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Journal of Neurosurgery. Pediatrics Jul 2024Congenital anomalies of the atlanto-occipital articulation may be present in patients with Chiari malformation type I (CM-I). However, it is unclear how these anomalies...
The role of occipital condyle and atlas anomalies on occipital cervical fusion outcomes in Chiari malformation type I with syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium.
OBJECTIVE
Congenital anomalies of the atlanto-occipital articulation may be present in patients with Chiari malformation type I (CM-I). However, it is unclear how these anomalies affect the biomechanical stability of the craniovertebral junction (CVJ) and whether they are associated with an increased incidence of occipitocervical fusion (OCF) following posterior fossa decompression (PFD). The objective of this study was to determine the prevalence of condylar hypoplasia and atlas anomalies in children with CM-I and syringomyelia. The authors also investigated the predictive contribution of these anomalies to the occurrence of OCF following PFD (PFD+OCF).
METHODS
The authors analyzed the prevalence of condylar hypoplasia and atlas arch anomalies for patients in the Park-Reeves Syringomyelia Research Consortium database who underwent PFD+OCF. Condylar hypoplasia was defined by an atlanto-occipital joint axis angle (AOJAA) ≥ 130°. Atlas assimilation and arch anomalies were identified on presurgical radiographic imaging. This PFD+OCF cohort was compared with a control cohort of patients who underwent PFD alone. The control group was matched to the PFD+OCF cohort according to age, sex, and duration of symptoms at a 2:1 ratio.
RESULTS
Clinical features and radiographic atlanto-occipital joint parameters were compared between 19 patients in the PFD+OCF cohort and 38 patients in the PFD-only cohort. Demographic data were not significantly different between cohorts (p > 0.05). The mean AOJAA was significantly higher in the PFD+OCF group than in the PFD group (144° ± 12° vs 127° ± 6°, p < 0.0001). In the PFD+OCF group, atlas assimilation and atlas arch anomalies were identified in 10 (53%) and 5 (26%) patients, respectively. These anomalies were absent (n = 0) in the PFD group (p < 0.001). Multivariate regression analysis identified the following 3 CVJ radiographic variables that were predictive of OCF occurrence after PFD: AOJAA ≥ 130° (p = 0.01), clivoaxial angle < 125° (p = 0.02), and occipital condyle-C2 sagittal vertical alignment (C-C2SVA) ≥ 5 mm (p = 0.01). A predictive model based on these 3 factors accurately predicted OCF following PFD (C-statistic 0.95).
CONCLUSIONS
The authors' results indicate that the occipital condyle-atlas joint complex might affect the biomechanical integrity of the CVJ in children with CM-I and syringomyelia. They describe the role of the AOJAA metric as an independent predictive factor for occurrence of OCF following PFD. Preoperative identification of these skeletal abnormalities may be used to guide surgical planning and treatment of patients with complex CM-I and coexistent osseous pathology.
Topics: Humans; Arnold-Chiari Malformation; Syringomyelia; Female; Male; Cervical Atlas; Child; Occipital Bone; Spinal Fusion; Adolescent; Atlanto-Occipital Joint; Treatment Outcome; Child, Preschool; Decompression, Surgical; Retrospective Studies; Cervical Vertebrae
PubMed: 38579359
DOI: 10.3171/2024.1.PEDS23229 -
Journal of Orthopaedic Science :... Apr 2024Postoperative airway obstruction after anterior cervical spine surgery (ACSS) can be a fatal complication. Occasionally, it rapidly progresses to complete obstruction....
BACKGROUND
Postoperative airway obstruction after anterior cervical spine surgery (ACSS) can be a fatal complication. Occasionally, it rapidly progresses to complete obstruction. There are no established standardized protocols on how medical staff should assess for signs and symptoms, seek help, or facilitate airway management after ACSS to prevent unfavorable events. This study aimed to primarily describe a systematic approach by assessing the signs and treatment outcomes of airway compromise in patients who underwent ACSS. Further, it recommended an action protocol after extubation for medical staff according to patients' symptoms to prevent unfavorable outcomes.
METHODS
An extensive literature search was performed on PubMed, Web of Science, and the Cochrane Library to identify case reports, case series, and cohort studies restricted to English and published between January 1990 and March 2023. We included cases that described the signs, symptoms, and treatment of airway obstruction after ACSS. Meanwhile, cases involving complications of other known causes, cases of trauma or occipital-cervical fixation, or those using bone morphogenetic protein were excluded.
