Specialists of the spinal division together with doctor V.Stepanenko (St.-Petersburg) have performed a unique operation on the patient with craniovertabral anomaly.

The specialists of the spinal neurosurgical division together with Vitaly Stepanenko (neurosurgeon from St.-Petersburg) have performed a unique operation on the patient with craniovertabral anomaly.

Craniovertabral anomalies are rare pathology of a human spinal column development. In such diseases there are changes of the junction point of the skull with the spinal column of a person, occurring in affection of not only supporting and movement functions but also of spinal column structures and brain stem.

The patient under operation had a basilar impression, a state when the odontoid bone shifts into the skull. In this case the spinal brain structures are compressed by the odontoid arm from the front and are pushed down to the edge of a great occipital foramen from the back, i.e. the spinal brain gets into the bone-cutting slipknot. It was impossible to remove it without surgical treatment. In such compressed state the blood isn’t supplied to the spinal brain and the brain column sufficiently, they gradually mortify and the patient feels arms and legs weakness, sensory decrement in the whole body, dysphasia, difficult swallowing, breathing, etc. and all these may lead to death of a patient.

Being compressed, nerve structures should be not only released from all sides (in the front and in the back) but also fix the skull to the cervical spine because compressing formations are support structure of the head.

That is why one of the most difficult types of surgical procedures in spinal surgery was offered for the patient: Transoral resection of odontoid bone by mouth. In case of this surgical procedure, the aditus to the oral cavity is performed with the use of a special Crawford mouth opener. Moving the tongue, palatine velum aside, this opener forms direct visual field for the posterior pharyngeal wall for beginning of surgical procedure. Soft tissues of the posterior pharyngeal wall are incised thanks to which the anterior surface of odontoid bone comes out. Going forward, step by step this odontoid bone is removed with the use of surgical equipment. After removal of odontoid bone anterior decompression of nerve structures is performed and the brine is being stitched. The patient was turned into prone position for the second phase of the operation to be performed. It consisted in removal of the anterior compressing factor, i.e. anterior occipital bone. For this purpose surgical approach to craniovertabral abarthrosis from behind was performed, occipital bone and its dorsal segments compressing the spinal cord were exposed. The procedure ended in installation of a special fixing construction – occipitospondylodesis, with the help of which the skull and cervical spine were secured.

The goal of this surgical treatment in this patient was achieved, full decompression of spinal and rachidian bulb was performed, and the skull and cervical spine were secured with the help of false construction. The patient’s state after that surgical procedure was stable; he receives treatment that will speed up his recovery.

Vitaly V.Stepanenko (St.-Petersburg) together with neurosurgeons of the spinal division of the Federal Neurosurgical Center perform transoral resection of odontoid bone by mouth.