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Neurosurgical Review Oct 2013The craniometric linear dimensions of the posterior fossa have been relatively well studied, but angular craniometry has been poorly studied and may reveal differences...
The craniometric linear dimensions of the posterior fossa have been relatively well studied, but angular craniometry has been poorly studied and may reveal differences in the several types of craniocervical junction malformation. The objectives of this study were to evaluate craniometric angles compared with normal subjects and elucidate the main angular differences among the types of craniocervical junction malformation and the correlation between craniocervical and cervical angles. Angular craniometries were studied using primary cranial angles (basal and Boogard's) and secondary craniocervical angles (clivus canal and cervical spine lordosis). Patients with basilar invagination had significantly wider basal angles, sharper clivus canal angles, larger Boogard's angles, and greater cervical lordosis than the Chiari malformation and control groups. The Chiari malformation group does not show significant differences when compared with normal controls. Platybasia occurred only in basilar invagination and is suggested to be more prevalent in type II than in type I. Platybasic patients have a more acute clivus canal angle and show greater cervical lordosis than non-platybasics. The Chiari group does not show significant differences when compared with the control, but the basilar invagination groups had craniometric variables significantly different from normal controls. Hyperlordosis observed in the basilar inavagination group was associated with craniocervical kyphosis conditioned by acute clivus canal angles.
Topics: Adult; Arnold-Chiari Malformation; Cephalometry; Cervical Vertebrae; Cranial Fossa, Posterior; Data Interpretation, Statistical; Female; Humans; Image Processing, Computer-Assisted; Lordosis; Magnetic Resonance Imaging; Male; Middle Aged; Platybasia; Radiography; Spine
PubMed: 23640096
DOI: 10.1007/s10143-013-0471-0 -
World Neurosurgery Jan 2020
Topics: Humans; Kyphosis; Platybasia
PubMed: 31881579
DOI: 10.1016/j.wneu.2019.10.119 -
Neurosurgery Aug 1994We describe our experience with total craniospinal decompression along the entire neuraxis, extending from the brain stem to the cauda equina, in seven patients with...
We describe our experience with total craniospinal decompression along the entire neuraxis, extending from the brain stem to the cauda equina, in seven patients with achondroplasia. These patients presented with clinically significant compression at multiple levels. In these patients, there were focal areas of complete myelographic block, typically at the cervicothoracic or thoracolumbar junction, as well as diffuse narrowing of the entire spinal subarachnoid space. In some, there were further complications of basilar impression, Arnold-Chiari malformation, or syringomyelia. Total craniospinal decompression was completed in either one or two stages. Only a small minority of our patients with achondroplasia had critical stenosis over this many levels, requiring total craniospinal decompression. However, with proper preparation and technique, we found that patients can tolerate even such an extensive decompressive procedure and benefit from surgery without suffering postoperative spinal instability.
Topics: Achondroplasia; Adult; Arnold-Chiari Malformation; Cervical Vertebrae; Craniotomy; Diagnostic Imaging; Female; Follow-Up Studies; Humans; Laminectomy; Lumbar Vertebrae; Male; Middle Aged; Neurologic Examination; Platybasia; Postoperative Complications; Reoperation; Spinal Cord Compression; Spinal Stenosis; Syringomyelia; Thoracic Vertebrae
PubMed: 7969832
DOI: 10.1227/00006123-199408000-00010 -
Croatian Medical Journal Aug 2001Osteogenesis imperfecta (OI), or brittle bone disease, is a heritable disorder characterized by increased bone fragility. Four different types of the disease are... (Review)
Review
Osteogenesis imperfecta (OI), or brittle bone disease, is a heritable disorder characterized by increased bone fragility. Four different types of the disease are commonly distinguished, ranging from a mild condition (type I) to a lethal one (type II). Types III and IV are the severe forms surviving the neonatal period. In most cases, there is a reduction in the production of normal type I collagen or the synthesis of abnormal collagen as a result of mutations in the type I collagen genes. These classic forms of OI are described in this review. There are instances, however, where alterations in bone matrix components, other than type I collagen, are the basic abnormalities of the OI. Recently, three such discrete types have been identified by histomorphometric evaluation (types V and VI) and linkage analysis (Rhizomelic OI). They provide evidence for the as yet poorly understood complexity of the phenotype-genotype correlation in OI. We also discuss bisphosphonates treatment as well as fracture management and surgical correction of deformities observed in the patients with OI. However, ultimately, strengthening bone in OI will involve steps to correct the underlying genetic mutations that are responsible for this disorder. Thus, we also describe different genetic therapeutic approaches that have been tested either on OI cells or on available OI murine models.
Topics: Animals; Child; Diphosphonates; Disease Models, Animal; Genetic Linkage; Genetic Therapy; Humans; Mice; Mutation; Osteogenesis Imperfecta; Platybasia; Polymorphism, Single-Stranded Conformational; Scoliosis
PubMed: 11471191
DOI: No ID Found -
Practica Oto-rhino-laryngologica 1955
Topics: Bone Diseases; Congenital Abnormalities; Ear, Inner; Humans; Occipital Bone; Platybasia; Vestibule, Labyrinth
PubMed: 13310364
DOI: 10.1159/000273908 -
Proceedings of the Royal Society of... Dec 1946
Topics: Humans; Musculoskeletal Abnormalities; Osteitis; Osteitis Deformans; Platybasia; Skull
PubMed: 19993456
DOI: No ID Found -
World Neurosurgery Aug 2021To describe the foramen magnum angle (FMA) as a new parameter for basilar invagination (BI) type B.
