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Journal of Clinical Neurology (Seoul,... Mar 2022
PubMed: 35274843
DOI: 10.3988/jcn.2022.18.2.241 -
World Neurosurgery Aug 2022Congenital basilar invagination (BI) is a craniocervical deformity marked by odontoid prolapse into the skull base. The foramen magnum angle (FMA), which is formed by...
OBJECTIVE
Congenital basilar invagination (BI) is a craniocervical deformity marked by odontoid prolapse into the skull base. The foramen magnum angle (FMA), which is formed by the Chamberlain's line and McRae's line, has not been fully studied. The study aimed to investigate the FMA and its relationship with other craniocervical parameters.
METHODS
Participants were divided into control, type A BI, and type B BI groups. Parameters included Chamberlain line violation, atlantodental interval, clivus height, clivus anteroposterior dimension, FMA, basal angle, clivo-axial angle, head and neck flexion angle, Boogard's angle, and subaxial cervical spine lordosis angle. A comparison of these parameters among the 3 groups and correlation analysis between FMA and other parameters were performed. The significance level was set at P < 0.05.
RESULTS
A total of 111 controls, 111 type A BI patients, and 62 type B BI patients were enrolled. The FMAs in the control, type A BI, and type B BI groups were 6.21° (3.67°, 8.71°), 22.16° ± 6.61°, and 22.39° (17.27°, 31.08°), respectively. Correlation analysis revealed correlations between the FMA and other variables. In the 2 BI subgroups, FMA was significantly correlated with Chamberlain line violation, clivus height, clivus anteroposterior dimension, basal angle, clivo-axial angle, and Boogard's angle.
CONCLUSIONS
The FMA in patients with BI was approximately 22° and approximately 6° in controls, indicating that the foramen magnum in BI had a greater tilt. As a pathological condition, FMA can reflect the degree of BI. Clivus hypogenesis is a reason for the excessive tilt of the FM.
Topics: Cervical Vertebrae; Cranial Fossa, Posterior; Foramen Magnum; Humans; Lordosis; Platybasia
PubMed: 35577208
DOI: 10.1016/j.wneu.2022.05.027 -
Surgical and Radiologic Anatomy : SRA Jul 2020There are many craniometric measurements that are used in evaluating craniovertebral junction (CVJ) pathologies such as basilar invagination, atlantoaxial dislocation...
INTRODUCTION
There are many craniometric measurements that are used in evaluating craniovertebral junction (CVJ) pathologies such as basilar invagination, atlantoaxial dislocation and platybasia. Therefore, it is important to determine the normal reference range of the craniometric measurements. This study aims to determine the morphometric reference values of the bony structures in the CVJ from cone-beam computed tomography (CBCT) images of a group of South Eastern Anatolian population.
MATERIALS AND METHODS
The CBCT images of 300 individuals were retrospectively evaluated. 14 parameters on midsagittal and 2 parameters on the coronal plane were studied. The data were statistically evaluated.
RESULTS
Measurement results were found as follows; the distances between odontoid process (OP) and McGregor line as 0.31 ± 3.22 mm, OP and Chamberlain line 1.06 ± 3.22 mm, OP and McRae line 5.30 ± 1.59 mm, OP and Fischgold digastric line 8.70 ± 4.12 mm, OP and Fischgold bimastoid line - 5.15 ± 4.86 mm, length of McRae line 35.58 ± 2.52 mm, atlantodental interval 1.28 ± 0.48 mm, posterior atlantodental interval 19.54 ± 2.24 mm, basion axial interval 4.01 ± 1.83 mm, basion dental interval 4.92 ± 1.77 mm, length of Modified Ranawat line 28.66 ± 2.38 mm, length of Redlund-Johnell line 35.11 ± 4.09 mm, clivus canal angle 157.62° ± 11.85°, Welcher basal angle 130.83° ± 6.29°, craniocervical tilt 126.98° ± 12.24° and Powers ratio as 0.72 ± 0.06.
CONCLUSION
In this study, the morphometric values were evaluated according to age and gender in individuals who did not have any radiologic anomalies. The normal reference ranges may be useful for researchers who are researching pathology in this region. It is recommended to conduct further studies with different populations to determine the normal reference range.
Topics: Adolescent; Adult; Aged; Anatomic Landmarks; Atlanto-Axial Joint; Atlanto-Occipital Joint; Cephalometry; Cone-Beam Computed Tomography; Female; Humans; Joint Dislocations; Male; Middle Aged; Occipital Bone; Odontoid Process; Platybasia; Reference Values; Retrospective Studies; Young Adult
PubMed: 32221664
DOI: 10.1007/s00276-020-02457-z -
Spine Nov 2022Retrospective study.
