormalities by Intraoperative Computed Tomography and Navigation System

Abstract

Background: Treatment of complex craniovertebral junction abnormalities (CCJA) with ventral cervicomedullary compression is challenging due to the aberrant anatomic structures. The exact site of the compression is usually away from the midline. The intraoperative CT and navigation system is helpful for the localization. Objective: To assess the feasibility and potential utility of this system in individualized treatment of CCJA. Methods: We applied this technology to endoscopic transnasal or microsurgical transoral odontoidectomy and/or clivusectomy in 25 cases, odontoidectomy through posterior midline approach in 1 case, and transoral C1 lateral mass resection in 1 case. The pre- and postoperative neurologic status was examined. Results: No neurovascular injury occurred during surgery. Neuronavigation was found to correlate well with the intraoperative findings. All the patients had the improvement of the presenting clinical symptoms. The mean postoperative Japanese Orthopedic Association score was 14.9, compared with the preoperative score of 10.6 (p < 0.01). One case had postoperative pulmonary infection and one case with clivusectomy had the rupture of the dura mater and leakage of cerebrospinal fluid. Conclusions: For some complicated situations of the craniovertebral junction abnormalities, the treatment strategies should be tailored and individualized and the intraoperative CT-based navigation is an effective method to be considered.