Scientific article

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

Published inActa neurochirurgica, vol. 163, no. 8, p. 2279-2288
Publication date2021-01-03
First online date2021-01-03

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.

  • Craniocervical
  • Eustachian tube
  • Pneumatization
  • Valsalva maneuvers
Citation (ISO format)
JANNELLI, Gianpaolo et al. Craniocervical fractures management in case of craniocervical pneumatization : case report and review of the literature. In: Acta neurochirurgica, 2021, vol. 163, n° 8, p. 2279–2288. doi: 10.1007/s00701-020-04683-1
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Article (Published version)
ISSN of the journal0001-6268

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