Asunto(s)
Malformaciones Vasculares del Sistema Nervioso Central , Enfermedades Vasculares de la Médula Espinal , Várices , Humanos , Columna Vertebral , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/etiología , Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Médula Espinal/diagnóstico por imagenRESUMEN
We draw attention to a unique presentation, severe unilateral loss of limb proprioception, in patients with medullary and rostral spinal cord infarction. Two patients developed acute severe proprioceptive loss in the limbs ipsilateral to infarcts that involved the caudal medulla and rostral spinal cord. They also had symptoms and signs often found in lateral medullary infarction. The proprioceptive loss is attributable to injury to the gracile and cuneate nuclei and/or their projections to the medial lemniscus. The infarct territory is supplied by the posterior spinal branches of the vertebral artery near its penetration into the posterior fossa. The presence of severe ipsilateral proprioceptive loss in a patient with features of lateral medullary infarction indicates involvement of the rostral spinal cord.
Asunto(s)
Extremidades/inervación , Síndrome Medular Lateral/complicaciones , Bulbo Raquídeo/irrigación sanguínea , Propiocepción , Trastornos Somatosensoriales/etiología , Enfermedades Vasculares de la Médula Espinal/complicaciones , Médula Espinal/irrigación sanguínea , Femenino , Humanos , Síndrome Medular Lateral/diagnóstico por imagen , Síndrome Medular Lateral/fisiopatología , Síndrome Medular Lateral/rehabilitación , Masculino , Recuperación de la Función , Índice de Severidad de la Enfermedad , Trastornos Somatosensoriales/diagnóstico , Trastornos Somatosensoriales/fisiopatología , Trastornos Somatosensoriales/rehabilitación , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/fisiopatología , Enfermedades Vasculares de la Médula Espinal/rehabilitación , Rehabilitación de Accidente Cerebrovascular , Resultado del TratamientoAsunto(s)
Inhibidores del Factor Xa/efectos adversos , Hemorragia/inducido químicamente , Pirazoles/efectos adversos , Piridonas/efectos adversos , Enfermedades Vasculares de la Médula Espinal/inducido químicamente , Vértebras Torácicas , Tromboembolia Venosa/prevención & control , Angiografía , Artroplastia de Reemplazo de Rodilla , Vértebras Cervicales , Femenino , Hematoma Subdural Espinal/inducido químicamente , Hematoma Subdural Espinal/diagnóstico por imagen , Hemorragia/diagnóstico por imagen , Hemorragia/fisiopatología , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Paraparesia/fisiopatología , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/fisiopatología , Retención Urinaria/fisiopatologíaAsunto(s)
Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Hemorragia/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Várices/diagnóstico por imagen , Angiografía , Dolor de Espalda/etiología , Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Edema/diagnóstico por imagen , Femenino , Hemorragia/complicaciones , Humanos , Imagenología Tridimensional , Imagen por Resonancia Magnética , Persona de Mediana Edad , Paraplejía/etiología , Enfermedades Vasculares de la Médula Espinal/complicaciones , Vértebras Torácicas , Várices/complicacionesRESUMEN
A 30-month-old Maine Coon presented with progressive proprioceptive ataxia, paraparesis, thoracolumbar pain, and decreased appetite. An extradural mass was detected within the left side of the 13th thoracic vertebral canal that compressed the spinal cord on magnetic resonance (MR) and was considered to be mineralized on computed tomography (CT) images. The resected mass was diagnosed as a vertebral vascular hamartoma. Clinical signs improved, but recurrence was diagnosed by MR and CT imaging at 7 months after surgery. Repeated excisional surgery yielded the same diagnosis and the clinical signs abated. Fifteen months after the second surgery, there was apparent vertebral deformation, but there was no further change on CT images by 29 months.
Asunto(s)
Enfermedades de los Gatos/cirugía , Hamartoma/veterinaria , Enfermedades Vasculares de la Médula Espinal/veterinaria , Animales , Enfermedades de los Gatos/diagnóstico por imagen , Gatos , Hamartoma/diagnóstico por imagen , Hamartoma/cirugía , Masculino , Recurrencia , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/cirugía , Vértebras Torácicas , Tomografía Computarizada por Rayos X/veterinariaRESUMEN
Herein, we described 2 patients with posterior spinal artery syndrome (PSAS) caused by vertebral artery dissection. The patients complained of sudden neck pain or walking instability. Neurological examination revealed sensory loss, muscle weakness, and sensory ataxia. Angiography showed double lumen sign or intimal flap in the vertebral artery. T2-weighted imaging and diffusion-weighted imaging of MRI showed a hyperintense lesion in the dorsal side of the cervical spinal cord at different times after onset. Both patients had good outcome after antiplatelet therapy and physiotherapy. A review of previously reported PSAS cases was also conducted in order to improve the understanding and awareness of this rare myelopathy.
