Abril - 2017

lternative

option

for

osteogenesis

imperfecta

and

trigeminal

neuralgia

ssoc

ras

2017; 63(4):307-310

309

mild in most cases and causes minimal deformities in

adults. Skeletal manifestations may include thinned cal-

varium and excessive wormian bone formation.

Basilar invagination is a rare complication of multiple

generalized bone diseases, and may cause severe disabil-

ity. The upward displacement of the basilar and condylar

portions of the occipital bone may cause the foramen

magnum to fold inward with subsequent translocation

of the upper cervical spine into the brainstem.

7,9

This

condition can result in bulbar dysfunction and myelopa-

thy with lower cranial nerve palsies due to stretching.

Few cases in the literature described basilar invagination

associated with trigeminal neuralgia.

3,8,12

This condition, due

to the complexity of anatomical deformities, hinders treat-

ment options. Microsurgical decompression may be con-

sidered as a definitive and long-term solution, but it carries

a high risk, since substantial bone deformity caused by

the disease may worsen after bone removal for craniotomy.

The foramen ovale approach is an alternative option,

although it can prove challenging or even impossible.

Normal anatomical relations are distorted by bone defor-

mity and the lower surface of the foramen ovale may be

posteromedially displaced, thus making the convention-

al route for percutaneous approaches virtually impossible

to use.

5,7,8

The authors found that Mayfield clamps, neces-

sary in the previous alternatives, also imply high compli-

cation risk given the potential fragmentation of wormian

bones and deformity worsening.

FIGURE 2

Submental view of the cannula positioned at the foramen ovale.

FIGURE 3

Intensifier control. Lateral view showing the pear-shaped aspect of the balloon.