RESULTS
Twenty cases from 17 studies were obtained, and their study quality was acceptable. Four patients died, and two presented with hypoxic ischemic encephalopathy. Further, five of six patients had fatal complications that initially developed within 7 h after surgery. Then, 9 (69%) of 13 patients with evidence of hematoma (69%) showed initial symptoms within 12 h after surgery. Finally, 9 of 11 patients with early-stage symptoms had favorable outcomes, and patients who developed late-stage symptoms commonly had unfavorable outcomes.
CONCLUSION
The early identification of signs and symptoms and immediate treatment are important, particularly within 12 h postoperatively. We suggest a novel action protocol for medical staff according to symptom urgency, which includes the measurement of neck circumference using a string for evaluating neck swelling.
PubMed: 38575427
DOI: 10.1016/j.jos.2024.03.011 -
Legal Medicine (Tokyo, Japan) Apr 2024Depressed skull fractures occur when broken bones displace inward, meaning that a portion of the outer table of the fracture line lies below the normal anatomical...
Depressed skull fractures occur when broken bones displace inward, meaning that a portion of the outer table of the fracture line lies below the normal anatomical position of the inner table. They typically result from force trauma, when the skull is struck by an object with a moderately large amount of kinetic energy but a small surface area, or when an object with a large amount of kinetic energy impacts only a small area of the skull. In the present case, a depressed fracture of the frontal bone was detected at the autopsy of a 52-year-old man who, according to the belated confession of the assailant, was kicked in the head. The assailant was wearing sneakers. Could such a fracture be caused "just" by a kick? In this case it was possible due to an extraordinarily thin cranial vault (0.2 cm frontal, 0.3 cm occipital), which allowed the fractures to occur from a kinetic force that might not have been sufficient with a normal cranial vault thickness. An important role in the forensic analysis of the case was played by the 3D CT reconstruction.
PubMed: 38569417
DOI: 10.1016/j.legalmed.2024.102443 -
Proceedings of the National Academy of... Apr 2024The axial columns of the earliest limbed vertebrates show distinct patterns of regionalization as compared to early tetrapodomorphs. Included among their novel features...
The axial columns of the earliest limbed vertebrates show distinct patterns of regionalization as compared to early tetrapodomorphs. Included among their novel features are sacral ribs, which provide linkage between the vertebral column and pelvis, contributing to body support and propulsion by the hindlimb. Data on the axial skeletons of the closest relatives of limbed vertebrates are sparce, with key features of specimens potentially covered by matrix. Therefore, it is unclear in what sequence and under what functional context specializations in the axial skeletons of tetrapods arose. Here, we describe the axial skeleton of the elpistostegalian and show that transformations to the axial column for head mobility, body support, and pelvic fin buttressing evolved in finned vertebrates prior to the origin of limbs. No atlas-axis complex is observed; however, an independent basioccipital-exoccipital complex suggests increased mobility at the occipital vertebral junction. While the construction of vertebrae in is similar to early tetrapodomorphs, its ribs possess a specialized sacral domain. Sacral ribs are expanded and ventrally curved, indicating likely attachment to the expanded iliac blade of the pelvis by ligamentous connection. Thus, the origin of novel rib types preceded major alterations to trunk vertebrae, and linkage between pelvic fins and axial column preceded the origin of limbs. These data reveal an unexpected combination of post-cranial skeletal characters, informing hypotheses of body posture and movement in the closest relatives of limbed vertebrates.
Topics: Animals; Biological Evolution; Fossils; Vertebrates; Bone and Bones; Lower Extremity
PubMed: 38564638
DOI: 10.1073/pnas.2316106121 -
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 -
Veterinary Radiology & Ultrasound : the... Mar 2024In veterinary radiotherapy, highly reproducible immobilization is important for accurate irradiation. Consequently, we developed a new reusable head-immobilization...
In veterinary radiotherapy, highly reproducible immobilization is important for accurate irradiation. Consequently, we developed a new reusable head-immobilization method for dogs using cylinders. This study aimed to compare the accuracy of our novel immobilization method using cylinders with that of bite-block type immobilization methods. Three immobilization methods were compared: bite-block only, bite-block combined with torso immobilization, and immobilization using cylinders. Five beagles with canine teeth underwent CT five times for each of the three immobilization methods. One beagle without canine teeth underwent CT 15 times using each method. Three maxillary landmarks (maxillary incisor, frontal sinus, and occipital bone) and one mandibular landmark (mandibular incisor) were established, and the errors in each immobilization method were measured. For all head landmarks, the error in the immobilization method using cylinders was the most reproducible, with the smallest errors. No significant differences were observed in the time required for immobilization. Although there were limitations (such as the use of dogs from a single breed, a single episode of anesthesia, no disassembly of the immobilization system between scans, and the same person performing the positioning on the same day), we found our new reusable immobilization method using cylinders was the most accurate among the three compared methods. This was a proof-of-principle study to evaluate head immobilization using cylinders, and further investigations are needed to confirm its clinical utility.
