Introduction: Surgical management of complex cranio-vertebral junction anomalies requires careful attention to complex anatomy of the region. Routine use of operating microscope and navigation have helped in making the surgery safer. Newer adjuncts like 3D printed models, bio-mechanical analysis and Doppler have potential to improve surgical safety.
Methods: Authors describe their case series of complex cranio-vertebral junction anomalies where surgical adjuncts helped in improving the safety of surgery.
Results: Use of 3D printed models ascertains precise anatomy of cranio-vertebral junction and helps in surgical planning. Bio-mechanical analysis of cervical spine using pre-operative images helps in optimal usage of implants. Use of Doppler helps to delineate the course of vertebral artery. Newer surgical adjuncts have made substantial impact on surgical safety.
Conclusions: Various surgical approaches are available for surgical management of complex cranio-vertebral junction anomalies. The surgical approach needs to be individualized and should be based on pre-operative evaluation- including the anatomy of the vertebral artery and morphology of the atlas, axis, occipital condyle as well as sagittal balance of sub-axial cervical spine. C1-C2 Joint distraction-reduction-realignment has the advantage of treating basilar invagination by a single stage procedure, with good outcome. This approach however is technically challenging. The use of newer surgical adjuncts like 3D printed models, bio-mechanical analysis and Doppler helps in improving the surgical outcome
Patient Care: Routine use of newer surgical adjuncts will improve the margin of surgical safety while operating on complex cranio-vertebral junction anomalies.
Learning Objectives: By the conclusion of this session, participants should be able to:
1. Describe the importance of surgical adjuncts in management of complex cranio-vertebral junction anomalies.
2. Discuss, in small groups, about the utility of 3D printed models, bio-mechanical studies and vertebral Doppler in surgical management of complex cranio-vertebral junction anomalies.