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Neurology India 2009Institute and personal experience (over 25 years) of basilar invagination was reviewed. The database of the department included 3300 patients with craniovertebral... (Review)
Review
Institute and personal experience (over 25 years) of basilar invagination was reviewed. The database of the department included 3300 patients with craniovertebral junction pathology from the year 1951 till date. Patients with basilar invagination were categorized into two groups based on the presence (Group A) or absence (Group B) of clinical and radiological evidence of instability of the craniovertebral junction. Standard radiological parameters described by Chamberlain were used to assess the instability of the craniovertebral junction. The pathogenesis and clinical features in patients with Group A basilar invagination appeared to be related to mechanical instability, whereas it appeared to be secondary to embryonic dysgenesis in patients with Group B basilar invagination. Treatment by facetal distraction and direct lateral mass fixation can result in restoration of craniovertebral and cervical alignment in patients with Group A basilar invagination. Such a treatment can circumvent the need for transoral or posterior fossa decompression surgery. Foramen magnum bone decompression appears to be a rational surgical treatment for patients having Group B basilar invagination. The division of patients with basilar invagination on the basis of presence or absence of instability provides insight into the pathogenesis of the anomaly and a basis for rational surgical treatment.
Topics: Arnold-Chiari Malformation; Atlanto-Axial Joint; Decompression, Surgical; Foramen Magnum; Humans; Magnetic Resonance Imaging; Platybasia; Syringomyelia; Tomography, X-Ray Computed
PubMed: 19587461
DOI: 10.4103/0028-3886.53260 -
Clinics (Sao Paulo, Brazil) 2019Basilar invagination (BI) and Chiari malformation type I (CM-I) are very important anomalies that introduce instability and compression in the occipitocervical... (Review)
Review
Basilar invagination (BI) and Chiari malformation type I (CM-I) are very important anomalies that introduce instability and compression in the occipitocervical transition region and have complex clinical characteristics. These anomalies vary according to the affected structures. The present study revises current knowledge regarding the anatomy, anatomo-physiology, clinical manifestations, and radiological findings of these entities and the associated surgical treatment approaches. A bibliographic survey was performed through a search in the Medline, PubMed, SciELO, Science and LILACS databases. When associated, these craniovertebral malformations result in neurological deficits due to neural parenchyma compression; however, the presence of microtraumas due to repetitive lesions caused by the bulb and cervical marrow instability has been highlighted as a determinant dysfunction. Surgical treatment is controversial and has many technical variations. Surgery is also challenging due to the complex anatomical characteristics and biomechanics of this region. Nevertheless, advances have been achieved in our understanding of related mechanisms, and compression and atlantoaxial instability are considered key elements when selecting the surgical approach.
Topics: Arnold-Chiari Malformation; Decompression, Surgical; Humans; Joint Instability; Magnetic Resonance Imaging; Odontoid Process; Platybasia
PubMed: 30970117
DOI: 10.6061/clinics/2019/e653 -
Acta Neurochirurgica. Supplement 2019Basilar invagination (BI) and Chiari malformation type I CM-I) are the most common adult craniovertebral junction malformations, and they are frequently associated with... (Review)
Review
Basilar invagination (BI) and Chiari malformation type I CM-I) are the most common adult craniovertebral junction malformations, and they are frequently associated with each other and present synchronously. The relationship between BI and CM-I has remained incompletely understood, and the choice of surgical strategy has remained controversial. This brief review focuses on the different aspects of BI and CM-I, and further discusses the relationship between these two concomitant pathologies on the basis of the concepts proposed over the last three decades.
Topics: Arnold-Chiari Malformation; Cervical Vertebrae; Decompression, Surgical; Foramen Magnum; Humans; Odontoid Process; Platybasia; Skull Base
PubMed: 30610310
DOI: 10.1007/978-3-319-62515-7_16 -
Revista de Neurologia Oct 1996A common aetiopathogenic theory for basilar groove (IMB), platybasia (PTB), odontoid retrocession (RTO), kinking of the brainstem (KTC) applied to idiopathic...
INTRODUCTION
A common aetiopathogenic theory for basilar groove (IMB), platybasia (PTB), odontoid retrocession (RTO), kinking of the brainstem (KTC) applied to idiopathic syringomyelia (SMI), idiopathic scoliosis (ESCID) and Arnold-Chiari malformation (ARCH) is presented. Confirmation is based on an abnormally low position of the conus medullaris (CMB) in the patients with SMI.
MATERIALS AND METHOD
292 patients with syringomyelia (SM), 231 with SMI were selected. Of these, 55 were chosen who had SMI and in whom the level of the conus medullaris (NCM) could be determined, together with the figures for SMI, IMB, PTB, RTO, KTC, ESCID and ARCH on cervical and lumbar MR. The position of the conus medullaris in 50 patients who did not have SM, ESCID nor ARCH on cervical and lumbar RM was determined.