Asunto(s)
Enfermedades Vasculares de la Médula Espinal/etiología , Disección de la Arteria Vertebral/complicaciones , Adulto , Femenino , Marcha , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/terapia , Humanos , Masculino , Dolor de Cuello/etiología , Dolor de Cuello/fisiopatología , Dolor de Cuello/terapia , Modalidades de Fisioterapia , Inhibidores de Agregación Plaquetaria/uso terapéutico , Recuperación de la Función , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/fisiopatología , Enfermedades Vasculares de la Médula Espinal/terapia , Resultado del Tratamiento , Disección de la Arteria Vertebral/diagnóstico por imagen , Disección de la Arteria Vertebral/fisiopatología , Disección de la Arteria Vertebral/terapiaRESUMEN
Atypical teratoid/rhabdoid tumours (AT/RTs) are highly aggressive and uncommon malignant tumours of the central nervous system (CNS) affecting children younger than 3 years of age. Primary spinal cord involvement is an extremely rare presentation. AT/RTs show necrosis and haemorrhages on histopathology frequently. However, spinal atypical teratoid/rhabdoid tumour (AT/RT) with hematomyelia and spinal subarachnoid haemorrhage (SAH), as seen in our case, has never been reported in the literature in the paediatric age group. We report a case of primary spinal AT/RT in a 3-year-old male child presenting acutely with hematomyelia and spinal SAH and try to elucidate its pathophysiological basis.
Asunto(s)
Neoplasias del Sistema Nervioso Central , Tumor Rabdoide , Enfermedades Vasculares de la Médula Espinal , Hemorragia Subaracnoidea , Teratoma , Preescolar , Humanos , Masculino , Tumor Rabdoide/complicaciones , Tumor Rabdoide/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/complicaciones , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/etiología , Teratoma/complicaciones , Teratoma/diagnóstico por imagen , Teratoma/cirugíaRESUMEN
BACKGROUND: Chronic subdural hematoma (CSDH) is uncommon in the spine. Most spinal CSDHs occur as solitary lesions in the lumbosacral region. We report a rare case of multiple spinal CSDHs associated with hematomyelia. The diagnostic and therapeutic management of these complex spinal CSDHs is reviewed as well as the pertinent literature. CASE DESCRIPTION: A 79-year-old woman on warfarin therapy presented with lower back pain and progressive lower extremity weakness that had developed in the previous 2 weeks. She subsequently developed paraplegia and urinary incontinence. Thoracolumbar magnetic resonance imaging showed a CSDH from T12-L3 compressing the cauda equina. Single-shot whole-spine magnetic resonance imaging showed another CSDH and hematomyelia at T2-3. She underwent L2-3 hemilaminectomy, which revealed a liquefied subdural hematoma. Delayed T2 laminectomy exposed an organized subdural hematoma and xanthochromic hematomyelia. After each surgery, the patient showed significant motor recovery. Finally, the patient could walk, and the urinary catheter was removed. CONCLUSIONS: Spinal CSDH may occur in multiple regions and may be associated with hematomyelia. Whole-spine magnetic resonance imaging is useful to examine the entire spine for CSDH accurately and thoroughly. Comprehensive surgical exploration of all symptomatic hematomas may restore neurologic functions even with delayed surgery.
