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Aguilera-Pena MP, Castiblanco MA, Osejo-Arcos V, Aponte-Caballero R, Gutierrez-Gomez S, Abaunza-Camacho JF, Guevara-Moriones N, Benavides-Burbano CA, Riveros-Castillo WM, Saavedra JM. Collet-Sicard syndrome: a scoping review. Neurosurg Rev 2023; 46:244. [PMID: 37707587 DOI: 10.1007/s10143-023-02145-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023]
Abstract
Collet-Sicard syndrome (CSS) is the unilateral palsy of the cranial nerves (CN) IX, X, XI, and XII. To our knowledge, no review describes the characteristics of patients diagnosed with CSS. Therefore, this review aims to collect and describe all cases in the literature labeled as CSS. We performed a scoping review of the literature and conducted a database search in Embase and PubMed. We included articles and abstracts with case reports or case series of patients with CSS diagnosis. We classified the cases into two groups: "CSS", referring to patients presenting exclusively with IX-XII nerve involvement, and "CSS-plus", which corresponds to cases with CSS and other neurological impairments. We included 135 patients from 126 articles, of which 84 (67.7%) were male. The most common clinical manifestations reported were dysphagia and dysphonia. The most common etiology was tumoral in 53 cases (39.6%) and vascular in 37 cases (27.6%). The majority of patients showed partial or total improvement, with just over half receiving conservative treatment. The most frequent anatomic space was the jugular foramen (44.4%) and the parapharyngeal retrostyloid space (28.9%). Approximately 21% of the patients had other CN impairments, with the seventh and eighth CN most frequently compromised. We conclude that although there is a need for greater rigor in CSS reporting, the syndrome has a clear utility in identifying the localization of jugular foramen and parapharyngeal retrostyloid space pathology.
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Affiliation(s)
| | - Maria A Castiblanco
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Valentina Osejo-Arcos
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Rafael Aponte-Caballero
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Santiago Gutierrez-Gomez
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Juan Felipe Abaunza-Camacho
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | | | - Camilo Armando Benavides-Burbano
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - William M Riveros-Castillo
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Javier M Saavedra
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
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Lian C, Liu S, Li X, Du ZH. The diagnosis process of Collet-Sicard syndrome caused by skull base fracture: A case report. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:649-651. [DOI: 10.1016/j.nrleng.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
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3
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Lian C, Liu S, Li X, Du ZH. The diagnosis process of Collet-Sicard syndrome caused by skull base fracture: A case report. Neurologia 2020; 36:S0213-4853(20)30422-9. [PMID: 33309200 DOI: 10.1016/j.nrl.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- C Lian
- Department of Acupuncture, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - S Liu
- Department of Acupuncture, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - X Li
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Z-H Du
- Department of Acupuncture, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
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4
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Martin-Giménez T, Cruz AM, Barragán A, Montero E, Sanchez PG, Caballero G, Corradini I. Delayed onset vagus nerve paralysis after occipital condyle fracture in a horse. J Vet Intern Med 2019; 33:2780-2785. [PMID: 31556150 PMCID: PMC6872609 DOI: 10.1111/jvim.15581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/15/2019] [Indexed: 11/30/2022] Open
Abstract
Occipital condylar fractures (OCFs) causing delayed onset lower cranial nerve paralysis (LCNPs) are rare. We present a 7‐year‐old Friesian horse with delayed onset dysphagia caused by vagus nerve (CNX) paralysis and suspicion of glossopharyngeal nerve (CNIX) paralysis developed several days after a minor head injury. Endoscopic examination revealed right laryngeal hemiplegia and intermittent dorsal displacement of the soft palate. An area of submucosal hemorrhage and bulging was appreciated over the dorsal aspect of the medial compartment of the right guttural pouch. Radiological examination of the proximal cervical region showed rotation of the atlas and the presence of a large bone fragment dorsal to the guttural pouches. Occipital condyle fracture with delayed onset cranial nerve paralysis was diagnosed. Delayed onset cranial nerve paralysis causing dysphagia might be a distinguishable sign of OCF in horses. Delayed onset dysphagia after head injury should prompt equine clinicians to evaluate the condition of the atlanto‐occipital articulation and skull base.
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Affiliation(s)
- Tamara Martin-Giménez
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Antonio M Cruz
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.,Department of Animal Medicine and Surgery, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Agustín Barragán
- Pathological Anatomy Service. Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Estefanía Montero
- Pathological Anatomy Service. Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Pedro G Sanchez
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Guillermo Caballero
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Ignacio Corradini
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.,Department of Animal Medicine and Surgery, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
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5
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Duque-Parra JE, Barco-Ríos J, Barco-Cano JA. El verdadero origen aparente de los nervios glosofaríngeo, vago y accesorio. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n2.68096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. Existe un vacío conceptual asociado con los sitios precisos por donde emergen las raíces de los nervios glosofaríngeo, vago y accesorio, un conocimiento que es de suma importancia para los neurocirujanos.Objetivo. Determinar el sitio preciso por donde las raíces de los nervios glosofaríngeo, vago y accesorio emergen como origen aparente en la médula oblongada.Materiales y métodos. Se valoraron 67 troncos encefálicos humanos que con anterioridad habían sido fijados en solución de formalina al 10%. Mediante inspección directa, luego de retirar las meninges, se examinó y registró el sitio preciso por donde emergen las raíces de tales nervios y se comparó con lo registrado en la literatura.Resultados. En el 100% de los troncos encefálicos estudiados se encontró que las raíces nerviosas emergen entre 2mm a 3mm por detrás del surco retro-olivar, distinto a lo reportado en la literatura consultada.Conclusión. Hay disparidad de criterios en cuanto al origen aparente de los nervios glosofaríngeo, vago y accesorio, lo que amerita un estudio más amplio que permita llegar a un consenso generalizado sobre el sitio preciso por donde las raíces de tales nervios hacen su aparición.
