case_images: PMC11799733_01
case_images: Imaging tests are recommended for the initial consultation. Sagittal T2-weighted MRI demonstrates substantial spinal cord compression at C1/2 (a). The atlantodental interval measures approximately 1 mm on the sagittal CT scan (b). X-ray images of anteflexion (c) and retroflexion (d) similarly reveal minimal instability at C1/2.
case_images: 2433-3298-8-1-0302-g001.jpg
case_images: PMC11799733_01_2433-3298-8-1-0302-g001.jpg
case_images: fig1
case_images: Quadriplegia was observed, with muscle strength at the MMT2 level, and magnetic resonance imaging (MRI) revealed a retro-odontoid pseudotumor and severe spinal cord compression by the posterior arch at the C1 level (Figure 1a). CT showed that the atlantodental interval was approximately 1 mm (Figure 1b), and even when viewing the anteroposterior bending and retroflexion X-ray images (Figure 1c and d), almost no instability was observed between C1 and C2. Consequently, posterior decompression of the craniocervical junction was performed.
case_images: Approximately 1 month postsurgery, subcutaneous swelling was noted, prompting an MRI evaluation. The imaging revealed a pseudomeningocele measuring 14 cm in length on the sagittal plane (a) and 4 cm in width on the horizontal plane (b).
case_images: 2433-3298-8-1-0302-g002.jpg
case_images: PMC11799733_01_2433-3298-8-1-0302-g002.jpg
case_images: fig2
case_images: However, subcutaneous swelling was noted and an MRI indicated PMC one month postsurgery (Figure 2).
case_images: Four months postsurgery, the patient exhibited drowsiness and vomiting. Head and cervical MRIs were performed in response to these symptoms. The head MRI revealed considerable ventricular enlargement (a), whereas the cervical MRI indicated an increase in the pseudomeningocele (b).
case_images: 2433-3298-8-1-0302-g003.jpg
case_images: PMC11799733_01_2433-3298-8-1-0302-g003.jpg
case_images: fig3
case_images: An MRI revealed considerable ventricular enlargement, leading to a diagnosis of communicating hydrocephalus (Figure 3), and immediate ventricular drainage was performed.
case_images: This computed tomography scan of the head, performed after ventriculoperitoneal shunt surgery, shows that the ventricles have returned to normal size (a) and the pseudomeningocele has significantly decreased (b).
case_images: 2433-3298-8-1-0302-g004.jpg
case_images: PMC11799733_01_2433-3298-8-1-0302-g004.jpg
case_images: fig4
case_images: A ventriculoperitoneal (VP) shunt was implanted one week later, resulting in an improvement of the hydrocephalus and PMC (Figure 4), and the patient resumed gait training.