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Hematoma Subdural Crónico/diagnóstico por imagen , Hematoma Subdural Espinal/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Anciano , Femenino , Hematoma Subdural Crónico/complicaciones , Hematoma Subdural Crónico/cirugía , Hematoma Subdural Espinal/complicaciones , Hematoma Subdural Espinal/cirugía , Humanos , Laminectomía , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Paraplejía/etiología , Enfermedades Vasculares de la Médula Espinal/etiología , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugía , Retención Urinaria/etiologíaAsunto(s)
Dengue/complicaciones , Cuadriplejía/etiología , Enfermedades Vasculares de la Médula Espinal/complicaciones , Anciano , Encéfalo/diagnóstico por imagen , Dengue/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Cuadriplejía/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagenRESUMEN
RATIONALE: Spontaneous intramedullary spinal cord hemorrhage (hematomyelia) is a rare disease and most cases have specific etiologies such as cavernous malformations and tumor. Most reported cases are about surgical treatment of intramedullary spinal cord hemorrhage, but there are no reports of rehabilitation effectiveness reported. This case reports the first case with positive effect of rehabilitation on a patient with intramedullary spinal cord hemorrhage, who did not undergo surgery. PATIENT CONCERNS: A 79-year old female visited the department of emergency complaining of sudden-onset back pain, weakness and sensory disturbance in both lower extremities and voiding difficulty. The symptoms started 2 weeks prior to her visit. DIAGNOSES: Whole spine magnetic resonance imaging revealed intramedullary spinal cord hemorrhage at the C7-T3 level and preoperative diagnosis was spinal cavernous malformation. INTERVENTIONS: Since the benefit of surgery was presumed to be low on her, she performed rehabilitation, divided into 2 sessions per day and each session took 30âmin. OUTCOMES: After 3 months of rehabilitation, numeric pain rating scale of back pain decreased, and Berg Balance Scale score, Korean version of modified Barthel index score improved. On discharge, she was able to walk independently under supervision and void without Foley catheter. LESSONS: This case suggests that early rehabilitation such as physical therapy is an effective treatment for improving function in patients with intramedullary spinal cord hemorrhage with or without operation.
Asunto(s)
Tratamiento Conservador , Modalidades de Fisioterapia , Enfermedades Vasculares de la Médula Espinal/rehabilitación , Anciano , Dolor de Espalda/fisiopatología , Femenino , Humanos , Imagen por Resonancia Magnética , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Resultado del TratamientoRESUMEN
PURPOSE: Neurointerventional approaches have improved myelopathy in patients with spinal vascular lesions by providing effective management, particularly when surgical approaches are difficult. However, there have been challenges in describing and comparing recovery status during the post-treatment period. METHODS: We evaluated 43 patients with venous congestive myelopathy (VCM) using Aminoff-Logue Disability Scale for gait (AL-G) and micturition (AL-M) scores. These results were compared with our new PSMS grading system that evaluates four categories (grades 0-3): pain, sensory symptoms, motor deficit, and sphincter change. Simple linear regression was used to identify the association or trend among the scales. We also calculated an overall area under the receiver operating characteristic curve to compare the predictive ability of the PSMS system with that of the previous grading system (AL-G and AL-M). RESULTS: Compared with other grading system, the PSMS system was more sensitively correlated with patient status and the results were easy to compare with previous clinical statuses during follow-up. The PSMS system also measured pain, which is commonly associated with spinal dural arteriovenous fistula and not precisely evaluated by other grading system. CONCLUSIONS: The new PSMS grading system for patients with VCM correlated well with the previously used systems and included pain evaluation. This new grading system is an easy tool for the evaluation and comparison of outcomes before and after endovascular treatment.
Asunto(s)
Enfermedades de la Médula Espinal/clasificación , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Evaluación de la Discapacidad , Progresión de la Enfermedad , Embolización Terapéutica/métodos , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Índice de Severidad de la Enfermedad , Enfermedades de la Médula Espinal/fisiopatología , Enfermedades Vasculares de la Médula Espinal/clasificación , Enfermedades Vasculares de la Médula Espinal/fisiopatologíaAsunto(s)
Paragonimiasis/complicaciones , Enfermedades Vasculares de la Médula Espinal/complicaciones , Animales , Anticuerpos/sangre , Niño , Femenino , Humanos , Imagen por Resonancia Magnética , Paragonimiasis/diagnóstico por imagen , Paragonimus/inmunología , Paragonimus/patogenicidad , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagenRESUMEN
Magnetic resonance imaging (MRI) is a common test for dogs with suspected intradural spinal cord lesions, however studies on diagnostic performance for this test are lacking. Objectives of this multi-institutional, retrospective, case-control study were to estimate sensitivity and specificity of MRI for (1) distinguishing between histopathologically confirmed intradural spinal cord disease versus degenerative myelopathy in dogs, (2) categorizing intradural spinal cord diseases as neoplastic, inflammatory, or vascular; and (3) determining tumor type within the etiologic category of neoplasia. Additional aims were to (1) determine whether knowledge of clinical data affects sensitivity and specificity of MRI diagnoses; and (2) report interrater agreement for MRI classification of intradural spinal lesions. Cases were recruited from participating hospital databases over a 7-year period. Three reviewers independently evaluated each MRI study prior to and after provision of clinical information. A total of 87 cases were sampled (17 degenerative myelopathy, 53 neoplasia, nine inflammatory, and eight vascular). Magnetic resonance imaging had excellent (>97.6%) sensitivity for diagnosis of intradural spinal cord lesions but specificity varied before and after provision of clinical data (68.6% vs. 82.4%, P = 0.023). Magnetic resonance imaging had good sensitivity (86.8%) and moderate specificity (64.7-72.5%) for diagnosing neoplasia. Sensitivity was lower for classifying inflammatory lesions but improved with provision of clinical data (48.1% vs. 81.5%, P = 0.015). Magnetic resonance imaging was insensitive for diagnosing vascular lesions (25.0%). Interrater agreement was very good for correctly diagnosing dogs with intradural lesions (ĸ = 0.882-0.833), and good (ĸ = 0.726-0.671) for diagnosing dogs with neoplasia.
