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Archives of Neurology Mar 1974
Topics: Adult; Arnold-Chiari Malformation; Brain Stem; Cerebellum; Computers, Analog; Diagnosis, Computer-Assisted; Electronics, Medical; Female; Fixation, Ocular; Humans; Infrared Rays; Middle Aged; Models, Biological; Nystagmus, Pathologic; Oculomotor Nerve; Photic Stimulation; Physical Stimulation; Platybasia; Reflex; Rotation; Tape Recording; Vestibular Function Tests; Vestibule, Labyrinth
PubMed: 4591431
DOI: 10.1001/archneur.1974.00490330035006 -
Rinsho Hoshasen. Clinical Radiography Sep 1984
Topics: Adolescent; Arnold-Chiari Malformation; Humans; Male; Platybasia; Radiography; Skull; Syringomyelia
PubMed: 6513080
DOI: No ID Found -
Radiologic Clinics of North America Aug 1977It is prudent to apply several methods of evaluation of cervicobasilar relationships in basilar impression and, in suggestive cases, to use tomographic evaluation for...
It is prudent to apply several methods of evaluation of cervicobasilar relationships in basilar impression and, in suggestive cases, to use tomographic evaluation for complete study. This discussion reviews normal cervicobasilar relationships and illustrates selected pathologic processes that produce basilar impression.
Topics: Achondroplasia; Breast Neoplasms; Cervical Vertebrae; Female; Foramen Magnum; Humans; Mastoid; Neoplasm Metastasis; Occipital Bone; Osteitis Deformans; Platybasia; Radiography; Skull Fractures; Skull Neoplasms
PubMed: 887737
DOI: No ID Found -
Neurosurgical Review 1983This short survey summarises the important craniocervical dysplasias, the malformations accompanying primary neuroectodermal and secondary lesions of the neural...
This short survey summarises the important craniocervical dysplasias, the malformations accompanying primary neuroectodermal and secondary lesions of the neural structures and their coverings, and complex malformations. The interpretation, classification and the identification of the static and/or dynamic biomechanical pathogenesis is a prerequisite for the correct diagnosis and for assessing the indications for and the choice of any operation to be adopted.
Topics: Axis, Cervical Vertebra; Bone Diseases, Developmental; Cervical Atlas; Cervical Vertebrae; Ectodermal Dysplasia; Humans; Platybasia; Skull
PubMed: 6674834
DOI: 10.1007/BF01743098 -
Journal of Medical Genetics Feb 1993
Topics: Child; Humans; Hydrocephalus; Male; Osteolysis, Essential; Platybasia
PubMed: 8445627
DOI: 10.1136/jmg.30.2.175 -
Clinical Neurology and Neurosurgery Jul 2023To present our experience with an individualized surgical approach to treat Chiari malformation type 1.
OBJECTIVE
To present our experience with an individualized surgical approach to treat Chiari malformation type 1.
METHODS
Based on (1) neurological symptoms, (2) the existence and extent of a syrinx and (3) the degree of the tonsillar descent we performed four types of approaches on a case-by-case basis in 81 patients: (1) foramen magnum decompression (FMD) with dura splitting (FMDds); (2) FMD with duraplasty (FMDdp); (3) FMD with duraplasty and tonsillar manipulation (FMDao); and (4) tonsillar resection/reduction (TR). Patient characteristics, Chiari Severity Index (CSI), fourth ventricular roof angle (FVRA) and Chicago Chiari Outcome Scale (CCOS) were analyzed.
RESULTS
CCOS was between 13 and 16 points in 8/11 (73 %) patients after FMDds, 38/45 (84 %) patients after FMDdp, and 24/24 (100 %, one patient lost to follow-up) patients after TR. We experienced an overall complication rate of 13.6 % (11/81) in this series, whereas seven of these eleven complications (64 %) occurred in the FMDao group and the complication rate increased with the invasiveness of the approach (0 % FMDds; 4 % FMDdp; 12 % TR).
CONCLUSION
Given the clear correlation between the extend of the approach and the complication rate the least invasive approach necessary to achieve clinical improvement should be selected. Due to the high complication rates, FMDao should not be used as a treatment option. The severity of the tonsillar descent, basilar invagination and current CM1 scores could be used to aid in the approach selection.
Topics: Humans; Treatment Outcome; Decompression, Surgical; Magnetic Resonance Imaging; Arnold-Chiari Malformation; Platybasia; Foramen Magnum; Retrospective Studies
PubMed: 37245455
DOI: 10.1016/j.clineuro.2023.107803 -
European Journal of Radiology Nov 2020
Topics: Humans; Magnetic Resonance Imaging; Platybasia; Radiography; Radiology
PubMed: 32950798
DOI: 10.1016/j.ejrad.2020.109280 -
Journal of Neurosurgery Feb 2024Craniocervical junction (CCJ) pathologies with ventral neural element compression are poorly understood, and appropriate management requires accurate understanding,...
OBJECTIVE
Craniocervical junction (CCJ) pathologies with ventral neural element compression are poorly understood, and appropriate management requires accurate understanding, description, and a more uniform nomenclature. The aim of this study was to evaluate patients to identify anatomical clusters and better classify CCJ disorders with ventral compression and guide treatment.
METHODS
A retrospective review of adult and pediatric patients with ventral CCJ compression from 2008 to 2022 at a single center was performed. The incidence of anatomical abnormalities and compressive etiologies was assessed. Surgical approach, radiographic data, and outcomes were recorded. Association rules analysis (ARA) was used to assess variable clustering.