STUDY DESIGN
Retrospective study.
OBJECTIVE
To present a morphological map of cervical sagittal alignment in basilar invagination (BI), a congenital anomaly of the craniovertebral junction, and contribute to a comprehensive understanding of cervical sagittal alignment in congenital cervical deformities.
SUMMARY OF BACKGROUND DATA
Ideal cervical sagittal alignment and surgical targets are debated by scholars. However, most of the literature focuses on the description of cervical sagittal alignment in acquired cervical diseases and normal subjects and few on congenital cervical spine deformities.
MATERIALS AND METHODS
This study analyzed cervical spine lateral radiographs of 87 BI patients and 98 asymptomatic subjects. They were analyzed for cranial, cervical spine, and thoracic inlet parameters.
RESULTS
Patients with BI manifested significantly larger values for the following parameters than asymptomatic subjects: cranial tilt, cranial incidence angle, sagittal vertical axis (SVA) CGH-C7, C2-C7 angle, cervical tilt, and significantly smaller values for the following parameters: cranial slope, C0-C2 angle, C0-C7 angle, SVA C2-C7, spine tilt, thoracic inlet angle, and neck tilt. In the BI group, SVA C2-C7 was the cervical parameter most strongly correlated with the cranial, cervical spine, and thoracic inlet parameters, and was smaller in BI patients with fusion (atlanto-occipital assimilation) than in those without.
CONCLUSION
A significant difference was observed between BI patients and asymptomatic subjects. BI patients have craniums tilted forward and downward, smaller upper cervical lordosis, larger lower cervical lordosis, and smaller thoracic inlet angle. In BI patients, the SVA C2-C7 is an important parameter in cervical sagittal alignment. In both individuals with congenital anomalies of the craniovertebral junction and the asymptomatic population, cervical spine alignment is significantly associated with cranial alignment, particularly thoracic inlet alignment.
Topics: Cervical Vertebrae; Humans; Lordosis; Neck; Platybasia; Radiography; Retrospective Studies
PubMed: 35867616
DOI: 10.1097/BRS.0000000000004423 -
World Neurosurgery Jul 2023Patients with Chiari malformation (CM) associated with atlantoaxial dislocation (AAD) and basilar invagination (BI) may present with a small posterior cranial fossa, but...
OBJECTIVE
Patients with Chiari malformation (CM) associated with atlantoaxial dislocation (AAD) and basilar invagination (BI) may present with a small posterior cranial fossa, but data on the volumetric analysis are lacking. Additionally, whether additional foramen magnum decompression (FMD) is needed together with atlantoaxial fusion remains controversial. This study evaluated the volumetric alterations of the posterior cranial fossa in these patients and analyzed the radiological and clinical outcomes after posterior C1-C2 reduction and fixation plus C1 posterior arch resection.
METHODS
Thirty-two adult CM patients with AAD and BI (CM-AAD/BI group) and 21 AAD and BI patients without CM (AAD/BI-only group) who received posterior atlantoaxial fusion plus C1 posterior arch resection were retrospectively studied. The clinical and radiological outcomes and volumetric measurements of the posterior cranial fossa were evaluated.
RESULTS
The majority of CM-AAD/BI patients (94%) improved clinically and radiologically at 12 mo postoperatively, and none required additional FMD. Morphological analysis revealed a significant reduction in the bony posterior cranial fossa volumes of the CM-AAD/BI group (P < 0.01) and the AAD/BI-only group (P < 0.01) relative to those of the CM group. No significant differences were observed between the CM-AAD/BI and AAD/BI groups.
CONCLUSIONS
Compared with patients with simple CM, patients with AAD/BI with or without CM demonstrated a considerably and equally reduced bony posterior cranial fossa volume. No additional FMD is needed in the treatment of CM-AAD/BI patients after posterior reduction and fusion plus C1 posterior arch resection.
Topics: Adult; Humans; Retrospective Studies; Arnold-Chiari Malformation; Platybasia; Joint Dislocations; Atlanto-Axial Joint; Decompression, Surgical; Neck Injuries; Spinal Fusion
PubMed: 37087038
DOI: 10.1016/j.wneu.2023.04.064 -
Osteoporosis International : a Journal... Jan 2022Craniocervical abnormalities in osteogenesis imperfecta (OI) such as basilar invagination or cervical kyphosis can cause severe neurological morbidity. These...
UNLABELLED
Craniocervical abnormalities in osteogenesis imperfecta (OI) such as basilar invagination or cervical kyphosis can cause severe neurological morbidity. These abnormalities may be more frequent in OI type V compared with other OI subtypes of similar disease severity, underlining the importance of screening in this group.