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Enfermedades de los Perros/diagnóstico , Mielitis/veterinaria , Neoplasias de la Médula Espinal/veterinaria , Enfermedades Vasculares de la Médula Espinal/veterinaria , Animales , Estudios de Casos y Controles , Enfermedades de los Perros/diagnóstico por imagen , Perros , Femenino , Imagen por Resonancia Magnética , Masculino , Mielitis/diagnóstico , Mielitis/diagnóstico por imagen , Estudios Retrospectivos , Sensibilidad y Especificidad , Neoplasias de la Médula Espinal/diagnóstico , Neoplasias de la Médula Espinal/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/diagnóstico , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagenRESUMEN
We present our recent experience with fluorescein sodium videoangiography (FLVA) in the intra-operative evaluation of a patient with conus medullaris arteriovenous malformation (AVM). To our knowledge this is the first report in the literature of use of FLVA in the surgery of spinal AVM. Intra-operative FLVA was done to identify an early filling vessel and to obliterate the site of fistulous connection. This was correlated and confirmed with simultaneous indocyanine green videoangiography (ICGVA). The conus and cauda equina roots could be appreciated and manipulated in relation to this fluorescence. Obliteration was confirmed with FLVA and correlated with ICGVA. There was no untoward reaction to the dye injection. We conclude that FLVA is a useful adjunct in the surgical treatment of conus medullaris AVMs since it is a real time, noninvasive, radiation-free, easily reproducible technique allowing surgical manipulation through the operating oculars with simultaneous visualization of surrounding critical structures.
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Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/cirugía , Angiografía con Fluoresceína/métodos , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/cirugía , Adulto , Humanos , Masculino , Cirugía Asistida por ComputadorRESUMEN
OBJECTIVE Vascular malformations of the spine represent rare clinical entities with profound neurological implications. Previously reported studies on management strategies for spinal dural arteriovenous fistulas (sDAVFs) appeared before the advent of modern liquid embolic agents. Authors of the present study review their institutional experience with endovascularly and surgically treated sDAVFs. METHODS The authors performed a retrospective, observational, single-center case series on sDAVFs treated with endovascular embolization, microsurgical occlusion, or both between 2004 and 2013. The mode, efficacy, and clinical effect of treatment were evaluated. RESULTS Forty-seven patients with spinal arteriovenous malformations were evaluated using spinal angiography, which demonstrated 34 Type I sDAVFs (thoracic 20, lumbar 12, and cervical 2). Twenty-nine of the patients (85%) were male, and the median patient age was 63.3 years. Twenty patients underwent primary endovascular embolization (16 Onyx, 4 N-butyl cyanoacrylate [NBCA]), and 14 underwent primary surgical clipping. At a mean follow-up of 36 weeks, according to angiography or MR angiography, 5 patients treated with endovascular embolization demonstrated persistent arteriovenous shunting, whereas none of the surgically treated patients showed lesion persistence (p = 0.0237). Thirty patients (88%) experienced some resolution of their presenting symptoms (embolization 17 [85%], surgery 13 [93%], p = 1.00). CONCLUSIONS Microsurgical occlusion remains the most definitive treatment modality for sDAVFs, though modern endovascular techniques remain a viable option for the initial treatment of anatomically amenable lesions. Treatment of these lesions usually results in some clinical improvement.
