Abstract：
Chiari malformations, characterized by the herniation of cerebellar tonsils through the foramen magnum, are complex neurosurgical conditions that pose significant diagnostic and therapeutic challenges.1 Traditional interventions, such as foramen magnum decompression, have been the mainstay of treatment but are not universally effective, especially in cases with underlying atlantoaxial instability. However, recent studies highlight the importance of atlantoaxial instability in their pathogenesis, shifting the therapeutic focus towards atlantoaxial fixation.2 Research shows that atlantoaxial fixation can effectively address the underlying instability, leading to better symptomatic relief and neurological outcomes compared to traditional decompression methods.3,4-17 The findings from these studies consistently demonstrate that atlantoaxial instability is a critical factor in the development of Chiari malformations. Atlantoaxial fixation not only resolves the mechanical instability but also leads to significant symptomatic relief and improved neurological outcomes. Comparative analysis indicates superior efficacy of atlantoaxial fixation over traditional decompression techniques, especially in patients with concurrent basilar invagination and syringomyelia. This surgical Video 1 illustrates a case of a 20-year-old male patient with tonsillar herniation, syringomyelia, atlantooccipital assimilation, atlantoaxial instability, basilar invagination and dorsolumbar scoliosis, who was successfully managed with cervical fixation using a bilateral C1 lateral mass and C2 transpedicular screw construct. This surgery was able to achieve clinical and radiologic improvement without the need for a foramen magnum decompression. The patient consented to the procedure and to the publication of his images.
摘要：
Chiari畸形,小脑扁桃体通过大孔突出，是复杂的神经外科疾病，构成重大的诊断和治疗挑战。1传统的干预措施，比如大孔减压,一直是治疗的支柱，但并不普遍有效，尤其是在潜在的寰枢椎不稳定的情况下。然而,最近的研究强调了寰枢椎不稳定在其发病机理中的重要性，将治疗重点转向寰枢椎固定。2研究表明，寰枢椎固定可以有效地解决潜在的不稳定性，与传统减压方法相比,这些研究结果一致表明,寰枢椎不稳定是Chiari畸形发展的关键因素.寰枢椎固定不仅解决了机械不稳定性，而且还导致了显着的症状缓解和改善的神经系统结果。比较分析表明，寰枢椎固定优于传统减压技术，尤其是并发基底内陷和脊髓空洞症的患者。这个手术视频1展示了一个20岁的男性扁桃体突出症患者的案例，脊髓空洞症,寰枕骨同化,寰枢椎不稳定，基底内陷和背腰脊柱侧凸，使用双侧C1侧块和C2经椎弓根螺钉构造成功进行颈椎固定。该手术能够在不需要大孔减压的情况下实现临床和放射学改善。患者同意该程序并发表其图像。
