Nontraumatic atlantoaxial rotatory subluxation: grisel syndrome. Case report and literature review.

Study Design Case report and literature review. Objective To describe a case of nontraumatic atlantoaxial rotatory subluxation (Grisel syndrome) and to review clinical and radiologic aspects, physiopathology, and treatment of this lesion. There is no well-established protocol in the management of patients without spontaneous reduction. The authors discuss the available strategies to achieve reduction and when to operate on these patients. Methods Case presentation of a 7-year-old patient who presented with torticollis ∼1 week after the onset of an upper airway infection. There was no history of head or neck trauma. Computed tomography demonstrated atlantoaxial rotatory subluxation and a normal atlantodental interval. Results The patient was treated with nonsteroidal anti-inflammatory drugs and antibiotics and by progressively increasing the soft cervical collar height. Clinical reduction of the subluxation occurred after 48 hours. He wore the rigid collar for 6 weeks. At that moment, the patient was completely asymptomatic and follow-up cervical spine radiograph demonstrated an anatomical C1-C2 relation. The patient was instructed to return to daily life activities in a gradual manner. Conclusions Grisel syndrome should be considered in the differential diagnosis of torticollis, especially in children. The management can be planned according to the classification of Fielding and Hawkins. The initial treatment involves medicines, injury reduction, and cervical spine immobilization. Surgical treatment is indicated only in cases of failure of conservative treatment, recurrences of subluxation, and irreducible subluxations.

Proposal of a new method to induce ventricular system dilation to simulate the features of hydrocephalus and provide an anatomical model for neuroendoscopy training.

OBJECTIVE: Create an anatomical model which simulates the real condition of a hydrocephalus and which can be used as a tool in the training of neurosurgeons in neuroendoscopy techniques and anatomical structure study. METHODS: Case-control type study, with an experimental group consisting of ten brains, in which the injection of distilled water was performed; and the control group consisting of three brains with saline solution. Inclusion criteria were brains with no history of contagious diseases or traumatic injury. RESULTS: t student test showed that the relation between frontal horn and internal frontal diameter (FH/ID), with an average of 13 % before the experiment, had a significant difference (t = -3.47, df = 9, p < 0.01) from the relation after the subsequent experiment with an average of 20 %. The Evan's index also showed a significant difference (t = -3.57, df = 9, p < 0.01) with an initial and final average of 12 % and 19 %, respectively. Friedman test showed significant difference of the size of the temporal horn before and after the experiment (f = 8.1, df = 1, p < 0.01), indicating that there was significant increase of the temporal horn. CONCLUSION: The adequate use of the anomalous chemical-physical characteristics of the water molecule may provide a good mechanism to expand the ventricular cavity, in order to create an experimental model of hydrocephalus. The endoscope may be introduced by the usual ways, allowing anatomical observation and simulation of the same tactile sensitivity that one would find during the actual procedure.