An investigation of craniocervical stability post-condylectomy.
Biomechanics
Condylectomy
Craniocervical stability
Craniovertebral junction
Journal
Surgical neurology international
ISSN: 2229-5097
Titre abrégé: Surg Neurol Int
Pays: United States
ID NLM: 101535836
Informations de publication
Date de publication:
2021
2021
Historique:
received:
08
05
2021
accepted:
23
06
2021
entrez:
13
9
2021
pubmed:
14
9
2021
medline:
14
9
2021
Statut:
epublish
Résumé
Occipital condylectomy is often necessary to gain surgical access to various neurological pathologies. As the lateral limit of the craniovertebral junction (CVJ), partial condylectomy can lead to iatrogenic craniocervical instability. What was once considered an inoperable location is now the target of various complex neurosurgical procedures such as tumor resection and aneurysm clipping. In this study, we will review the anatomical structure of the CVJ and provide the first comprehensive assessment of studies investigating craniovertebral stability following condylectomy with the transcondylar surgical approaches. Furthermore, we discuss future considerations that must be evaluated to optimize the chances of preserving craniocervical stability postcondylectomy. The current findings postulate upward of 75% of the occipital condyle can be resected without significantly affecting mobility of the CVJ. The current findings have only examined overall dimensions and have not established a significant correlation into how the shape of the occipital condyles can affect mobility. Occipitocervical fusion should only be considered after 50% condyle resection. In terms of indicators of anatomical stability, components of range of motion (ROM) such as the neutral zone (NZ) and the elastic zone (EZ) have been discussed as potential measures of craniocervical mobility. These components differ by the sense that the NZ has little ligament tension, whereas the EZ does represent ROM where ligaments experience tension. NZ is a more sensitive indicator of instability when measuring for instability postcondylectomy. Various transcondylar approaches have been developed to access this region including extreme-lateral and far-lateral condylectomy, with hopes of preserving as much of the condyle as possible and maintaining postoperative craniocervical stability.
Sections du résumé
BACKGROUND
BACKGROUND
Occipital condylectomy is often necessary to gain surgical access to various neurological pathologies. As the lateral limit of the craniovertebral junction (CVJ), partial condylectomy can lead to iatrogenic craniocervical instability. What was once considered an inoperable location is now the target of various complex neurosurgical procedures such as tumor resection and aneurysm clipping.
METHODS
METHODS
In this study, we will review the anatomical structure of the CVJ and provide the first comprehensive assessment of studies investigating craniovertebral stability following condylectomy with the transcondylar surgical approaches. Furthermore, we discuss future considerations that must be evaluated to optimize the chances of preserving craniocervical stability postcondylectomy.
RESULTS
RESULTS
The current findings postulate upward of 75% of the occipital condyle can be resected without significantly affecting mobility of the CVJ. The current findings have only examined overall dimensions and have not established a significant correlation into how the shape of the occipital condyles can affect mobility. Occipitocervical fusion should only be considered after 50% condyle resection. In terms of indicators of anatomical stability, components of range of motion (ROM) such as the neutral zone (NZ) and the elastic zone (EZ) have been discussed as potential measures of craniocervical mobility. These components differ by the sense that the NZ has little ligament tension, whereas the EZ does represent ROM where ligaments experience tension. NZ is a more sensitive indicator of instability when measuring for instability postcondylectomy.
CONCLUSION
CONCLUSIONS
Various transcondylar approaches have been developed to access this region including extreme-lateral and far-lateral condylectomy, with hopes of preserving as much of the condyle as possible and maintaining postoperative craniocervical stability.
Identifiants
pubmed: 34513147
doi: 10.25259/SNI_456_2021
pii: 10.25259/SNI_456_2021
pmc: PMC8422489
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
380Informations de copyright
Copyright: © 2021 Surgical Neurology International.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
Références
World Neurosurg. 2020 Feb;134:e144-e152
pubmed: 31605848
Okajimas Folia Anat Jpn. 1999 Mar;75(6):329-34
pubmed: 10217952
J Anat. 1975 Dec;120(Pt 3):507-18
pubmed: 1213952
J Neurosurg. 1997 Oct;87(4):555-85
pubmed: 9322846
J Neurol Surg B Skull Base. 2014 Aug;75(4):236-42
pubmed: 25093146
Neurosurgery. 1996 Dec;39(6):1086-94; discussion 1094-5
pubmed: 8938761
Neurosurg Clin N Am. 1994 Apr;5(2):299-330
pubmed: 8032229
Childs Nerv Syst. 2019 Jul;35(7):1263-1266
pubmed: 30701298
Surg Neurol. 1997 Apr;47(4):371-9
pubmed: 9122842
Acta Neurochir Suppl. 2019;125:3-8
pubmed: 30610295
Cureus. 2020 Mar 2;12(3):e7160
pubmed: 32257703
Childs Nerv Syst. 2008 Oct;24(10):1091-100
pubmed: 18389261
Neuroimaging Clin N Am. 2009 Aug;19(3):483-510
pubmed: 19733319
Neurosurg Focus. 2015 Apr;38(4):E2
pubmed: 25828496
Neurol India. 2019 Jan-Feb;67(1):142-148
pubmed: 30860113
J Neurol Surg B Skull Base. 2019 Feb;80(1):1-9
pubmed: 30733894
Br J Neurosurg. 1993;7(2):129-40
pubmed: 8494614
Neurol Med Chir (Tokyo). 2002 Nov;42(11):472-8; discussion 479-80
pubmed: 12472211
J Neurosurg. 2001 Aug;95(2):268-74
pubmed: 11780897
Neurosurgery. 2005 Apr;56(2 Suppl):324-36; discussion 324-36
pubmed: 15794829
J Neurosurg. 2017 Oct;127(4):829-836
pubmed: 27739941
World J Surg Oncol. 2015 Sep 18;13:279
pubmed: 26384486
Neurosurgery. 2001 Jul;49(1):102-6; discussion 106-7
pubmed: 11440430
Pan Afr Med J. 2019 Sep 03;34:5
pubmed: 31762874
Asian J Neurosurg. 2018 Jul-Sep;13(3):651-655
pubmed: 30283520
Clin Neurol Neurosurg. 2005 Apr;107(3):191-9
pubmed: 15823674
J Neurosurg. 2000 Jan;92(1 Suppl):71-80
pubmed: 10616061
J Neurosurg. 1999 Jan;90(1 Suppl):91-8
pubmed: 10413132
Acta Neurochir Suppl. 1996;65:82-5
pubmed: 8738503
Neurosurgery. 2013 Jun;72(6):1021-29; discussion 1029-30
pubmed: 23442513
Neurosurgery. 2017 Aug 1;81(2):268-274
pubmed: 28379515
J Neurosurg Spine. 2006 Feb;4(2):137-44
pubmed: 16506481
Anthropol Anz. 1984 Jun;42(2):117-9
pubmed: 6465869
J Neurosurg. 1986 Apr;64(4):559-62
pubmed: 3950739
Oper Neurosurg (Hagerstown). 2020 Aug 1;19(2):157-164
pubmed: 31768546
J Korean Neurosurg Soc. 2013 Apr;53(4):223-7
pubmed: 23826478
Neurochirurgia (Stuttg). 1993 May;36(3):75-80
pubmed: 8321382
Neurol Res. 1998 Oct;20(7):577-84
pubmed: 9785584
Neurosurgery. 1990 Aug;27(2):197-204
pubmed: 2385336