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Malformaciones Vasculares del Sistema Nervioso Central/terapia , Embolización Terapéutica , Procedimientos Endovasculares , Microcirugia , Procedimientos Neuroquirúrgicos , Enfermedades Vasculares de la Médula Espinal/terapia , Angiografía , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Microcirugia/efectos adversos , Microcirugia/métodos , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/efectos adversos , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Resultado del TratamientoRESUMEN
We report a case of left upper cervical posterior spinal artery (PSA) syndrome caused by atherosclerosis of the left vertebral artery. A 70-year-old female experienced sudden dizziness and paralysis of the left upper and lower limbs. Diffusion-weighted magnetic resonance imaging (DWI) of the brain showed high signal intensity at the vermis and lower left hemisphere of the cerebellum, and magnetic resonance angiography showed that the entire left vertebral artery was thin. The patient was treated with an intravenous infusion of tissue plasminogen activator 2 hours after symptom onset and made a full recovery. Repeat DWI, fluid-attenuated inversion recovery images, and T2-weighted images showed high signal intensity in the left upper cervical PSA area from the lower medulla oblongata to the C2 level in addition to the cerebellum. Previously reported cases of cervical posterior artery syndrome are reviewed.
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Aterosclerosis/complicaciones , Vértebras Cervicales/irrigación sanguínea , Enfermedades Vasculares de la Médula Espinal/etiología , Arteria Vertebral/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Aterosclerosis/diagnóstico , Aterosclerosis/tratamiento farmacológico , Aterosclerosis/fisiopatología , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Infusiones Intravenosas , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/tratamiento farmacológico , Enfermedades Vasculares de la Médula Espinal/fisiopatología , Terapia Trombolítica , Activador de Tejido Plasminógeno/administración & dosificación , Resultado del Tratamiento , Arteria Vertebral/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: Spontaneous or idiopathic intramedullary bleeding is a very rare event in pediatric patients. This diagnosis requires an extended clinical, laboratory, and radiologic work-up to rule out all potential causes of hematomyelia. However, children may present with hematomyelia or spinal cord injury without radiographic abnormality even after a minor trauma. CASE DESCRIPTION: A 15-month-old girl presented with a 24-hour history of progressive neurologic deficits. A trivial trauma had occurred a few days before the clinical onset. Head computed tomography scan and craniospinal magnetic resonance imaging revealed an isolated hemorrhagic central medullary lesion extending from the obex to C3 level. No underlying causes of intramedullary bleeding were identified. In the absence of obvious vascular abnormalities, the patient underwent an urgent occipitocervical decompression with hematoma evacuation. Postoperatively, the patient's motor symptoms rapidly resolved, and she was discharged with cervical collar immobilization. CONCLUSIONS: We discuss the differential diagnosis of intramedullary bleeding in children, focusing on the diagnostic protocol and therapeutic options in this age group.
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Hemorragia/etiología , Hemorragia/cirugía , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/etiología , Enfermedades Vasculares de la Médula Espinal/cirugía , Vértebras Cervicales/diagnóstico por imagen , Diagnóstico Diferencial , Drenaje , Femenino , Hemorragia/diagnóstico por imagen , Humanos , Lactante , Cirugía para Descompresión Microvascular , Traumatismos de la Médula Espinal/cirugía , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagenRESUMEN
PURPOSE: The aim of this paper is to discuss the problems of craniocervical instability and craniocervical fusion in infancy. Despite the relative frequency of carniovertebral joint malformations, actual instability is quite rare in infancy. METHODS: An infant 8 months of age presented with tetraparesis and sleep apnea due to a complex malformation of her craniovertebral joint. An initial attempt at conservative treatment using a rigid neck collar failed, so the patient was surgically managed by the onlay placement of two autologous rib grafts. The rigid collar was maintained for 5 months. RESULTS: Both rib grafts progressively reabsorbed within a few months, while the clinical deficits recurred. Reoperation consisted of occipitocervical interposition of two robust struts of banked cadaveric adult fibula. This time, the skull appeared mature enough to allow immobilization by the halo system. Adequate occipitocervical fusion was eventually achieved, and the patient fully recovered. CONCLUSIONS: To the best of our knowledge, there is no other reported case of an infant undergoing craniovertebral fusion using cadaveric adult bone. When screw placement is not considered advisable to manage small infants, appropriate stability may be obtained using struts of robust cadaveric bone. A meticulous carpentry technique with graft interposition under compression and adequate postoperative immobilization remains mandatory.