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Khaku A, Patel V, Zacharia T, Goldenberg D, McGinn J. Guidelines for radiographic imaging of cranial neuropathies. EAR, NOSE & THROAT JOURNAL 2018; 96:E23-E39. [PMID: 29121382 DOI: 10.1177/0145561317096010-1106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Disruption of the complex pathways of the 12 cranial nerves can occur at any site along their course, and many, varied pathologic processes may initially manifest as dysfunction and neuropathy. Radiographic imaging (computed topography or magnetic resonance imaging) is frequently used to evaluate cranial neuropathies; however, indications for imaging and imaging method of choice vary considerably between the cranial nerves. The purpose of this review is to provide an analysis of the diagnostic yield and the most clinically appropriate means to evaluate cranial neuropathies using radiographic imaging. Using the PubMed MEDLINE NCBI database, a total of 49,079 articles' results were retrieved on September 20, 2014. Scholarly articles that discuss the etiology, incidence, and use of imaging in the context of evaluation and diagnostic yield of the 12 cranial nerves were evaluated for the purposes of this review. We combined primary research, guidelines, and best practice recommendations to create a practical framework for the radiographic evaluation of cranial neuropathies.
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Affiliation(s)
- Aliasgher Khaku
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, 500 University Dr., MC H091, Hershey, PA 17033-0850, USA
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7
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Chacko J, Brar G, Mundlapudi B, Kumar P. Bilateral Lower Cranial Nerve Palsy after Closed Head Injury: A Case Report and Review of Literature. Indian J Crit Care Med 2018; 22:879-882. [PMID: 30662229 PMCID: PMC6311977 DOI: 10.4103/ijccm.ijccm_476_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paralysis of the lower cranial nerves is uncommon after closed head injuries. Most cases reported are unilateral and associated with base of skull fractures, usually involving the occipital condyles. Bilateral lower cranial nerve palsy is even less common, with only a handful of cases reported in literature. A 17-year-old girl presented to us after she was involved in a side-on collision with a car while driving a scooter. She sustained traumatic brain injury requiring mechanical ventilation. Detailed neurological evaluation revealed bilateral paralysis of the IXth, Xth, and XIIth cranial nerves with no evidence of a fracture of the base of skull or brain stem injury. A traction type of injury to the nerves arising from a whiplash mechanism may have led to paralysis of the lower cranial nerves in our patient. An exhaustive review of literature revealed 11 reports of bilateral lower cranial nerve palsy associated with closed head injuries; there were only four cases without underlying fracture of the occipital condyles. Our patient made a complete recovery over a period of 4 months. A traction type of injury to the lower cranial nerves may occur due to a whiplash mechanism. This type of injury may be associated with a favorable outcome.
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Affiliation(s)
- Jose Chacko
- Department of Critical Care Medicine, Narayana Multispeciality Hospital, Bengaluru, Karnataka, India
| | - Gagan Brar
- Department of Critical Care Medicine, Narayana Multispeciality Hospital, Bengaluru, Karnataka, India
| | - Bhargav Mundlapudi
- Department of Critical Care Medicine, Narayana Multispeciality Hospital, Bengaluru, Karnataka, India
| | - Pradeep Kumar
- Department of Critical Care Medicine, Narayana Multispeciality Hospital, Bengaluru, Karnataka, India
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8
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Mazur MD, Couldwell WT, Cutler A, Shah LM, Brodke DS, Bachus K, Dailey AT. Occipitocervical Instability After Far-Lateral Transcondylar Surgery: A Biomechanical Analysis. Neurosurgery 2017; 80:140-145. [PMID: 28362894 DOI: 10.1093/neuros/nyw002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/19/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND After a far-lateral transcondylar approach, patients may maintain neutral alignment in the immediate postoperative period, but severe occipitoatlantal subluxation may occur gradually with cranial settling and possible neurological injury. Previous research is based on assumptions regarding the extent of condylar resection and the change in biomechanics that produces instability. OBJECTIVE To quantify the extent of bone removal during a far-lateral transcondylar approach, determine the changes in range of motion (ROM) and stiffness that occur after condylar resection, and identify the threshold of condylar resection that predicts alterations in occipitocervical biomechanics. METHODS Nine human cadaveric specimens were biomechanically tested before and after far-lateral transcondylar resection extending into the hypoglossal canal (HC). The extent of condylar resection was quantified using volumetric comparison between pre- and postresection computed tomography scans. ROM and stiffness testing were performed in intact and resected states. The extent of resection that produced alterations in occipitocervical biomechanics was assessed with sensitivity analysis. RESULTS Bone removal during condylar resection into the HC was 15.4%-63.7% (mean 35.7%). Sensitivity analysis demonstrated that changes in biomechanics may occur when just 29% of the occipital condyle was resected (area under the curve 0.80-1.00). CONCLUSION Changes in occipitocervical biomechanics may be observed if one-third of the occipital condyle is resected. During surgery, the HC may not be a reliable landmark to guide the extent of resection. Patients who undergo condylar resections extending into or beyond the HC require close surveillance for occipitocervical instability.
