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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1992 Jul;55(7):609–612. doi: 10.1136/jnnp.55.7.609

Somatosensory and brainstem auditory evoked potential in congenital craniovertebral anomaly; effect of surgical management.

S Sood 1, A K Mahapatra 1, R Bhatia 1
PMCID: PMC489175  PMID: 1640240

Abstract

Clinical features and evoked potential recordings were analysed in 32 patients with congenital atlantoaxial dislocation before and after surgery. Seven patients (group 1) had atlantoaxial dislocation, while 22 patients had associated basilar invagination (group 2). In both groups, pyramidal tract signs, posterior column signs, wasting of the upper limbs, and abnormality of somatosensory evoked potentials (SSEP) were similar. Conversely, lower cranial nerve involvement and abnormal brainstem auditory evoked potentials (BAEP) were significantly more in patients with basilar invagination (p less than 0.05). All seven patients in group 1 and 17 patients in group 2 were operated upon. Clinical and electrophysiological deterioration were significant in patients with basilar invagination (group 2), following posterior fixation compared with group 1. Among the patients in group 2, who clinically deteriorated following posterior fixation, seven had transoral excision of odontoid and six of them improved both clinically and electrophysiologically. Two patients in group 2 had odontoid excision before posterior fixation, and in both the evoked potentials improved postoperatively. In group 1 the patient's BAEP remained unaffected following posterior fixation, however, in group 2, eight patients over 53% showed improvement in brainstem function following posterior fixation. This study shows the value of evoked potentials in congenital atlantoaxial dislocation, and rationalizes the surgical procedure in these patients. In patients with basilar invagination, odontoid excision is the preferred first stage procedure.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Chiappa K. H., Ropper A. H. Evoked potentials in clinical medicine (second of two parts). N Engl J Med. 1982 May 20;306(20):1205–1211. doi: 10.1056/NEJM198205203062004. [DOI] [PubMed] [Google Scholar]
  2. Crockard H. A., Pozo J. L., Ransford A. O., Stevens J. M., Kendall B. E., Essigman W. K. Transoral decompression and posterior fusion for rheumatoid atlanto-axial subluxation. J Bone Joint Surg Br. 1986 May;68(3):350–356. doi: 10.1302/0301-620X.68B3.3733795. [DOI] [PubMed] [Google Scholar]
  3. Dastur D. K. Pathology and pathogenesis of chronic myelopathy in atlanto-axial dislocation, with operative or postoperative haematomyelia or other cord complications. Clin Exp Neurol. 1979;16:9–25. [PubMed] [Google Scholar]
  4. Dastur D. K., Wadia N. H., Desai A. D., Sinh G. Medullospinal compression due to atlanto-axial dislocation and sudden haematomyelia during decompression. Pathology, pathogenesis and clinical correlations. Brain. 1965 Dec;88(5):897–924. doi: 10.1093/brain/88.5.897. [DOI] [PubMed] [Google Scholar]
  5. Desmedt J. E., Cheron G. Prevertebral (oesophageal) recording of subcortical somatosensory evoked potentials in man: the spinal P13 component and the dual nature of the spinal generators. Electroencephalogr Clin Neurophysiol. 1981 Oct;52(4):257–275. doi: 10.1016/0013-4694(81)90055-9. [DOI] [PubMed] [Google Scholar]
  6. Greenberg R. P., Ducker T. B. Evoked potentials in the clinical neurosciences. J Neurosurg. 1982 Jan;56(1):1–18. doi: 10.3171/jns.1982.56.1.0001. [DOI] [PubMed] [Google Scholar]
  7. Holliday P. O., 3rd, Pillsbury D., Kelly D. L., Jr, Dillard R. Brain stem auditory evoked potentials in Arnold-Chiari malformation: possible prognostic value and changes with surgical decompression. Neurosurgery. 1985 Jan;16(1):48–53. [PubMed] [Google Scholar]
  8. Menezes A. H., VanGilder J. C. Transoral-transpharyngeal approach to the anterior craniocervical junction. Ten-year experience with 72 patients. J Neurosurg. 1988 Dec;69(6):895–903. doi: 10.3171/jns.1988.69.6.0895. [DOI] [PubMed] [Google Scholar]
  9. STRATFORD J. Myelopathy caused by atlanto-axial dislocation. J Neurosurg. 1957 Jan;14(1):97–104. doi: 10.3171/jns.1957.14.1.0097. [DOI] [PubMed] [Google Scholar]
  10. Schoenhuber R., Bortolotti P., Malavasi P., Mussini C., Fontana M. R., Manzini E. Neurophysiological assessment of the somatosensory pathway in rheumatic patients with atlanto-axial subluxation. Electromyogr Clin Neurophysiol. 1984 Mar-Apr;24(3):213–216. [PubMed] [Google Scholar]
  11. Selman W. R., Spetzler R. F., Brown R. The use of intraoperative fluoroscopy and spinal cord monitoring for transoral microsurgical odontoid resection. Clin Orthop Relat Res. 1981 Jan-Feb;(154):51–56. [PubMed] [Google Scholar]
  12. Sinh G. Congenital atlanto - axial dislocations. Neurol India. 1976 Jun;24(2):69–76. [PubMed] [Google Scholar]
  13. Sollazzo D., Bruni P. Brainstem auditory evoked potential (BAEP) abnormalities in subjects with craniovertebral malformations. Ital J Neurol Sci. 1985 Jun;6(2):185–189. doi: 10.1007/BF02229190. [DOI] [PubMed] [Google Scholar]
  14. Starr A. Sensory evoked potentials in clinical disorders of the nervous system. Annu Rev Neurosci. 1978;1:103–127. doi: 10.1146/annurev.ne.01.030178.000535. [DOI] [PubMed] [Google Scholar]
  15. Toolanen G., Knibestöl M., Larsson S. E., Landman K. Somatosensory evoked potentials (SSEPs) in rheumatoid cervical subluxation. Scand J Rheumatol. 1987;16(1):17–25. [PubMed] [Google Scholar]
  16. Wadia N. H. Myelopathy complicating congenital atlanto-axial dislocation. (A study of 28 cases). Brain. 1967 Jun;90(2):449–472. doi: 10.1093/brain/90.2.449. [DOI] [PubMed] [Google Scholar]

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