Download PDF
Neuropediatrics 2011; 42(05): 197-199
DOI: 10.1055/s-0031-1287762
Short Communication
© Georg Thieme Verlag KG Stuttgart · New York

Atlantoaxial Rotatory Fixation after Ventriculoperitoneal Shunting

R. F. Heary
1   UMDNJ – New Jersey Medical School, Neurological Institute of New Jersey, Newark, New Jersey, USA
,
P. Reid
1   UMDNJ – New Jersey Medical School, Neurological Institute of New Jersey, Newark, New Jersey, USA
,
P. W. Carmel
1   UMDNJ – New Jersey Medical School, Neurological Institute of New Jersey, Newark, New Jersey, USA
› Author Affiliations
Further Information

Publication History

received 17 June 2010

accepted 07 August 2011

Publication Date:
29 September 2011 (online)

    Permissions and Reprints

Abstract

Ventriculoperitoneal (VP) shunting is a common neurosurgical procedure in the pediatric population. Atlantoaxial rotatory fixation (AARF) is not uncommon in this same group. We present the first reported case of AARF following a VP shunt procedure. A 10-year-old boy, with hydrocephalus and a left temporal arachnoid cyst since birth, underwent a revision of his VP and cystoperitoneal shunts. A second operation was performed 2 days later to optimize catheter placement. Postoperative neck pain was attributed to tunneling of the subcutaneous catheter. 2 months after surgery, the child had minimal neck discomfort but maintained his head in a “cock-robin” position. Plain radiographs and computed tomographic (CT) images confirmed AARF. The child was admitted and placed in halo traction. After 3 days of traction, analgesics, sedation, and muscle relaxants, anatomic re-alignment of the C1-C2 vertebral complex was confirmed on CT scan. Following 3 months of immobilization in a halo-vest apparatus, the halo was removed. At 8-year follow-up, the clinical examination is normal and repeat imaging studies remain normal. Due to surgical positioning, and postoperative signs attributed to normal postoperative pain, an AARF was not initially recognized. This case represents the first time that AARF has been reported following a VP shunt procedure.

Key words

atlantoaxial rotatory fixation - traction - ventriculoperitoneal shunt - halo
 

  • References

  • 1 Bondurant CP, Jimenez DF. Epidemiology of cerebrospinal fluid shunting. Pediatr Neurosurg 1995; 23: 254-259
    CrossrefPubMedGoogle Scholar
  • 2 Corner EM. Rotatory dislocation of the atlas. Ann Surg 1907; 45: 9-26
    CrossrefPubMedGoogle Scholar
  • 3 Fielding JW. Cineroentgenography of the normal cervical spine. J Bone Joint Surg [Am] 1957; 39: 1280-1288
    PubMedGoogle Scholar
  • 4 Hopla DM, Mazur JM, Bass RM. Cervical vertebrae subluxation. Laryngoscope 1993; 93: 1155-1159
    PubMedGoogle Scholar
  • 5 Maheshwaran S, Sgouros S, Jeyapalan K et al. Imaging of childhood torticollis due to atlanto-axial rotatory fixation. Child’s Nerv Syst 1995; 11: 667-671
    PubMedGoogle Scholar
  • 6 Moore KR, Frank EH. Traumatic atlantoaxial rotatory subluxation and dislocation. Spine 1995; 20: 1928-1930
    CrossrefPubMedGoogle Scholar
  • 7 Phillips WA, Hensinger RN. The management of rotary atlanto-axial subluxation in children. J Bone Joint Surg [Am] 1989; 71: 664-668
    PubMedGoogle Scholar
  • 8 Subach BR, McLaughlin MR, Albright AL et al. Current management of pediatric atlantoaxial rotatory subluxation. Spine 1998; 23: 2174-2179
    CrossrefPubMedGoogle Scholar
  • 9 Wu Y, Green NL, Wrensch MR et al. Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery 2007; 61 (03) 557-562
    CrossrefPubMedGoogle Scholar
  • 10 Pang D, Li V. Atlantoaxial rotatory fixation: part 3 − a prospective study of the clinical manifestation, diagnosis, management, and outcome of children with atlantoaxial rotatory fixation. Neurosurgery 2005; 57: 954-972
    CrossrefPubMedGoogle Scholar