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Affiliation(s)
- Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Aaron Cutler
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Lubdha M Shah
- Department of Radiology, University of Utah, Salt Lake City, Utah
| | - Darrel S Brodke
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Kent Bachus
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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Vadivelu S, Masood Z, Krueger B, Marciano R, Chen D, Houseman C, Insinga S. Long-term resolution of delayed onset hypoglossal nerve palsy following occipital condyle fracture: Case report and review of the literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:149-152. [PMID: 28694600 PMCID: PMC5490350 DOI: 10.4103/jcvjs.jcvjs_34_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present the case of a patient that demonstrates resolution of delayed onset hypoglossal nerve palsy (HNP) subsequent to occipital condyle fracture following a motor vehicle accident. Decompression of the hypoglossal nerve and craniocervical fixation led to satisfactory long-term (>5 years) outcome. There is a scarcity of literature in recognizing HNPs following trauma and a lack of pathophysiological understanding to both a delayed presentation and to resolution versus persistence. This is the first report demonstrating long-term resolution of hypoglossal nerve injury following trauma to the craniocervical junction.
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Affiliation(s)
- Sudhakar Vadivelu
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Zihan Masood
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bryan Krueger
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rudy Marciano
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA
| | - David Chen
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA
| | - Cliff Houseman
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA
| | - Salvatore Insinga
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA
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Byström O, Jensen TS, Poulsen FR. Outcome of conservatively treated occipital condylar fractures - A retrospective study. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:322-327. [PMID: 29403243 PMCID: PMC5763588 DOI: 10.4103/jcvjs.jcvjs_97_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Occipital condyle fracture (OCF) is rare. It may, however, pose a serious threat to the patient due to destabilization of the craniocervical junction. Correct diagnosis and effective treatment are essential to prevent long-term complications. The aim of this study was to retrospectively investigate our current treatment program with focus on the functional outcome. Diagnosis and classification systems were evaluated for their usefulness in the clinical practice. Materials and Methods: We retrospectively reviewed all patients treated conservatively for an occipital condylar fracture from 2010 to 2015 at our department. Fracture classifications were performed according to three established systems. The patients were followed up with clinical examination and plain radiographs at weeks 2, 6, and 12 with the addition of a dynamic flexion-extension X-ray at week 14. Results: Totally 24 patients met the inclusion criteria. One was lost to follow-up and two ended treatment before completing the full treatment program due to a clinical decision. Fracture displacement was neither detected nor was any neurological deficits observed. Most patients were pain free after 6 weeks. After 14 weeks’ treatment, two patients still had neck pain; the rest were pain free. Conclusions: Our data suggest that twelve weeks’ conservative treatment is not necessary for unilateral OCFs without atlanto-occipital dissociation (AOD). We recommend 6 weeks of conservative treatment, with clinical control and flexion-extension radiographs before ending treatment. Plain radiography is of limited value in the clinical control of this fracture type. Anderson and Montesano and Tuli et al. classification systems fulfill an academic role. We found the classification system by Mueller et al. to be more helpful in everyday clinical practice.
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Affiliation(s)
- Olof Byström
- Department of Neurosurgery, Odense University Hospital and University of Southern Denmark, Denmark
| | - Torben S Jensen
- Department of Neurosurgery, Odense University Hospital and University of Southern Denmark, Denmark
| | - Frantz R Poulsen
- Department of Neurosurgery, Odense University Hospital and University of Southern Denmark, Denmark
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Mnari W, Kilani M, Harrathi K, Maatouk M, Koubaa J, Golli M. An unusual etiology of posttraumatic Collet-Sicard Syndrome: a case report. Pan Afr Med J 2016; 23:143. [PMID: 27279968 PMCID: PMC4885715 DOI: 10.11604/pamj.2016.23.143.9143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/16/2016] [Indexed: 11/16/2022] Open
Abstract
Posttraumatic Unilateral paralysis of the last four cranial nerves (IX-XI), known as collet-Sicard syndrome, is rare following closed head injury. A 21-year-old man presented with slurred speech, hoarseness voice and difficulty swallowing his saliva following closed head trauma. The cranial nerve examination revealed left sided severe dysfunction of cranial nerves VII, IX, X, XI, and XII. A CT-Scan of the neck was performed demonstrating a fracture of the left styloid process at the base of the skull. The Magnetic Resonance Imaging showed unusually well seen lower cranial nerves due to nerve edema. The patient was managed conservatively with steroids and regular sessions of neuromuscular and orthophonic rehabilitation. The nutrition had to be administered by gastrostomy since he was unable to swallow. Six months after the injury a total neurological recovery was noted. We present the exceptional case of Collet-Sicard Syndrome caused by styloid process fracture.
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Affiliation(s)
- Walid Mnari
- Imaging Department, Fattouma Bourguiba University Hospital, Medical university, Monastir, Tunisia
| | - Mohamed Kilani
- Neurosurgery Department, Fattouma Bourguiba University Hospital, Medical university, Monastir, Tunisia
| | - Khaled Harrathi
- Otorhinolaryngology Department, Fattouma Bourguiba University Hospital, Medical University, Monastir, Tunisia
| | - Mezri Maatouk
- Imaging Department, Fattouma Bourguiba University Hospital, Medical university, Monastir, Tunisia
| | - Jamel Koubaa
- Otorhinolaryngology Department, Fattouma Bourguiba University Hospital, Medical University, Monastir, Tunisia
| | - Mondher Golli
- Imaging Department, Fattouma Bourguiba University Hospital, Medical university, Monastir, Tunisia
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12
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Yoo SD, Kim DH, Lee SA, Joo HI, Yeo JA, Chung SJ. Bilateral Cranial IX and X Nerve Palsies After Mild Traumatic Brain Injury. Ann Rehabil Med 2016; 40:168-71. [PMID: 26949684 PMCID: PMC4775751 DOI: 10.5535/arm.2016.40.1.168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/03/2015] [Indexed: 11/24/2022] Open
Abstract
We report a 57-year-old man with bilateral cranial nerve IX and X palsies who presented with severe dysphagia. After a mild head injury, the patient complained of difficult swallowing. Physical examination revealed normal tongue motion and no uvular deviation. Cervical X-ray findings were negative, but a brain computed tomography revealed a skull fracture involving bilateral jugular foramen. Laryngoscopy indicated bilateral vocal cord palsy. In a videofluoroscopic swallowing study, food residue remained in the vallecula and pyriform sinus, and there was reduced motion of the pharynx and larynx. Electromyography confirmed bilateral superior and recurrent laryngeal neuropathy.
