RESUMO
Treatment of patients with atlantoaxial instability caused by various diseases of the skull base and craniovertebral junction combined with ventral compression of the brainstem is a complex issue that is ambiguously resolved in different ways. We present a case of stepped treatment, the most important component of which was successful transoral removal of an aggressive aneurysmal bone cyst of the CII vertebra with anterior CI-CIII segment stabilization using an individual system, which was performed through the same approach. CLINICAL CASE: A 31-year-old male patient presented with destruction of the CII body and odontoid process affected by an aggressive aneurysmal bone cyst causing disintegration of the CII posterior wall and odontoid process, which clinically manifested by constricted motion and pain in the cervical spine. RESULTS: Three-step surgical treatment was performed. First, we performed a puncture biopsy of the CII body through the submandibular approach as well as posterior occipitospondylodesis with metal instrumentation from the occipital bone level to the CIV vertebra. Two months later, the patient underwent transoral removal of the CII body and odontoid process lesion and anterior CI-CIII segment stabilization using an individual cover metal system through the same approach. Two weeks after the second intervention, the occipitospondylodesis was transformed to a posterior CI-CIII stabilization system. Control CT 8 months after surgery showed the correct position of both stabilization systems. CONCLUSION: The use of individual instrumentation for anterior stabilization of the CI-CIII vertebrae in various diseases of the craniovertebral junction area is an effective and promising technique.