PubMed: 38554033
DOI: 10.1111/vru.13364 -
Veterinary Medicine and Science May 2024Obtaining accurate knowledge of the anatomical structure of the skull helps in ontogenetic studies and determining sexual polymorphisms.
BACKGROUND
Obtaining accurate knowledge of the anatomical structure of the skull helps in ontogenetic studies and determining sexual polymorphisms.
OBJECTIVES
This study uses anatomical dissection and radiography to develop a size standard for the skull of the Saanen goat; information that will be applied to clinical evaluation and decision-making.
METHODS
A total of 14 adult Saanen goat skulls (7 male and 7 female goats) were taken from the slaughterhouse and transferred to the clinic of the Faculty of Veterinary Medical Teaching Hospital, Urmia University, Urmia, Iran. Radiographs of each skull were prepared in the dorsal-ventral, left and right lateral recumbency. These heads were then brought over to the anatomy department, where the chosen morphometric traits were assessed and their means recorded.
RESULTS
According to the findings of this study, the dorsal view of the skull revealed an incisive raphe and a widespread foramen of the nose. In the ventral view, the incisive bones were observed in the most cranial region of the skull. The base of the occipital bone was relatively large, and the jugular process was well-developed. In the lateral view, the incisive bone was extended to the cranial and had a narrow process on the dorsal surface. Regarding infra-orbital foramen, it was visible in the maxillary bone. Moreover, the lacrimal bone was perceived as a distinct bone.
CONCLUSION
The precise standards acquired in this study can be utilized to interpret the findings and make clinical decisions about the normal and abnormal size of the bones that make up the skulls of the Saanen goats.
Topics: Male; Female; Animals; Skull; Radiography; Goats; Iran
PubMed: 38551464
DOI: 10.1002/vms3.1435 -
World Neurosurgery Jun 2024Basilar invagination is one of the most frequently observed abnormalities at the craniovertebral junction, in which the odontoid process of C2 prolapses into the foramen...
OBJECTIVE
Basilar invagination is one of the most frequently observed abnormalities at the craniovertebral junction, in which the odontoid process of C2 prolapses into the foramen magnum.
METHODS
The current study included 27 patients who underwent surgery for basilar invagination between October 2013 and January 2023. The study group was divided into 2 groups according to basilar invagination types; type I (the presence of type A atlantoaxial instability and instability is the main pathology) and type II (the presence of type B and C atlantoaxial instability and skull base dysgenesis is the main pathology). Craniometric parameters included in the study were atlantodental interval, posterior atlantodental interval, Chamberlain's line violation, clivus-canal angle, Welcher's basal angle, and Boogaard angle.
RESULTS
The mean age of the patients was 24.30 ± 14.36 years (5-57 years). Fourteen patients (51.9%) were female, and 13 patients (48.1%) were male. Ten patients (37%) had type I basilar invagination, and 17 patients (63%) had type II basilar invagination. Preoperative and postoperative atlantodental interval and Boogaard angle were significantly higher in type I basilar invagination, as preoperative and postoperative posterior atlantodental interval and clivus-canal angle were significantly higher in type II basilar invagination. There was a positive strong correlation between Chamberlain's line violation and Boogaard angle. Postoperative Chamberlain's line violation was significantly higher in occipitocervical fixation (P = 0.035). C1 lateral mass screw fixation was found more successful in Chamberlain's line violation correction than occipital plates. Occipitocervical fixation was found to be associated with higher postoperative Nurick scores (P = 0.015) and complication rates (P = 0.020). Cages applied to the C1-C2 joint space were found to be associated with higher fusion rates (P = 0.023) and lower complication rates (P = 0.024).
CONCLUSIONS
In the present study, it was found that C1-C2 fixation was more successful in correcting craniometric parameters and had lower complication rates than occipitocervical fixation. In appropriate patients, it was determined that cage application increased the success rates of the operations.
