Functional Neurosurgical Rehabilitation in Craniovertebral Junction Abnormality. An Exemplary Case Report

Abstract

Today, thanks to the tremendous progress in modern neurosurgery, intensive care treatment, CT, MRI, and PET diagnostic imaging techniques and multi-disciplinary management of complications ever more patients survive from severe brain and spinal cord lesions, mainly secondary to trauma, tumours, vascular pathologies, and congenital malformations. Functional impairments after difficult and risky operative procedures or concomitant complications may also cause disturbances of sensory motor and mental-cognitive behavioural functioning that are assessed today according to the WHO-ICF criteria. Early postoperative Neurorehabilitation aims at functional recovery. it starts with the assessment of the impairments and the underlying pathophysiology by using all modern diagnostic tools. Its efficiency can be exemplary demonstrated in one patient who developed an acute Locked-in Syndrome after ventral decompression and dorsal fixation of a CO-C1 congenital malformation secondary to instability with local compression of the lower brain stem. Rehabilitation is a team approach for personal interaction and has to respect the patient's and the relative's needs and social-cultural background. The second look operation followed our algorithm for treatment of craniovertebral abnormalities. The postoperative course was uneventful and the patient regained consciousness. Being still on the ventilator the severe tetraparesis improved over time with aid of active nursing, neuropsychological, physical-, physio-, occupational- and speech/language therapies at the ICU. After four months (FIM better 30 points, ERBI above 50 points) he was transferred for long term rehabilitation. After two years he was fully reintegrated into social life and his job as an active soldier. This case report demonstrates the importance of individually tailored functional rehabilitation in neurosurgery that became a challenge for young neurosurgeons.