Situation
Mr. J.M. is a 32-year-old man from
Mexico who was born with a deformity at the base of the skull. He was told by his
neurosurgeon in Mexico that he had basilar invagination of the skull and over time he
would become completely paralyzed due to pressure on the spinal cord from a deformed bone
(Figures 9 and 10). The medical term for this condition is skull base basilar invagination
with myelopathy. He was referred to Dr. McCormack.
Figure 9. MRI of head. "x" indicates abnormal bone pressing against the
brainstem causing paralysis. Double "x" indicates brainstem compression.
Figure 10. CT scan of junction of the head with the spine. "x" indicates
abnormal bone projecting into the patient’s head and brainstem region.
Treatment
On examination the patient had difficulty
swallowing and could barely walk. His studies demonstrated pressure on his brainstem from
the second cervical vertebrae. In staged operations, Dr. McCormack first relieved the
pressure on his brainstem by using a microscope and dissecting the bone off the spinal
cord through the patient’s mouth (Figure 11). The base of the skull was reconstructed
using the patient’s own rib bone to fuse the skull to the spine and a titanium rod
(Figure 12). The patient regained all his strength and could eat normally after surgery.
Figure 11. CT scan after removal of the abnormal bone to relieve pressure on the
brainstem. The surgery was performed through the patient’s mouth using a microscope.
A. 
Figure 12A. The base of the skull was reconstructed using the patient’s own rib bone.
B. 
Figure 12B. Dr. McCormack then used a titanium rod to fuse the skull to the
spine.
Patient Comment
"They told me that there was
no one in Mexico who could do this surgery. My government helped me find Dr. McCormack.
I’m glad I did."
Next case
Copyright the Neurospine Institute 1998.
Last edited 09/11/98.