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Affiliation(s)
- Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University, Seoul, Korea
| | - Dong Hwan Kim
- Department of Rehabilitation Medicine, Kyung Hee University, Seoul, Korea
| | - Seung Ah Lee
- Department of Rehabilitation Medicine, Kyung Hee University, Seoul, Korea
| | - Hye In Joo
- Department of Rehabilitation Medicine, Kyung Hee University, Seoul, Korea
| | - Jin Ah Yeo
- Department of Rehabilitation Medicine, Kyung Hee University, Seoul, Korea
| | - Sung Joon Chung
- Department of Rehabilitation Medicine, Kyung Hee University, Seoul, Korea
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Yellinek S, Cohen A, Merkin V, Shelef I, Benifla M. Clinical significance of skull base fracture in patients after traumatic brain injury. J Clin Neurosci 2015; 25:111-5. [PMID: 26724846 DOI: 10.1016/j.jocn.2015.10.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/10/2015] [Indexed: 10/22/2022]
Abstract
About 4% of all head injuries include skull base fractures. Most of these fractures (90%) are secondary to closed head trauma; the remainder are due to penetrating trauma. We reviewed the records from January 2006 through December 2008 of all patients older than 18 years of age who arrived at Soroka Medical Center in Be'er-Sheva, Israel, with skull base fractures following a traumatic brain injury (TBI). We identified 107 patients with a mean age of 42 years at the time of TBI. Glasgow Coma score on arrival predicted the clinical outcome. We observed temporal fractures in 30% of these patients, occipital fractures in 20%, pyramidal fractures in 19%, anterior skull base fractures in 17%, and multiple fractures in 14%. Cerebrospinal fluid (CSF) leak was observed in 16 patients (15%). Of the patients experiencing CSF leaks, otorrhea occurred in 10 (62%) and rhinorrhea occurred in six (37%). Three patients required surgical intervention to repair the leak. Meningitis occurred in four patients with clinically evident CSF leak. Multiple skull base fractures are associated with poor neurological outcome. The low rate of meningitis in this patient sample implies that there is no indication to administer prophylactic antibiotics to patients with skull base fractures.
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Affiliation(s)
- Shlomi Yellinek
- Neurosurgery Department, Soroka Medical Center and Ben-Gurion University, Be'er-Sheva, Israel
| | - Avi Cohen
- Neurosurgery Department, Soroka Medical Center and Ben-Gurion University, Be'er-Sheva, Israel
| | - Vladimir Merkin
- Neurosurgery Department, Soroka Medical Center and Ben-Gurion University, Be'er-Sheva, Israel
| | - Ilan Shelef
- Neuroradiology Division, Soroka Medical Center and Ben-Gurion University, Be'er-Sheva, Israel
| | - Mony Benifla
- Neurosurgery Department, Hadassah Medical Center, Jerusalem, Israel.
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Abstract
Lesions of the lower cranial nerves (LCN) are due to numerous causes, which need to be differentiated to optimize management and outcome. This review aims at summarizing and discussing diseases affecting LCN. Review of publications dealing with disorders of the LCN in humans. Affection of multiple LCN is much more frequent than the affection of a single LCN. LCN may be affected solely or together with more proximal cranial nerves, with central nervous system disease, or with nonneurological disorders. LCN lesions have to be suspected if there are typical symptoms or signs attributable to a LCN. Causes of LCN lesions can be classified as genetic, vascular, traumatic, iatrogenic, infectious, immunologic, metabolic, nutritional, degenerative, or neoplastic. Treatment of LCN lesions depends on the underlying cause. An effective treatment is available in the majority of the cases, but a prerequisite for complete recovery is the prompt and correct diagnosis. LCN lesions need to be considered in case of disturbed speech, swallowing, coughing, deglutition, sensory functions, taste, or autonomic functions, neuralgic pain, dysphagia, head, pharyngeal, or neck pain, cardiac or gastrointestinal compromise, or weakness of the trapezius, sternocleidomastoid, or the tongue muscles. To correctly assess manifestations of LCN lesions, precise knowledge of the anatomy and physiology of the area is required.
