Interfacet Distraction for Type B-Basilar Invagination Assisted by a Novel Sliding-Traction Head Holder: 2-Dimensional Operative Video.

Abstract

Type B basilar invagination (BI) refers to odontoid process prolapse into skull base without dislocation, which is often associated with Chiari malformation and syringomyelia.¹ Its pathogenesis and treatment are in controversy. Posterior fossa decompression has been introduced to treat the associated Chiari malformation; however, it may not be effective for symptoms with severe ventral nerve compression.² C1-2 in situ fixation has been reported to treat minor instability in type B BI,³ yet the assessment of minor instability has not been widely accepted. We believe that the pathogenesis is chronic ventral compression of the brainstem. Transoral odontoidectomy is a classic surgical procedure to treat the pathogenesis, but it is associated with high risks of infection, velopharyngeal incompetence, and airway obstruction and often requires posterior surgery for fusion.⁴ Thus we use an interfacet distraction technique to move the odontoid process down and relieve ventral brainstem compression.⁵ Therefore interfacet structural support is necessary to maintain the distance of the interfacet. The reason for fixation is that interfacet distraction disrupts atlantoaxial stability. We designed a novel sliding-traction head holder, which can quantitatively tract and stabilize the head without support for the head or face, avoiding the risk of eyeball compression. It adapts to a variety of surgical methods and allows intraoperative changes in the patient's position. Assisted by the device, a satisfied interfacet distraction and a correction of BI were obtained. Video 1 describes how the interfacet distraction technique assisted by a sliding-traction head holder was performed in an illustrative case. The patient consented to the procedure.