INTRODUCTION
Craniocervical abnormalities in osteogenesis imperfecta (OI) can cause severe neurological morbidity. Although radiological cranial base abnormalities in OI have been well described in the literature, there are limited data on these abnormalities in OI type V and their association with clinical sequelae.
METHODS
A retrospective case series on patients with craniocervical abnormalities in OI type V at our institution.
RESULTS
Craniocervical abnormalities were present in 7 of 37 patients with OI type V (19%). For 5 patients (age at last follow-up: 5 to 26 years; 2 females), sufficient information was available for inclusion in the case series. All had genetically confirmed OI type V. Age range at diagnosis of the craniocervical abnormality was 1 day to 18 years. Basilar invagination was present in 3 patients; 2 had cervical kyphosis. Dysplasia of upper cervical vertebrae or base of skull was seen in 3 patients. The severity of the craniocervical abnormality did not clearly correlate with the severity of the OI phenotype. Three patients required surgical intervention (ages 7, 11, and 26 years) due to compression of the spinal cord or brainstem. Craniocervical abnormalities were detected incidentally or on screening in 3 patients, and only 2 had significant positive findings on neurological examination.
CONCLUSION
A variety of craniocervical abnormalities are seen in OI type V including dysplasia of the cervical vertebrae. These cases highlight the importance of screening patients with OI type V with lateral skull and cervical spine x-rays throughout childhood and after skeletal maturity.
Topics: Cervical Vertebrae; Child; Female; Humans; Infant; Kyphosis; Osteogenesis Imperfecta; Platybasia; Retrospective Studies
PubMed: 34350492
DOI: 10.1007/s00198-021-06088-x -
Zhonghua Yi Xue Za Zhi Nov 2022To assess the clinical impact of direct two-step distraction reduction (TSDR) for basilar invagination (BI) with atlantoaxial dislocation (AAD). Retrospective analysis...
To assess the clinical impact of direct two-step distraction reduction (TSDR) for basilar invagination (BI) with atlantoaxial dislocation (AAD). Retrospective analysis was conducted on the clinical data of patients who underwent TSDR and occipitocervical fusion in West China Hospital between October 2013 and March 2021. Depending on whether the preoperative decrease was greater than 50% on preoperative hyperextension X-rays, the patients were split into two groups. The neurological function [Japanese Orthopedic Association (JOA) score], atlantodens interval (ADI), the distance of odontoid process beyond McRae Line (ML) and Wackenheim Line (WL), cervicomedullary angle (CMA), O-C angle (OC2A), and complications incidence were compared between two groups preoperatively and postoperatively. There were 12 men and 23 women among the 35 patients with BI and AAD, and the age ranged from 28 to 71 years, with an mean age of (52.0±13.4) years. In the preoperative reduction ≥50% group, there were 4 males and 9 females with an average age of (54.0±13.8) years; in the preoperative reduction <50% group, there were 8 males and 14 females with a mean age of (50.9±13.4) years. All the patients were followed-up for a mean time of (23.3±13.4) months. There was no significant difference in age, gender, bleeding, length of hospital stay and follow-up time between the two groups (all >0.05). The JOA score, ADI, WL, ML and CMA of 35 patients were significantly improved when compared with those before operation (all <0.05). The reduction degree of ADI, ML and WL was more than 80% in 31 cases (88.57%), 30 cases (85.71%) and 31 cases (88.57%), respectively. There was no significant difference in postoperative ADI, ML and WL between the two groups (all >0.05). All patients had no incision infection, no loosening or breakage of the internal fixators. Dysphagia occurred in 3 patients, non-fusion happened in 1 patient, but no instability in X-ray of cervical dynamic position was found, no loosening or displacement occurred in internal fixators, and partial spontaneous fusion occurred between atlantoaxial lateral mass joints. For BI with AAD without atlantoaxial bony connection or serious atlantoaxial facet joint inclination, TSDR could obtain satisfactory reduction degree. The reduction degree on preoperative hyperextension X-ray doesn't affect the degree of intraoperative reduction.
Topics: Male; Humans; Female; Adult; Middle Aged; Aged; Retrospective Studies; Decompression, Surgical; Platybasia; Joint Dislocations; Atlanto-Axial Joint; Neck Injuries
PubMed: 36396359
DOI: 10.3760/cma.j.cn112137-20220426-00933 -
World Neurosurgery Aug 2022We sought to compare the diagnostic accuracy of cephalic indices for type B basilar invagination (BI).
OBJECTIVE
We sought to compare the diagnostic accuracy of cephalic indices for type B basilar invagination (BI).