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Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Kaiser-Franz-Josef Spital, Vienna, Austria, Europe
| | - Wolfgang Grisold
- Department of Neurology, Kaiser-Franz-Josef Spital, Vienna, Austria, Europe
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Utheim NC, Josefsen R, Nakstad PH, Solgaard T, Roise O. Occipital condyle fracture and lower cranial nerve palsy after blunt head trauma - a literature review and case report. J Trauma Manag Outcomes 2015; 9:2. [PMID: 25897322 PMCID: PMC4403883 DOI: 10.1186/s13032-015-0024-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/13/2015] [Indexed: 11/22/2022]
Abstract
Background Lower cranial nerve (IX-XII) palsy is a rare condition with numerous causes, usually non-traumatic. In the literature it has been described only a few times after trauma, mostly accompanied by a fracture of the occipital condyle. Although these types of fractures have rarely been reported one could suspect they have been under-diagnosed. During the past decade they have been seen more frequently, most probably due to increased use of CT- and MRI-scanning. The purpose of this review is to increase the awareness of complications following injuries in the craniocervical region. Methods We based this article on a retrospective review of the medical record of a 24-year old woman admitted to our trauma center after being involved in a car accident and a review of the literature on occipital condyle fractures associated with lower cranial nerve palsy. Results The multitraumatized patient had suffered a dislocated occipital condyle fracture. Months later she was diagnosed with palsy to cranial nerve IX-XII. Literature review shows that occipital condyle fractures are rare as isolated injuries and are in many cases accompanied by further injuries to the cervical spine and soft tissue structures, in many cases ending with severe disability. The exact mechanism leading to these injuries cannot always be explained. Conclusion Recognition of soft tissue injuries in patients with blunt head trauma is important. CT findings involving the craniocervical junction in these patients advocates further investigations including a thorough neurological examination and liberal use of MRI.
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Affiliation(s)
- Nils Christian Utheim
- Department of Neurosurgery, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Roger Josefsen
- Department of Neurosurgery, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Per Hjalmar Nakstad
- Department of Neuroradiology, Division of Diagnostics and Intervention, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torfinn Solgaard
- Department of Neurosurgery, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Olav Roise
- Department of Orthopedics, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Post-traumatic Collet–Sicard syndrome: personal observation and review of the pertinent literature with clinical, radiologic and anatomic considerations. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:663-70. [DOI: 10.1007/s00586-014-3527-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/17/2014] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
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Daley NC, Colliver EB. A case of Vernet syndrome associated with internal jugular phlebectasia. PM R 2014; 6:1163-5. [PMID: 24998404 DOI: 10.1016/j.pmrj.2014.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 05/01/2014] [Accepted: 05/13/2014] [Indexed: 11/18/2022]
Abstract
A 36-year-old woman presented with right shoulder weakness after a left parotid tumor resection. The overall clinical presentation included severe paralysis and atrophy of the right sternocleidomastoid and upper trapezius, an absent right gag reflex, and diminished right posterior tongue pinprick sensation. A diagnosis of right-sided Vernet syndrome (cranial nerve IX, X, XI lesions) was made, presumably from compression of cranial nerves by internal jugular vein phlebectasia. To our knowledge, this is the first case report of spontaneous Vernet syndrome associated with internal jugular vein phlebectasia in the absence of other lesions of the jugular foramen.
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Affiliation(s)
- Nicholas C Daley
- Edward Via College of Osteopathic Medicine, Virginia Campus, Blacksburg, VA∗
| | - Ethan B Colliver
- Edward Via College of Osteopathic Medicine, Virginia Campus, Blacksburg, VA(†).
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Traumatisme crânien : atteintes des paires crâniennes inférieures (IX, X, XI, XII). À propos de 3 observations. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cugy E, Marsollet H, Minvielle C, Bordes J, Delleci C, Petit L. Traumatic brain injury: Lower cranial nerves palsy. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Joaquim AF, Ghizoni E, Tedeschi H, Lawrence B, Brodke DS, Vaccaro AR, Patel AA. Upper cervical injuries - a rational approach to guide surgical management. J Spinal Cord Med 2014; 37:139-51. [PMID: 24559418 PMCID: PMC4066422 DOI: 10.1179/2045772313y.0000000158] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
CONTEXT The complex anatomy and the importance of ligaments in providing stability at the upper cervical spine region (O-C1-C2) require the use of many imaging modalities to evaluate upper cervical injuries (UCI). While separate classifications have been developed for distinct injuries, a more practical treatment algorithm can be derived from the injury pattern in UCI. OBJECTIVE To propose a practical treatment algorithm to guide treatment based on injuries characteristic of UCI. METHODS A literature review was performed on the Pubmed database using the following keywords: (1) "occipital condyle injury"; (2) "craniocervical dislocation or atlanto-occipital dislocation or craniocervical dislocation"; (3) "atlas fractures"; and (4) "axis fractures". Just articles containing the diagnosis, classification, and treatment of specific UCI were included. The data obtained were analyzed by the authors, dividing the UCI into two groups: Group 1 - patients with clear ligamentous injury and Group 2 - patients with fractures without ligament disruption. RESULTS Injuries with ligamentous disruption, suggesting surgical treatment, include: atlanto-occipital dislocation, mid-substance transverse ligament injury, and C1-2 and C2-3 ligamentous injuries. In contrast, condyle, atlas, and axis fractures without significant displacement/misalignment can be initially treated using external orthoses. Odontoid fractures with risk factors for non-union are an exception in Group 2 once they are better treated surgically. Patients with neurological deficits may have more unstable injuries. CONCLUSIONS Ascertaining the status of relevant ligamentous structures, fracture patterns and alignment are important in determining surgical compared with non-surgical treatment for patients with UCI.
