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Craniocervical fractures management in case of craniocervical pneumatization: case report and review of the literature

  • Review Article - Spine trauma
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Abstract

Introduction

Extensive craniocervical pneumatization (CCP) refers to an abnormal pneumatization extended from the temporal bone into adjacent bone structures, especially the skull base and the craniocervical junction. The etiology remains controversial; however several studies reported a correlation with recurrent Valsalva maneuvers or Eustachian tube dysfunction. Although some cases requiring surgical treatment have been reported, conservative treatment remains the gold standard. The authors aimed to describe a case of CCP, complicated by a spontaneous fracture of a pneumatized left occipital condyle. Furthermore, they reviewed all previously reported cases of fractures in CCP in order to propose a standardized approach to this pathology.

Methods

A total of 148 studies were retrieved. Of those, 23 studies (including 26 patients in addition to our case) were included in the review. These studies consisted of case reports or small case series (up to 3 patients).

Results

In 3 patients (11.1%), bone pneumatization involved C0; all remaining patients had both C0 and C1 pneumatization, while in 7 cases (25.9%), an extension to C2 and/or C3 was reported. Radiological follow-up was performed in 20 patients (74.1%), showing in all of the cases either stability (6 patients, 22.2%), improvement, or complete resolution (6 patients, 22.2% vs 8 patients, 29.7%). Two patients underwent surgical intervention.

Conclusions

This review suggests that fractures secondary to CCP are extremely rare and are associated to a good clinical and radiological outcome with conservative treatment. Ear, nose, and throat (ENT) evaluation is recommended to detect cases who need treatment for a subjacent middle ear disease.

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Abbreviations

CCP:

Craniocervical pneumatization

ENT:

Ear, nose, and throat

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Author information

Author notes

  1. Gianpaolo Jannelli and Alessandro Moiraghi contributed equally to this work.

Authors and Affiliations

  1. Neurosurgical Unit, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland

    Gianpaolo Jannelli, Alessandro Moiraghi, Karl Schaller & Enrico Tessitore

  2. Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France

    Alessandro Moiraghi

  3. Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, V5Z 1L3, Canada

    Alberto Delaidelli

  4. Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, V6T 1Z4, Canada

    Alberto Delaidelli

  5. Division of Neuroradiology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland

    Aikaterini Fitsiori

Authors
  1. Gianpaolo Jannelli
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Correspondence to Gianpaolo Jannelli.

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Conflict of interest

Enrico Tessitore: Training fees from: Spineart, Medtronic, Depuy Synthes, Nuvasive.

Other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Due to the nature of the present study (literature review), no ethic committee was obtained.

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Due to the nature of the present study (literature review), no informed consent was obtained. The informed consent for the case report was obtained. For this type of study, formal consent is not required. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Jannelli, G., Moiraghi, A., Delaidelli, A. et al. Craniocervical fractures management in case of craniocervical pneumatization: case report and review of the literature. Acta Neurochir 163, 2279–2288 (2021). https://doi.org/10.1007/s00701-020-04683-1

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