METHODS
This retrospective study examined head and neck magnetic resonance imaging sequences of 31 Group B BI cases and 96 controls. Two examiners blinded to diagnostic data evaluated the cephalic indices of each magnetic resonance imaging sequence, described as width/length (WLI) and height/width (HWI). The distance of the odontoid process apex to Chamberlain line and clivus canal angle were measured. The interexaminer and intraexaminer reproducibility of the cephalic indices was calculated using intraclass correlation coefficient. The diagnostic accuracy was discerned by the receiver operating characteristic (ROC) curve. All analyses were scrutinized with a 95% confidence interval.
RESULTS
Cephalic indices showed interexaminer and intraexaminer reproducibility ≥94%. The areas under the ROC curve were 0.639 (WLI) and 0.874 (HWI) (95% confidence interval: P < 0.05). The HWI showed a sensitivity of 74.7% and a specificity of 85.5% for the cutoff criterion ≤58. The WLI presented a sensitivity of 53.3% and a specificity of 66.7% for the cutoff criterion ≥86.
CONCLUSIONS
The HWI showed the largest area under the ROC curve in comparison with the WLI, with robust sensitivity and specificity values, indicating that the proportions between cranial height and width can help clinicians in investigating type B BI.
Topics: Humans; Odontoid Process; Platybasia; ROC Curve; Reproducibility of Results; Retrospective Studies
PubMed: 35688370
DOI: 10.1016/j.wneu.2022.06.007 -
World Neurosurgery Sep 2022Although posterior procedures are used for most cases of basilar invagination, transoral decompression is an important tool in complex deformities with severe...
BACKGROUND
Although posterior procedures are used for most cases of basilar invagination, transoral decompression is an important tool in complex deformities with severe degeneration and neural compression.
METHODS
Consecutive patients who underwent transoral odontoidectomy for basilar invagination and atlantoaxial dislocation at the neurosurgical unit of Lady Reading Hospital Peshawar between June 2016 and January 2022 were retrospectively included. Preoperative and postoperative neurological, clinical, and radiological parameters were recorded and compared.
RESULTS
Of the 33 patients included in this study, 22 were men and 11 were women. The mean age was 23.4 years ±8.4 years (mean ± standard deviation). The most common presenting symptoms were gait abnormalities and neck pain. A total of 28 patients were treated for the first time, while 5 patients had prior posterior fusion. The mean distance of the tip of the dens above the chamberlain line was 8.9 ± 4.2 mm, while the mean anterior atlantodental interval was 6.5 ± 2.1 mm. Seven patients had an anomalous course of vertebral artery on at least one side. A total of 28 patients improved significantly, while 5 patients did not improve at the follow-up. The mean follow-up was 8.5 months ±6.3 (mean ± standard deviation). The mean Nurick and Modified Japanese Orthopedic Association scores improved postoperatively (P < 0.05). Three patients underwent reoperation including one with vertebral artery injury. Three patients underwent tracheostomy.
CONCLUSIONS
With proper patient selection, transoral odontoidectomy can be safely performed in a limited-resource setting.
Topics: Adult; Atlanto-Axial Joint; Decompression, Surgical; Female; Humans; Joint Dislocations; Male; Platybasia; Retrospective Studies; Spinal Fusion; Young Adult
PubMed: 35700863
DOI: 10.1016/j.wneu.2022.06.024 -
Journal of Neurological Surgery. Part... Jul 2023There is evidence that Chiari malformation (CM) and basilar invagination (BI) are largely due to disproportion between the content and volume of the posterior fossa....
BACKGROUND
There is evidence that Chiari malformation (CM) and basilar invagination (BI) are largely due to disproportion between the content and volume of the posterior fossa. A recent study identified an increased association between brachycephaly and BI. In several types of craniosynostosis, the posterior fossa volume is smaller than normal, and this is more pronounced in coronal synostosis. The aim of this study is to evaluate the association between CM and BI.
METHODS
The cephalic index (CI) measured on magnetic resonance imaging (MRI) from a sample of patients with craniocervical malformation was compared with that of normal subjects.
RESULTS
The average CI in the craniovertebral junction malformation (CVJM) group was significantly higher in BI patients than in normal subjects. The BI patients also had the highest CI among the whole sample of patients ( = 0.009).
CONCLUSIONS
In this study, BI patients had the highest CI among patients with CVJM and a significantly higher CI than those in the control group. Our data confirm the association between BI and brachycephaly.
Topics: Humans; Platybasia; Arnold-Chiari Malformation; Magnetic Resonance Imaging; Craniosynostoses
PubMed: 34929749
DOI: 10.1055/s-0041-1739503