RESULTS
32 patients had an increased basal angle (58.18%). There was an IMB in a quarter of the patients (25.45%). RTO was observed in half of the patients (47.27%). Just over one third presented a KTC. 6% of the control group had CM at the level of the body of L1, whilst 84.21% of the patients with SMI presented a partial or complete CM image at this level.
CONCLUSIONS
CMB in SMIU and its close relationship with IMB, PTB, RTO AND KTC and also with ESCID and ARCH make it likely that they share the same aetiopathogenic mechanism: an abnormal lack of synchronization of the growth of the neuro-axis and the neural canal (AACNN), causing a specific disorder which is seen as different syndromes.
Topics: Adult; Arnold-Chiari Malformation; Brain; Brain Stem; Female; Humans; Magnetic Resonance Imaging; Male; Medulla Oblongata; Odontoid Process; Platybasia; Scoliosis; Syringomyelia
PubMed: 8983722
DOI: No ID Found -
Surgical Neurology Feb 1982Osteogenesis imperfecta, a rare, genetically transmitted disorder of bone, is known to be associated with the development of basilar impression and platybasia. These...
Osteogenesis imperfecta, a rare, genetically transmitted disorder of bone, is known to be associated with the development of basilar impression and platybasia. These deformities of the base of the skull may cause neurosurgical abnormalities secondary to compression of the brainstem and hydrocephalus. The case is presented of a young boy with a family history of osteogenesis imperfecta tarda who suffered respiratory arrest during hospitalization. Cranial nerves and pyramidal tract signs were demonstrated. Roentgenograms showed severe basilar impression and hydrocephalus. Decompression of the brainstem and shunting were performed with improvement in the patient's neurological status. This case represents a rare by significant central nervous system complication of osteogenesis imperfecta. Early recognition and implementation of aggressive treatment are important if irreversible neurological deficits are to be avoided.
Topics: Adolescent; Humans; Male; Nervous System Malformations; Osteogenesis Imperfecta; Platybasia; Radiography
PubMed: 7071726
DOI: 10.1016/s0090-3019(82)80033-5 -
Pediatric Radiology 1994Basilar impression (BI) assessed by either plain lateral skull radiograph or computerized tomography (CT) sagittal reconstruction of the craniocervical junction is a... (Review)
Review
Basilar impression (BI) assessed by either plain lateral skull radiograph or computerized tomography (CT) sagittal reconstruction of the craniocervical junction is a common finding occurring in 25% of subjects with osteogenesis imperfecta (OI). It appears to occur with highest frequency in a group of subjects with OI type IV B, i.e. patients with mild/moderate liability to fractures, normal sclerae but dentinogenesis imperfecta. Neurologic signs indicating compression of posterior fossa structures occur predominantly in subjects with BI and OI type IV. Screening is recommended for all patients with OI but particularly OI type IV B.
Topics: Cervical Vertebrae; Child; Humans; Magnetic Resonance Imaging; Molecular Biology; Osteogenesis Imperfecta; Platybasia; Skull; Tomography, X-Ray Computed
PubMed: 7700720
DOI: 10.1007/BF02011910 -
Connective Tissue Research 1995Progressive spinal deformity can be an anathma for indivudials with osteogenesis imperfecta. Scoliosis or khyphosis develop indolently, being less dramatic than long... (Review)
Review
Progressive spinal deformity can be an anathma for indivudials with osteogenesis imperfecta. Scoliosis or khyphosis develop indolently, being less dramatic than long bone fractures, but once significant deformities evolve, they tend to remain progressive on into adulthood. State of the art spinal fixation systems are of little help in correcting such deformities due to poor bone stock. However, most curves can be arrested by posterior spinal fusion, performed either in situ, or by utilizing basic Harrington type instrumentation with methylmethacylate supplemtation for the hook sites, along with Drummond wires where feasible. Platybasia is yet another issue involving the spine which may be complicated by neurologic deterioration. It has been posulated as a cause of death, but can respond to shunting and brain stem decompression when recognized.
Topics: Braces; Decompression, Surgical; Humans; Internal Fixators; Osteogenesis Imperfecta; Platybasia; Skull Base; Spinal Curvatures; Spinal Fusion; Spine
PubMed: 15612384
DOI: 10.3109/03008209509116836 -
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 -
A.M.A. Archives of Neurology and... Nov 1951
Topics: Bone Diseases; Health Services; Humans; Occipital Bone; Platybasia
PubMed: 14868039
DOI: No ID Found -
The Journal of Nervous and Mental... May 1952
Topics: Health Services; Humans; Occipital Bone; Platybasia; Spine
PubMed: 14928074
DOI: No ID Found