OBJECTIVE
To describe the foramen magnum angle (FMA) as a new parameter for basilar invagination (BI) type B.
METHODS
The FMA was performed on sagittal slice of magnetic resonance imaging (MRI) as a line from the hard palate to the opisthion (angle vertex), and another line from the opisthion to the basion. The MRIs from 31 participants with BI type B and 96 controls were used. Intraclass correlation coefficient, descriptive data, and receiver operating characteristic (ROC) curve were used for statistical analysis at the 95% confidence interval.
RESULTS
The interobserver agreement of the FMA was 0.952. Patients with BI type B had a FMA significantly greater (25.9° ± 9.3°) than control participants (11.6° ± 4.9°) (P < 0.001). The area under the ROC curve showed a diagnostic value of 0.947. The FMA showed sensitivity 0.900 and specificity 0.854 for the cutoff criterion 17° (P < 0.001).
CONCLUSIONS
The FMA had an optimal diagnostic value that provided complementary evidence to investigate BI type B.
Topics: Adult; Aged; Female; Foramen Magnum; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Platybasia
PubMed: 34129970
DOI: 10.1016/j.wneu.2021.06.028 -
World Neurosurgery Jul 2022Basilar invagination usually shows a decrease of clivus axis angle (CAA), which could give rise to progressive neural compression. Exploring a safe and effective...
OBJECTIVE
Basilar invagination usually shows a decrease of clivus axis angle (CAA), which could give rise to progressive neural compression. Exploring a safe and effective fixation technique to achieve atlantoaxial stability and neural decompression remains necessary. In this study, we introduce a modified posterior C1-C2 distraction and fixation technique by which we obtained indirect ventral neural decompression and atlantoaxial stability in a series of patients with decreased CAA.
METHODS
Thirty patients of basilar invagination were enrolled in our series. All patients underwent thin-slice computed tomography (CT) scan, magnetic resonance imaging, and dynamic plain radiography examinations before surgery, at discharge and during the follow-ups. Posterior C1-C2 facet joint release and intraoperative reduction by fastening rods were performed in all patients. The CAA was measured on midsagittal CT scans. Patients' neurologic status was evaluated by the Japanese Orthopaedic Association score.
RESULTS
No neurovascular injury and serious postoperative complication occurred in all patients. Complete ventral brainstem decompression was achieved in 20 patients and partial in 10 patients. The mean postoperative CAA significantly improved to 132.6 degrees compared with the preoperative 123.6 degrees (P < 0.01). The bone fusion was confirmed in all patients on the basis of the last follow-up spine CT scans.
CONCLUSIONS
Indirect ventral brainstem decompression by posterior C1-C2 distraction and fixation is a safe and effective technique for treatment of basilar invagination.
Topics: Atlanto-Axial Joint; Brain Stem; Decompression, Surgical; Humans; Joint Dislocations; Platybasia; Spinal Fusion
PubMed: 35314410
DOI: 10.1016/j.wneu.2022.03.064 -
Neurosurgical Review 1983The transoral approach to the lower third of the clivus and to the ventral aspect of the upper cervical spine is used in craniospinal malformations with or without...
The transoral approach to the lower third of the clivus and to the ventral aspect of the upper cervical spine is used in craniospinal malformations with or without dislocation as well as in basilar aneurysms, ventrally situated cranio-spinal tumours, fractures of the odontoid process, and in rheumatoid arthritis compressing the spinal cord. In consideration of the literature and ten personal cases the indications and techniques of the transoral approach in craniospinal malformations are discussed. According to our own experiences and those of other authors it is possible to expose the lower clivus and the cervical spine down to C2 by a midline incision of the pharyngeal wall using a mouth retractor and oral intubation. Splitting of the soft palate or resection of the hard palate are not necessary, a tracheotomy should be performed only in exceptional cases. In congenital craniospinal malformations without dislocation or instability causing a ventral compression of the spinal cord, for instance by the odontoid process, the transoral decompression is preferable to dorsal decompressing operations. In cases of pure instability without any space-occupying lesion the transoral and posterior approach are possible in order to perform a fusion. The last one seems more advantageous in these cases. In craniospinal malformations with dislocation causing a ventral and dorsal narrowing of the spinal canal, apart from the decompression a stabilization has to be achieved. In these usually complex malformations individual treatment is necessary. According to the rare cases in the literature and to our own experience a primary anterior decompression, followed by a most careful posterior stabilization seems to produce the most favourable results.
Topics: Adult; Atlanto-Axial Joint; Axis, Cervical Vertebra; Bone Diseases, Developmental; Cervical Vertebrae; Female; Humans; Joint Dislocations; Klippel-Feil Syndrome; Male; Methods; Middle Aged; Platybasia; Radiography; Skull
PubMed: 6674837
DOI: 10.1007/BF01743101 -
Acta Oto-laryngologica 1963
Topics: Congenital Hypothyroidism; Deafness; Goiter; Goiter, Endemic; Hearing; Hearing Loss; Humans; Incidence; Platybasia
PubMed: 13944186
DOI: 10.3109/00016486309127409