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Affiliation(s)
- Andrei F. Joaquim
- Department of Neurosurgery, State University of Campinas, UNICAMP, Campinas-SP, Brazil,Correspondence to: Andrei F. Joaquim, Neurosurgery Division, State University of Campinas, 13083-970, Campinas-SP, Brazil. E-mail:
| | - Enrico Ghizoni
- Department of Neurosurgery, State University of Campinas, UNICAMP, Campinas-SP, Brazil
| | - Helder Tedeschi
- Department of Neurosurgery, State University of Campinas, UNICAMP, Campinas-SP, Brazil
| | - Brandon Lawrence
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Darrel S. Brodke
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | - Alpesh A. Patel
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
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Theodore N, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Walters BC, Hadley MN. Occipital Condyle Fractures. Neurosurgery 2013; 72 Suppl 2:106-13. [DOI: 10.1227/neu.0b013e3182775527] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Nicholas Theodore
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Sanjay S. Dhall
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Daniel E. Gelb
- Department of Orthopaedics, University of Maryland, Baltimore, Maryland
| | - R. John Hurlbert
- Department of Clinical Neurosciences, University of Calgary Spine Program, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Timothy C. Ryken
- Iowa Spine & Brain Institute, University of Iowa, Waterloo/Iowa City, Iowa
| | - Beverly C. Walters
- Department of Neurosciences, Inova Health System, Falls Church, Virginia
- Division of Neurological Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark N. Hadley
- Division of Neurological Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
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22
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Singh I, Singla S, Kumar G, Rohilla S. Isolated glossopharyngeal and vagus nerve palsy due to fracture involving the jugular foramen – Report of three cases. INDIAN JOURNAL OF NEUROTRAUMA 2012. [DOI: 10.1016/j.ijnt.2012.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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A Case of Bilateral Lower Cranial Nerve Palsies After Base of Skull Trauma With Complex Management Issues. Neurologist 2012; 18:152-4. [DOI: 10.1097/nrl.0b013e318247bb6f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Schrödel MH, Kestlmeier R, Trappe AE. Bilateral occipital condyle fracture: report of two cases. Skull Base 2011; 12:93-6. [PMID: 17167657 PMCID: PMC1656924 DOI: 10.1055/s-2002-31571-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Occipital condyle fractures are a rare finding in trauma victims. Bilateral fractures are even more unusual and have typically been reported in autopsy studies. We treated two patients with bilateral occipital condyle fractures who had only minor symptoms. Anderson and Montesano's classification,(1) possible cranial nerve palsies, diagnosis, and treatment of this rare fracture are discussed.
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Isolated paralysis of glossopharyngeal and vagus nerve associated with type II occipital condyle fracture: case report. Childs Nerv Syst 2010; 26:719-22. [PMID: 20054599 DOI: 10.1007/s00381-009-1070-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 12/09/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Occipital condyle fractures (OCFs) can occasionally be complicated with lower cranial nerve palsies. DISCUSSION Isolated 9th and 10th cranial nerve palsies following OCF are very rare. To our knowledge, we report the first case of an early onset of 9th and 10th cranial nerve palsies with an early full recovery in short period of time and discuss the probable mechanism of isolated nerve palsy in the light of the relevant literature.
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26
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Maserati MB, Stephens B, Zohny Z, Lee JY, Kanter AS, Spiro RM, Okonkwo DO. Occipital condyle fractures: clinical decision rule and surgical management. J Neurosurg Spine 2009; 11:388-95. [PMID: 19929333 DOI: 10.3171/2009.5.spine08866] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Occipital condyle fractures (OCFs) are rare injuries and their treatment remains controversial. Several classification systems have been proposed, first by Anderson and Montesano and more recently by Tuli and colleagues and Hanson and associates, who sought to stratify these fractures in a manner that would guide treatment that has typically ranged from semirigid collar immobilization to halo fixation or occipitocervical fusion. It has been the authors' impression, based on experience with OCFs at their institution, that classification is cumbersome and contributes little to the clinical decision-making process, while the identification of craniocervical misalignment and neural element compromise is paramount, and sufficient, for the planning of treatment. METHODS The authors performed a retrospective review of 24,745 consecutive trauma presentations to a single Level I trauma center (UPMC Presbyterian Hospital) over a 6-year period, identifying 100 patients with 106 OCFs. All patients were evaluated by the spine trauma service and underwent imaging of the craniocervical junction using reconstructed CT scans. Patient characteristics, fracture characteristics (including fracture classification according to the 2 major classification systems), initial management, and status at follow-up were recorded. RESULTS The incidence of OCF in this trauma population was 0.4%. Two patients had evidence of craniocervical misalignment on reconstructed CT imaging at the time of admission; both patients underwent occipitocervical fusion. One patient underwent occipitocervical fusion for unrelated C1-2 fractures. The remainder of those surviving to discharge, whose fractures represented all fracture subtypes, received treatment with a rigid cervical collar or counseling alone. No patients, including 4 patients with bilateral OCFs, were found to have developed delayed craniocervical instability or misalignment on follow-up, or to require further neurosurgical intervention for an OCF. Neural element compression was not identified in any of the patients, and there were no cases of delayed cranial neuropathy. CONCLUSIONS Beyond the identification of craniocervical misalignment on reconstructed CT scans at admission, further classification of OCFs is unnecessary. Management should consist of up-front occipitocervical fusion or halo fixation in cases demonstrating occipitocervical misalignment, or of immobilization in a rigid cervical collar followed by delayed clinical and radiographic evaluation in a spine trauma clinic if misalignment is not present.
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Affiliation(s)
- Matthew B Maserati
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh, Pennsylvania 15213, USA
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27
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Policeni BA, Smoker WR. Pathologic Conditions of the Lower Cranial Nerves IX, X, XI, and XII. Neuroimaging Clin N Am 2008; 18:347-68, xi. [DOI: 10.1016/j.nic.2007.12.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Alcelik I, Manik KS, Sian PS, Khoshneviszadeh SE. Occipital condylar fractures. Review of the literature and case report. ACTA ACUST UNITED AC 2006; 88:665-9. [PMID: 16645117 DOI: 10.1302/0301-620x.88b5.16598] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fractures of the occipital condyle are rare. Their prompt diagnosis is crucial since there may be associated cranial nerve palsies and cervical spinal instability. The fracture is often not visible on a plain radiograph. We report the case of a 21-year-old man who sustained an occipital condylar fracture without any associated cranial nerve palsy or further injuries. We have also reviewed the literature on this type of injury, in order to assess the incidence, the mechanism and the association with head and cervical spinal injuries as well as classification systems, options for treatment and outcome.
