title: Pitfalls in the Management of Atlanto-Occipital Dislocation.
abstract: Atlanto-occipital dislocation (AOD) is rarely seen in clinic because it is characteristically immediately fatal. With recent progress in the pre-hospital care, an increasing number of AOD survivors have been reported. However, because the pathophysiology of AOD is not clearly understood yet, the appropriate strategy for the initial management remains still unclear. We report a case of successful AOD treatment and describe important points in the management of this condition. It is important to note that abducens nerve palsy is a warning sign of AOD and that AOD can result in a life-threatening distortion of the arteries and the brain stem. We recommend the application of a halo vest to protect the patient's neural and vascular competence as the immediate initial step in the treatment of AOD. Horn's grading system is useful in assessing indications for surgery. Finally, when performing posterior fixation, C2 should be included because of the anatomy of the ligamentous architecture.
authors.affiliation: Department of Neurosurgery, Aichi Medical University, Nagakute, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Aoyama
authors.affiliation: Department of Neurosurgery, Aichi Medical University, Nagakute, Japan.
authors.forename: Muneyoshi
authors.initials: M
authors.lastname: Yasuda
authors.affiliation: Department of Neurosurgery, Aichi Medical University, Nagakute, Japan.
authors.forename: Masahioro
authors.initials: M
authors.lastname: Joko
authors.affiliation: Department of Neurosurgery, Aichi Medical University, Nagakute, Japan.
authors.forename: Mikinobu
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: Department of Neurosurgery, Aichi Medical University, Nagakute, Japan.
authors.forename: Aichi
authors.initials: A
authors.lastname: Niwa
authors.affiliation: Department of Neurosurgery, Aichi Medical University, Nagakute, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Takayasu
keywords: Atlanto-occipital joint; External fixators; Internal fixators