AI Article Synopsis
- A 55-year-old woman presented with simultaneous congenital irreducible atlantoaxial dislocation (AAD) and a cervical intramedullary astrocytoma, leading to severe neurological symptoms like spastic quadriparesis and pain.
- Lateral radiographs and MRI confirmed AAD and the presence of a tumor in the cervical spine, prompting surgical intervention including suboccipital craniectomy and laminectomy to relieve pressure on the spinal cord.
- Post-surgery, while some symptoms improved, issues like quadriparesis and sphincter disturbances persisted, but the structural stability of the spine was successfully maintained.
Article Abstract
Simultaneous presence of congenital irreducible atlantoaxial dislocation (AAD) and cervical intramedullary astrocytoma has not been previously described and may cause disabling myelopathy. This 55-year-old lady presented with suboccipital pain, spastic quadriparesis, Lhermitte's phenomenon and sphincteric disturbances. Lateral radiographs and magnetic resonance imaging showed irreducible AAD, occipitalized atlas, C2-3 fusion, and,an intramedullary tumor from C2-5 level iso-to-hypointense, non-enhancing, except in a small segment in the dorsal C2 level. A suboccipital craniectomy with C2-5 laminectomy revealed a greyish-white tenacious tumor. The tumor was decompressed using a C2-5 midline myelotomy and duroplasty. An occipitocervical lateral mass fixation was performed. Histopathology revealed a low-grade astrocytoma. At three-month follow-up, her spasticity had decreased and quadriparesis and sphincteric disturbances were persisting. Postoperative lateral radiographs and intrathecal contrast CT scan showed a stable occipitocervical construct. Thus, the suboccipital craniectomy and laminectomy with midline myelotomy and duroplasty facilitated space for progressively expanding intramedullary astrocytoma with irreducible AAD; the lateral mass fixation provided stability at the craniovertebral junction.
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