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Affiliation(s)
- I Alcelik
- Bradford Royal Infirmary, Duckworth Lane, Bradford, West Yorkshire BD9 6RJ, UK
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29
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Abstract
Injuries to the upper cervical spine (C0-C2) play a major role in surgical treatment of traumatic sequelae in the entire cervical spine. Even though the number of such operations has increased in recent years, there are no clear treatment recommendations for most types of cervical spine injuries. In view of the wide range of injury types and the correspondingly large number of treatment options, this review focuses mainly on the following types of injuries: C0 fractures, occipital condyle fractures (OCF), atlanto-occipital dislocation (AOD), atlas fractures, atlantoaxial dislocation (AAD), and axis fractures. Important aspects of the mechanisms of injury, clinical signs and symptoms, diagnostic procedures, and treatment options are discussed. Special emphasis is placed on comparatively reviewing the different treatment options discussed in the literature. A summary in table form is presented at the end of each chapter for quick reference.
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Affiliation(s)
- R Kayser
- Zentrum für spezielle Chirurgie des Bewegungsapparates, Klinik und Hochschulambulanz für Unfall- und Wiederherstellungschirurgie, Charité, Campus Benjamin Franklin, Universitätsmedizin Berlin.
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Kuitwaard K, Vandertop WP. A patient with an odontoid fracture and atrophy of the tongue: a case report and systematic review of the literature. SURGICAL NEUROLOGY 2005; 64:525-32, discussion 532-3. [PMID: 16293473 DOI: 10.1016/j.surneu.2005.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Accepted: 03/28/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traumatic hypoglossal nerve palsy is a rare entity and has rarely been described in association with an odontoid fracture. CASE DESCRIPTION We present a patient with a posttraumatic odontoid fracture who developed selective weakness of his arms and a unilateral hypoglossal nerve palsy. A systematic review of the literature is presented, and hypothetical causes for the injury are discussed. CONCLUSION Bell's cruciate paralysis and central cord syndrome are probably expressions of the same mechanism rather than 2 separate entities based on a preferential damage of pyramidal crossing arm fibers. C2 fractures with concomitant lower cranial nerve injury are relatively rare and have a reasonably good outcome, especially when unilateral.
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Affiliation(s)
- Krista Kuitwaard
- Department of Neurosurgery, VU University Medical Center, Postbox 7057, 1007 MB Amsterdam, The Netherlands
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31
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Baldauf J, Junghans D, Schroeder HWS. Endoscope-assisted microsurgical resection of an intraneural ganglion cyst of the hypoglossal nerve. J Neurosurg 2005; 103:920-2. [PMID: 16304998 DOI: 10.3171/jns.2005.103.5.0920] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ An unusual case of an intraneural ganglion cyst of the hypoglossal nerve is presented. Only one case of this rare clinical entity has been reported previously. A 51-year-old woman presented with a 6-month history of left-sided hypoglossal nerve palsy. Magnetic resonance imaging revealed a cystic lesion related to the hypoglossal canal. There was no enhancement of the lesion after administration of Gd. A high-resolution computerized tomography scan of the skull base demonstrated an enlargement of the hypoglossal canal.
To access the lesion, a far-lateral endoscope-assisted microsurgical approach was used. An intraneural ganglion lesion invading the hypoglossal nerve was found and resected. A histopathological examination confirmed that the lesion was an intraneural ganglion cyst. The occurrence of an intraneural ganglion cyst at the hypoglossal nerve is very rare. This case exemplifies an atypical location of a synovial cyst with cranial nerve involvement.
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Affiliation(s)
- Jörg Baldauf
- Departments of Neurosurgery and Neuropathology, Ernst Moritz Arndt University, Greifswald, Germany.
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Abstract
This report describes a pediatric case of delayed glossopharyngeal nerve, vagus nerve, and facial nerve palsies after a head injury. Computed tomography scan of the skull base revealed the fracture of the petrous part of the temporal bone, and the fracture involved the tip of petrous pyramid, in front of the jugular foramen. The anatomical features, mechanisms, diagnosis, and treatment are discussed.
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Affiliation(s)
- Altan Yildirim
- Otolaryngology and Head Neck Surgery Department, Cumhuriyet University Medical Faculty, Sivas, Turkey.
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33
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Caroli E, Rocchi G, Orlando ER, Delfini R. Occipital condyle fractures: report of five cases and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2005; 14:487-92. [PMID: 15754215 PMCID: PMC3454667 DOI: 10.1007/s00586-004-0832-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2004] [Accepted: 09/26/2004] [Indexed: 11/29/2022]
Abstract
Occipital condyle fractures (OCFs) are uncommon and potentially fatal lesions. After the advent of CT, prompt diagnosis can be readily made and consequently better prognosis of these patients is expected. Early recognition of some types of OCF is imperative to avoid fatal results. We analyzed 121 cases of OCF (116 from the literature and five of our own). Rarely patients with a deficit of the lower cranial nerves make a complete recovery. However, quoad vitam prognosis of patients with "pure OCFs" remains good. Immobilization provides good recovery of most OCFs, but delay of treatment can lead to serious morbidity. We want to emphasize that not only an OCF with instability of O-C1-C2 can be a fatal injury unless prompt surgical intervention, but a displacement and migration of the fractured condylar fragment can also result in a fatal outcome. A high level of suspicion is fundamental for the early diagnosis of these fractures, so that when a posterior basal cranial or occipital squama fracture occurs, a CT study of the occipital condyles becomes imperative.
