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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(03): e262-e269
DOI: 10.1055/s-0042-1744430
Review Article

Traumatic Atlanto-occipital Dislocation in Children Followed by Hydrocephalus – A Case Report and Literature Review

Deslocamento atlanto-occipital em crianças seguido por hidrocefalia – Relato de caso e revisão da literatura
Cleiton Formentin 
1   Neurosurgery Division, Department of Neurology, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
,
Lucas de Souza Rodrigues dos Santos
1   Neurosurgery Division, Department of Neurology, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
,
Fernando Luis Maeda
1   Neurosurgery Division, Department of Neurology, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
,
Helder Tedeschi
1   Neurosurgery Division, Department of Neurology, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
,
Enrico Ghizoni
1   Neurosurgery Division, Department of Neurology, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
,
Andrei F. Joaquim
1   Neurosurgery Division, Department of Neurology, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
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Abstract

Traumatic atlanto-occipital dislocation (TAOD) are uncommon injuries associated with high immediate mortality rate and occurs more than twice in children than adults, due to biomechanical properties and immaturity of children's cervical spine. We report a pediatric patient with TAOD, who underwent occipitocervical stabilization and also developed a late hydrocephalus requiring a shunt procedure. A six-year-old boy was admitted to the emergency department after a car accident with refractory cervical pain. A cervical computed tomography (CT) scan showed an anterior C1–C2 level hematoma, and a dynamic CT scan demonstrated an increasing basion-dens interval on extension. Cervical magnetic resonance imaging (MRI) showed discontinuity of the tectorial membrane and diffused hyperintense signal on the left alar ligament. These findings were attributed to TAOD, and an occipitocervical fusion was performed. The pain and neurological status improved after surgery, but after 3 months he returned with persistent vomiting, headache, and a CT scan showing hydrocephalus. Then, a ventriculoperitoneal shunt was performed, improving the symptoms. One year after the injury, the patient remained asymptomatic, and a later radiography demonstrated satisfactory bone fusion. In conclusion, the decision-making process regarding treatment should consider several clinical and radiographic findings. Occipitocervical fusion is the treatment of choice, while hydrocephalus is not an unusual complication in children.

Resumo

O deslocamento atlanto-occipital (DAO) é uma lesão incomum associada a uma alta taxa de mortalidade imediata que ocorre duas vezes mais em crianças do que em adultos, fato relacionado às propriedades biomecânicas e à imaturidade da coluna cervical pediátrica. Relatamos o caso de um paciente pediátrico com DAO traumático submetido à fixação occipitocervical, evoluindo com hidrocefalia e necessidade de um procedimento de derivação liquórica. Paciente do sexo masculino de 6 anos de idade admitido no pronto-socorro após um acidente automobilístico, apresentando dor cervical refratária. A tomografia computadorizada (TC) de coluna cervical demostrou um hematoma epidural ao nível de C1–C2, e a TC dinâmica evidenciou um intervalo basion-odontoide aumentado em extensão. A ressonância magnética (RM) da coluna cervical demonstrou descontinuidade da membrana tectorial e hiperintensidade difusa no ligamento alar esquerdo. Esses achados permitiram o diagnóstico de um DAO, sendo realizada uma fusão occipitocervical. A dor e o status neurológico melhoraram após a cirurgia, mas 3 meses após, o paciente evoluiu com vômitos persistentes, cefaleia e TC de crânio evidenciando hidrocefalia. Em seguida, foi realizada uma derivação ventriculoperitoneal, com melhora dos sintomas. Um ano após, o paciente permaneceu assintomático, e a radiografia demonstrou fusão óssea satisfatória. Em conclusão, o processo de tomada de decisão quanto ao tratamento deve levar em consideração diversos achados clínicos e radiográficos. A fixação occipitocervical é o tratamento de escolha, enquanto a hidrocefalia não é uma complicação incomum em crianças.

Keywords

atlanto-occipital dislocation - pediatric spine - trauma - hydrocephalus

Palavras-chave

deslocamento atlanto-occipital - coluna vertebral - trauma - hidrocefalia


Publication History

Received: 15 April 2021

Accepted: 08 June 2021

Article published online:
06 September 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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