Association of Atlanto-Occipital Dislocation, Retroclival Hematoma, and Hydrocephalus: Management and Survival in a Pediatric Patient

Abstract

Atlanto-occipital dislocation (AOD) is an injury with high morbidity and mortality. We present a case of survival of a pediatric patient with the diagnoses of AOD, retroclival hematoma, and resulting hydrocephalus. The patient's cervical spine was stabilized until occipital-cervical fusion provided definitive treatment, and the hydrocephalus was treated with a ventriculostomy. The patient survived with no neurological deficits. A better understanding and awareness of the radiologic criteria of AOD will lead to earlier recognition of AOD and improved outcomes, even in the presence of complications from AOD. Surgical fixation should be used for definitive treatment of injuries with AOD.

Keywords

atlanto-occipital dislocation - retroclival hematoma - hydrocephalus - pediatric trauma

Note

The content from this article has not been presented in any form previously.

• References

• 1 Hall GC, Kinsman MJ, Nazar RG. , et al. Atlanto-occipital dislocation. World J Orthop 2015; 6 (02) 236-243
• 2 Astur N, Sawyer JR, Klimo Jr P, Kelly DM, Muhlbauer M, Warner Jr WC. Traumatic atlanto-occipital dislocation in children. J Am Acad Orthop Surg 2014; 22 (05) 274-282
• 3 Klimo Jr P, Astur N, Gabrick K, Warner Jr WC, Muhlbauer MS. Occipitocervical fusion using a contoured rod and wire construct in children: a reappraisal of a vintage technique. J Neurosurg Pediatr 2013; 11 (02) 160-169
• 4 Vera M, Navarro R, Esteban E, Costa JM. Association of atlanto-occipital dislocation and retroclival haematoma in a child. Childs Nerv Syst 2007; 23 (08) 913-916
• 5 Raj D, Rao RD, Smuck M. Orthopaedic Knowledge Update: Spine 4. 4th ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2012
• 6 Theodore N, Aarabi B, Dhall SS. , et al. The diagnosis and management of traumatic atlanto-occipital dislocation injuries. Neurosurgery 2013; 72 (Suppl. 02) 114-126
• 7 Agrawal D, Cochrane DD. Traumatic retroclival epidural hematoma - a pediatric entity?. Childs Nerv Syst 2006; 22 (07) 670-673
• 8 Guillaume D, Menezes AH. Retroclival hematoma in the pediatric population. Report of two cases and review of the literature. J Neurosurg 2006; 105 (4, Suppl): 321-325
• 9 Diaz R, Zouros A, Stewart GM. Atlanto-occipital dislocation with retroclival hematoma in a pediatric patient presenting to the emergency department. Pediatr Emerg Care 2010; 26 (11) 843-847
• 10 Horn EM, Feiz-Erfan I, Lekovic GP, Dickman CA, Sonntag VKH, Theodore N. Survivors of occipitoatlantal dislocation injuries: imaging and clinical correlates. J Neurosurg Spine 2007; 6 (02) 113-120
• 11 Kalani MA, Ratliff JK. Considering the diagnosis of occipitocervical dissociation. Spine J 2013; 13 (05) 520-522
• 12 Pang D, Nemzek WR, Zovickian J. Atlanto-occipital dislocation: part 1--normal occipital condyle-C1 interval in 89 children. Neurosurgery 2007; 61 (03) 514-521 , discussion 521
• 13 Wholey MH, Bruwer AJ, Baker Jr HL. The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology 1958; 71 (03) 350-356
• 14 Pang D, Nemzek WR, Zovickian J. Atlanto-occipital dislocation--part 2: The clinical use of (occipital) condyle-C1 interval, comparison with other diagnostic methods, and the manifestation, management, and outcome of atlanto-occipital dislocation in children. Neurosurgery 2007; 61 (05) 995-1015 , discussion 1015
• 15 National Guideline Clearinghouse (NGC). Guideline summary: The diagnosis and management of traumatic atlanto-occipital dislocation injuries. In: Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries. . Available at: https://www.guideline.gov/summaries/summary/44301/the-diagnosis-and-management-of-traumatic-atlantooccipital-dislocation-injuries-in-guidelines-for-the-management-of-acute-cervical-spine-and-spinal-cord-injuries . Accessed December 16, 2016
• 16 National Institute of Neurological Disorders and Stroke. Hydrocephalus fact sheet. Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Hydrocephalus-Fact-Sheet#3125_6 . Accessed March 25, 2016