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Affiliation(s)
- Emanuela Caroli
- Department of Neurological Sciences, Neurosurgery, S. Andrea Hospital, University of Rome "La Sapienza", Via Meropia, 85-00147 Rome, Italy.
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Freeman BJC, Behensky H. Bilateral occipital condyle fractures leading to retropharyngeal haematoma and acute respiratory distress. Injury 2005; 36:207-12. [PMID: 15589943 DOI: 10.1016/j.injury.2004.05.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2004] [Indexed: 02/02/2023]
Abstract
Injuries to the occipito-cervical junction are rare and not easily diagnosed on conventional radiographs. The authors report such a case where the diagnosis was delayed. The patient developed a significant retrophyarngeal haematoma resulting in acute respiratory distress and required emergency endotracheal intubation. The patient remained intubated for five days and received a tapered dose of intravenous dexamethazone to reduce swelling in the proximity of the airway. At six weeks the patient had developed a left hypoglossal nerve palsy that persisted at 12 months. Occipital condyle fractures and the difficulties of diagnosis are discussed. The importance of measuring pre-vertebral soft tissue swelling on lateral radiographs is emphasized. Computed tomography of the C0-C2 region should be performed to identify base of skull and upper cervical fractures.
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Affiliation(s)
- Brian J C Freeman
- The Centre for Spinal Studies and Surgery, University Hospital, Queens Medical Centre, Nottingham NG7 2UH, UK.
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35
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Affiliation(s)
- Raj D Rao
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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36
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Dvorak MFS, Fisher C, Boyd M, Johnson M, Greenhow R, Oxland TR. Anterior occiput-to-axis screw fixation: part I: a case report, description of a new technique, and anatomical feasibility analysis. Spine (Phila Pa 1976) 2003; 28:E54-60. [PMID: 12567042 DOI: 10.1097/01.brs.0000042237.97483.7b] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report of anterior screw fixation from the axis to the occiput is described, as is the surgical technique. The pertinent anatomy is described with a radiographic assessment of the feasibility, safety, and general applicability of this technique. OBJECTIVES To describe a novel technique of anterior occipitocervical fixation and the pertinent anatomy. SUMMARY OF BACKGROUND DATA In unique clinical situations where posterior fixation techniques may not be possible or may have already failed, an anterior screw fixation technique may add stability to further attempts at obtaining a posterior arthrodesis. METHODS A case report is presented, followed by a detailed description of the surgical technique. Ten normal cervical spines had radiographs and computed tomography scans with reformats reviewed to determine screw entry points, target points, and proposed screw trajectories. Following screw insertion in eight fresh frozen human cadaver spine specimens, dissection verified screw location relative to structures at risk. RESULTS The ideal entry point is located caudal to the C2 superior facet joint in line with the medial third of the C2 superior facet. The screw is directed 25 degrees posteriorly in the sagittal plane and 15 degrees laterally in the coronal plane. The screw tip is located in the posterolateral third of the occipital condyle. Anatomic variation is considerable and makes this technique inadvisable in up to 20% of cases. Structures at risk include the vertebral artery and the hypoglossal nerve. CONCLUSIONS This new technique of anterior fixation of the atlas to the occiput is feasible and safe if meticulous surgical planning is performed.
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Affiliation(s)
- Marcel F S Dvorak
- Division of Spine, Department of Orthopaedics, University of British Columbia and the Combined Neurosurgical and Orthopaedic Spine Program, Vancouver Hospital and Health Sciences Centre, Canada.
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Falavigna A, da Silva FM, Hennemann AS. [Occipital condyle fracture associated with Jefferson's fracture and injury of lower cranial nerves: case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 2002; 60:1038-41. [PMID: 12563404 DOI: 10.1590/s0004-282x2002000600030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Occipital condyle fracture(OCF) is rarely seen and can be missed during medical evaluation due to the variety of clinical presentations and the difficulty to be visualized radiographically. This fracture can be associated with cranial nerves injuries (31%), being the hipoglossal nerve the most frequently involved (67%). We report a 58 years old female patient who presented with OCF, injury of lower cranial nerves and Jefferson's fracture. The patient was treated with cervical traction for six weeks followed by halo immobilization for three months. There was bone consolidation recovery of the nervous injury after this period. This report emphazises the importance of investigating the skull-cervical transition in all patients with cervical trauma. Although Jefferson's fracture is rarely associated with OCF, it should be remembered and treated appropriately when diagnosed.
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Bibliography. Neurosurgery 2002. [DOI: 10.1097/00006123-200203001-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
DIAGNOSTIC STANDARDS There is insufficient evidence to support diagnostic standards. GUIDELINES Computed tomographic imaging is recommended for establishing the diagnosis of occipital condyle fractures. Clinical suspicion should be raised by the presence of one or more of the following criteria: blunt trauma patients sustaining high-energy craniocervical injuries, altered consciousness, occipital pain or tenderness, impaired cervical motion, lower cranial nerve paresis, or retropharyngeal soft tissue swelling. OPTIONS Magnetic resonance imaging is recommended to assess the integrity of the craniocervical ligaments. TREATMENT STANDARDS There is insufficient evidence to support treatment standards. GUIDELINES There is insufficient evidence to support treatment guidelines. OPTIONS Treatment with external cervical immobilization is recommended.
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