RESUMO
STUDY DESIGN: Case report and review of the literature. OBJECTIVE: We describe the first case of a synovial cyst arising from pseudarthrosis of a previous dens fracture. The literature is reviewed and etiological, diagnostic, and therapeutic options of atlantoaxial cysts are discussed. SUMMARY OF BACKGROUND DATA: Symptomatic synovial cysts of the atlantoaxial joint are rare. To the authors' knowledge only 24 cases have been reported.A 60-year-old patient presented with bilateral hand numbness, quadrihyperreflexia, and gait deterioration. Magnetic resonance imaging of the cervical spine disclosed a cystic mass located at the transverse ligament of dens axis causing bulbomedullary compression. METHODS: Surgery was performed via transoral image guided approach. The ventral atlas arch, dens, transverse ligament, tectorial membrane, and the compressing cyst were removed, followed by a C0-C3 fusion. RESULTS: Two months postsurgery the patient recovered completely from the cervical myelopathy with transient remnant dysparesthesia of the finger tips. CONCLUSION: Magnetic resonance imaging findings are not specific enough to establish a preoperative diagnosis. Radical resection via image-guided transoral route followed by posterior fusion allows complete resection of the cystic lesion and results in excellent long-term decompression.
Assuntos
Articulação Atlantoaxial/cirurgia , Descompressão Cirúrgica/métodos , Procedimentos Neurocirúrgicos/métodos , Pseudoartrose/cirurgia , Cisto Sinovial/cirurgia , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/patologia , Atlas Cervical/diagnóstico por imagem , Atlas Cervical/patologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Hipestesia/etiologia , Ligamentos/diagnóstico por imagem , Ligamentos/patologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/patologia , Pseudoartrose/etiologia , Pseudoartrose/patologia , Radiografia , Reflexo Anormal/fisiologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Fraturas da Coluna Vertebral/complicações , Fusão Vertebral/métodos , Cirurgia Assistida por Computador/métodos , Cisto Sinovial/etiologia , Cisto Sinovial/patologia , Membrana Tectorial/cirurgia , Resultado do TratamentoRESUMO
A 38-year-old man presented with progressive cervical myelopathy due to atlas hypoplasia associated with non-traumatic retro-odontoid mass. The neuroimaging findings suggested hypertrophy of the transverse ligament of the atlas. No histological confirmation of the retro-odontoid mass was obtained. Clinical manifestations improved after posterior decompression. Decompressive laminectomy of the atlas with or without fusion can achieve a good outcome in such cases.