Topics: Humans; Male; Female; Adult; Middle Aged; Adolescent; Child; Young Adult; Child, Preschool; Treatment Outcome; Atlanto-Axial Joint; Cephalometry; Joint Instability; Odontoid Process; Foramen Magnum; Retrospective Studies; Spinal Fusion
PubMed: 38537788
DOI: 10.1016/j.wneu.2024.03.120 -
World Neurosurgery May 2024Recent years have witnessed a rapidly growing interest in CVJ bony abnormalities, and a qualitative and quantitative analysis of relevant literatures is necessary. This...
OBJECTIVE
Recent years have witnessed a rapidly growing interest in CVJ bony abnormalities, and a qualitative and quantitative analysis of relevant literatures is necessary. This study aims to identify and summarize the published articles related to craniovertebral junction bony abnormalities, to analyze and visualize the current research trends and major contributors.
METHODS
We collected data from Web of Science, excluding certain article types. Two researchers screened articles for relevance. Data were organized with EndnoteX9, and analyzed using VOSviewer and CiteSpace for co-authorship, co-occurrence, keyword burst, and co-citation analyses to identify research trends and collaborations.
RESULTS
A total of 2,776 articles were included, revealing an increasing trend in annual publications of CVJ bony abnormalities. The USA was the leading country. King Edward Memorial Hospital was the most prolific institution, and Seth GS Medical College had the most citations. The Spine is the most popular journal with the highest number of publications and citations. Professor Goel Atul from India emerged as the most influential pioneer in this field. Keyword analysis highlighted surgical techniques, diagnosis, and anatomy as the primary research hotspots and Fixation, Placement, and Basilar invagination gradually become the new research trend. However, there is a relative weakness in basic research and epidemiology.
CONCLUSIONS
This study provides valuable insights into the current research trends and critical contributors in CVJ bony abnormalities, guiding evidence-based decisions and fostering international collaborations to advance knowledge in this field.
Topics: Humans; Bibliometrics; Atlanto-Occipital Joint; Atlanto-Axial Joint
PubMed: 38522787
DOI: 10.1016/j.wneu.2024.03.090 -
Anatomia, Histologia, Embryologia May 2024Cranial measurements have been widely used in various studies in wildlife sciences, ranging from understanding predator ecology to wildlife forensics. However, detailed...
Cranial measurements have been widely used in various studies in wildlife sciences, ranging from understanding predator ecology to wildlife forensics. However, detailed description of morphometry and sexual dimorphism of the skull of gaur Bos gaurus gaurus is lacking. The present study was undertaken to determine the sexual dimorphism based on the cranial measurements of gaur. A total of 12 individual gaur skulls of male (n = 6) and female (n = 6) were studied in the field from the naturally deceased animals between January 2018 and December 2021 in different ranges of Bandhavgarh tiger reserve (BTR), Madhya Pradesh, India. The skull measurements were analysed using univariate and multivariate statistics to determine whether cranial dimensions could be used to differentiate male and female skulls reliably. A total of 43 morphometrical parameters grouped into nine indices were calculated. Select morphometrical parameters viz PL, GFL, AKI, LBB, LFB, GBEE, GBAN, BPOP and GTCH were significantly different (p < 0.05) between sexes, whereas GBAN were significantly higher in female skulls. The measurements demonstrated that the skull of the gaur was dolichocephalic as the profile length and the otion to otion breath in both male and female were <75% of the length. Overall, 28 linear measurements of both the sexes were statistically significant (p < 0.05; <0.01). The calculated indices revealed that the foramen magnum index in the female gaur were significantly higher. In calculated cranial indices the facial index (a) was higher in female and facial index (b) were higher in males. The two important parameters, facial breadth in facial index (a) and the greatest breadth in facial index (b) were positively correlated, though facial index (a) was statistically not significant between the sexes. The greater inner length of the foramen magnum in female skull resulted in foramen being oval whereas it was circular in males. These parameters were decisive for sexual dimorphism, skull comparison and craniological studies. This study ascertained that the frontal index and skull index had no significant influence and were not good indices for discriminating skulls between male and female. Based on the Principal Component Analysis, it was found that skull of male and female gaurs exhibits differences in cranial morphology viz. cranial profile length or total length (PL) and the least inner height of the temporal groove (LIHT). The findings of the present study provide baseline information on various craniometrical measurements of skull of gaur, indices and parameters for sex identification that can be effectively used in understanding sex biased predation ecology, provide base line information to describe variation across its geographic range, and in identifying skulls recovered in wildlife offence cases.
Topics: Male; Female; Animals; Cattle; Sex Characteristics; Skull; Cephalometry; Foramen Magnum; Animals, Wild
PubMed: 38519866
DOI: 10.1111/ahe.13031