CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2017; 36(01): 62-65
DOI: 10.1055/s-0036-1579661
Case Report | Relato de Caso
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Management of a Complex Basilar Invagination Case with Multiple Revision Surgeries – Case Report

Tratamento de invaginação basilar complexa com múltiplas cirurgias de correção – relato de caso
Carlos Eduardo Vasconcelos Miranda
1  Department of Neurology, Neurosurgery Division, Universidade Estadual de Campinas Campinas, SP, Brazil
,
Hélio Henrique Jorge Torres
1  Department of Neurology, Neurosurgery Division, Universidade Estadual de Campinas Campinas, SP, Brazil
,
Guilherme Cardinali Barreiro
2  Division of Plastic Surgery, Universidade de São Paulo, Medical School, São Paulo, SP, Brazil and Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Andrei F. Joaquim
1  Department of Neurology, Neurosurgery Division, Universidade Estadual de Campinas Campinas, SP, Brazil
,
Helder Tedeschi
1  Department of Neurology, Neurosurgery Division, Universidade Estadual de Campinas Campinas, SP, Brazil
› Author Affiliations
Further Information

Publication History

21 May 2015

30 November 2015

Publication Date:
24 February 2016 (online)

  

Abstract

We describe a Basilar Invagination (BI) case with craniocervical instability and many previous failure surgeries and poor wound coverage. The patient had been submitted to a large posterior fossa craniectomy (which greatly limited the availability of an adequate area for bone fixation) and showed a poor quality of the surgical wound in the posterior craniocervical region. We performed an occipito-cervical fixation, using the bone overlying the torculla as a point of cranial fixation. Craniocervical realignment was achieved by the use of distractive maneuvers with occipital rods, followed by coverage of the hardware via a pedicled longitudinal trapeze myocutaneous flap. We used local ribs removed from the region where the myocutaneous flap was harvested as autologous bone grafts for craniocervical fusion. Post-operatively, the patient was placed in a halo-vest for three months. The patient improved substantially after the procedure, recovered some muscular strength and experienced total relief of her pain. We hereby discuss the surgical strategy used for treating this complex case in details, with illustrative pictures.

Resumo

Descrevemos caso de paciente com diagnóstico de invaginação basilar e instabilidade crânio cervical com múltiplas cirurgias prévias e deiscência de ferida operatória. Devido a falha de osso na escama occipital, assim como da cobertura cutânea adequada, realizamos realinhamento craniocervical, com descompressão indireta anterior, fixação occipitocervical na região da tórcula e cobertura da pele com flap miocutâneo longitudinal pediculado de trapézio. As costelas removidas da região do retalho miocutâneo foram transferidas para serem usadas como enxerto autólogo de osso para fusão craniocervical. No pós-operatório, a paciente utilizou um halo-vest por 3 meses. No presente artigo, apresentamos nuances ilustrados de manobras para realinhamento craniocervical por via posterior na invaginação basilar, bem como estratégias para otimizar a artrodese e o fechamento cutâneo.