RESULTS
Among 51 patients, the main causes of compression were either purely bony (retroflexed dens [n = 18]; basilar invagination [BI; n = 13]) or soft tissue (degenerative pannus [n = 16]; inflammatory pannus [n = 2]). The primary cluster in ARA was a retroflexed dens, platybasia, and Chiari malformation (CM), and the secondary cluster was BI, C1-2 subluxation, and reducibility. These, along with degenerative pannus, formed the three major classes. In assessing the optimal treatment strategy, reducibility was evaluated. Of the BI cases, 12 of the 13 patients had anterolisthesis of C1 that was potentially reducible, compared with 2 of the 18 patients with a retroflexed dens (both with concomitant BI), and no pannus cases. The mean C1-2 facet angle was significantly higher in BI at 32.4°, compared with -2.3° in retroflexed dens and 8.1° in degenerative pannus (p < 0.05). Endonasal decompression with posterior fixation was performed in 48 (94.0%) of the 51 patients, whereas posterior reduction/fixation alone was performed in 3 patients (6.0%). Of 16 reducible cases, open posterior reduction alone was successful in 3 (60.0%) of 5 cases, with all successes containing isolated BI. Reduction was not attempted if vertebral anatomy was unfavorable (n = 9) or the C1 lateral mass was absent (n = 5). The mean follow-up was 28 months. Symptoms improved in 88.9% of patients and were stable in the remaining 11.1%. Tracheostomy and percutaneous G-tube placement occurred in 7.8% and 11.8% of patients, respectively. Reoperation for an endonasal CSF leak repair or posterior cervical wound revision both occurred in 3.9% of patients.
CONCLUSIONS
In classifying, one cluster caused decreased posterior fossa volume due to an anatomical triad of retroflexed dens, platybasia, and CM. The second cluster caused pannus formation due to degenerative hypertrophy. For both, endonasal decompression with posterior fixation was ideal. The third group contained C1 anterolisthesis characterized by a steep C1-2 facet angle causing reducible BI. Posterior reduction/fixation is the first-line treatment when anatomically feasible or endonasal decompression with in situ posterior fixation when anatomical constraints exist.
Topics: Adult; Humans; Child; Platybasia; Decompression, Surgical; Arnold-Chiari Malformation; Odontoid Process; Reoperation
PubMed: 37503952
DOI: 10.3171/2023.5.JNS23677 -
Endocrinologia, Diabetes Y Nutricion Mar 2024Secondary basilar invagination or basilar impression is an anomaly at the craniovertebral junction where the odontoid process prolapses into the foramen magnum with the... (Review)
Review
Secondary basilar invagination or basilar impression is an anomaly at the craniovertebral junction where the odontoid process prolapses into the foramen magnum with the risk of compressing adjacent structures and obstructing the proper flow of cerebrospinal fluid (CSF). The incidence is less than 1% in the general population and occurs mainly in the first three decades of life when it is associated with malformations of the neuroaxis. In older age, the main aetiologies are diseases that alter bone mineral density. The clinical course is usually progressive and the most common symptoms are asthenia, cervical pain and restricted movement, but also dysphonia, dyspnoea and dysphagia. It is a progressive disease which, if left untreated, can cause severe neurological damage and death. We report the case of a 79-year-old woman with osteoporosis and progressive dysphagia leading to severe malnutrition, which conditioned the decision not to intervene due to the high perioperative risk.
Topics: Female; Humans; Aged; Platybasia; Deglutition Disorders; Foramen Magnum; Odontoid Process
PubMed: 38555110
DOI: 10.1016/j.endien.2024.03.013 -
Journal of Neurology, Neurosurgery, and... Dec 1992Syringobulbia is a term which has been clinically applied to brain stem symptoms or signs in patients with syringomyelia. Syringobulbia clefts are found on investigation...
Syringobulbia is a term which has been clinically applied to brain stem symptoms or signs in patients with syringomyelia. Syringobulbia clefts are found on investigation or at necropsy caused by cutting outwards of the CSF under pressure from the fourth ventricle into the medulla. These should be differentiated from the ascending syringobulbia which may occur from upward impulsive fluid movements in a previously established syringomyelia. Clinical analysis of 54 patients suggests that bulbar features are most often found with neither of the above mechanisms but are due to the effects of pressure differences acting downward upon the hind-brain with consequent distortion of the cerebellum and brainstem, traction on cranial nerves or indentation of the brain-stem by vascular loops. The commonest symptoms in the 54 patients were headache (35), vertigo (27), dysphonia or dysarthria (21), trigeminal paraesthesiae (27), dysphagia (24), diplopia (16), tinnitus (11), palatal palsy (11) and hypoglossal involvement (11). Careful attention to hydrocephalus is advisable before craniovertebral surgery, but the decompression of the hindbrain and the correction of craniospinal pressure dissociation remains the mainstay of surgical treatment. The results of careful surgery are good, 45 of the 54 cases reported improvement. Most of the reported deterioration occurred in a few patients who did conspicuously badly.
Topics: Adolescent; Adult; Brain Stem; Cerebrospinal Fluid Shunts; Child; Cranial Nerves; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nerve Compression Syndromes; Neurologic Examination; Platybasia; Postoperative Complications; Syringomyelia
PubMed: 1479391
DOI: 10.1136/jnnp.55.12.1132