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World Neurosurgery 2011Ventral decompressive surgery of the craniocervical junction is performed to manage a variety of conditions, including basilar invagination, which can be associated with...
OBJECTIVE
Ventral decompressive surgery of the craniocervical junction is performed to manage a variety of conditions, including basilar invagination, which can be associated with platybasia. We have noted that the anatomic changes of platybasia could affect the height of the odontoid over a line drawn along the nasal cavity floor, the palatine line (PL). This anatomic change may influence the use of nasal endoscopic surgery for patients with platybasia who also have basilar invagination. We investigated whether the height of the craniocervical junction is elevated over the PL in patients with and without platybasia.
METHODS
We conducted a retrospective review of consecutive craniovertebral junction surgical cases during a 14-month period. During that time we treated 12 patients, including 4 with platybasia and 8 without. The average age was 50 years (range, 18-64 years). Preoperative and postoperative radiographic images were evaluated and charts reviewed.
RESULTS
The mean height of the odontoid over the PL without platybasia was 3.5 mm (range, 0-19.0 mm). In those with platybasia, it was 15.5 mm (range, 7-26.0 mm; P=.021). There was a statistically significant increase in the height of the clival tip and C1 ring in patient with platybasia as well.
CONCLUSIONS
Platybasia is associated with an increase in the odontoid and craniocervical junction over the PL. This increase in height has implications for endoscopic approach selection in patients with platybasia. Platybasia patients with basilar invagination may be better suited to a transnasal approach.
Topics: Adolescent; Adult; Atlanto-Axial Joint; Atlanto-Occipital Joint; Cervical Vertebrae; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nasal Cavity; Neurosurgical Procedures; Odontoid Process; Palate, Hard; Platybasia; Retrospective Studies; Spinal Cord Compression; Tomography, X-Ray Computed; Young Adult
PubMed: 21839972
DOI: 10.1016/j.wneu.2011.02.018 -
Arquivos de Neuro-psiquiatria Oct 2010
Topics: Arnold-Chiari Malformation; Atrophy; Brain Stem; Cerebellar Diseases; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Platybasia; Spinal Cord Diseases; Tissue Adhesions; Tomography, X-Ray Computed
PubMed: 21049199
DOI: 10.1590/s0004-282x2010000500026 -
Journal of Bone and Mineral Research :... Feb 2011Cranial base abnormalities are an important complication of osteogenesis imperfecta (OI), a hereditary bone fragility disorder that in most patients is caused by...
Cranial base abnormalities are an important complication of osteogenesis imperfecta (OI), a hereditary bone fragility disorder that in most patients is caused by mutations affecting collagen type I. To elucidate which clinical characteristics are associated with the occurrence of cranial base abnormalities in OI, we compared cephalometric results of 187 OI patients (median age 12.0 years, range 3.4 to 47 years; 96 female) with those of 191 healthy subjects and related findings to clinical descriptors of the disease. Overall, 41 patients (22%) had at least one unambiguously abnormal skull base measure. Multivariate logistic regression analysis in patients with OI types I, III, and IV (n = 169) revealed that height Z-score [odds ratio (OR) = 0.53, 95% confidence interval (CI) 0.43-0.66, p < .001]--but not age, gender, scleral hue, lumbar spine areal bone mineral density, or a history of bisphosphonate treatment--was a significant independent determinant of skull base abnormalities. Among patients with a height Z-score below -3, 48% had a skull base abnormality regardless of whether they had received bisphosphonate treatment in the first year of life or not. Genotype-phenotype correlations were evaluated in patients with detectable mutations in COL1A1 or COL1A2, the genes coding for collagen type I (n = 140). Skull base abnormalities were present in 6% of patients with haploinsufficiency (frameshift or nonsense) mutations, in 43% of patients with helical glycine substitutions caused by COL1A1 mutations, in 32% of patients with helical glycine substitutions owing to COL1A2 mutations, and in 17% of patients with splice-site mutations affecting either COL1A1 or COL1A2. However, multivariate logistic regression analysis showed that height Z-score but not the type of collagen type I mutation was independently associated with the prevalence of skull base abnormalities. In conclusion, this study shows that clinical severity of OI, as expressed by the height Z-score, was the strongest predictor of skull base abnormalities. We did not find evidence for the hypothesis that bisphosphonate treatment protects against skull base abnormalities.
Topics: Adolescent; Bone and Bones; Child; Collagen; Collagen Type I; Collagen Type I, alpha 1 Chain; Densitometry; Female; Genotype; Humans; Male; Mutation; Osteogenesis Imperfecta; Phenotype; Platybasia; Regression Analysis; Skull
PubMed: 20721936
DOI: 10.1002/jbmr.220 -
The Angle Orthodontist Sep 2010To test the null hypothesis that there is no difference between craniofacial measurements of individuals with Down syndrome (DS) and normal controls. (Comparative Study)
Comparative Study
OBJECTIVE
To test the null hypothesis that there is no difference between craniofacial measurements of individuals with Down syndrome (DS) and normal controls.
MATERIALS AND METHODS
A cephalometric analysis including additional landmarks and measurements to study specific craniofacial features was undertaken on pretreatment cephalograms of 25 patients with DS (12 male, 13 female; mean age 15.1 years) treated at The Hospital for Sick Children, Toronto. Measurements were compared with those from cephalograms of racial groups age and gender matched, normal, Class I children, available from the Burlington Growth Center. Data were analyzed using paired t-tests.
RESULTS
Large reductions were measured in the size and spatial relationships of craniofacial structures in the DS group. The greatest differences included a larger cranial base angle; reduced elevation of sella from FHP; reduced anterior and posterior cranial base lengths; reduced anterior and posterior face heights; smaller maxilla with reduced anterior basal and apical dimensions; and smaller mandibular ramus, body and symphyseal dimensions and proclined symphysis. Maxillary incisors were severely proclined and undererupted, while mandibular incisors were undererupted. Alveolar heights were reduced. Anterior open bite was frequently noted. Maxillary and mandibular planes exhibited forward rotation patterns, promoting overclosure. Mandibular hypoplasia was less severe than cranial base and maxillary hypoplasia. Hypodontia of one or more permanent teeth was found in 92% of the sample.
CONCLUSIONS
The null hypothesis was rejected. Significant hypoplasia in endochondral, mesodermal, and ectomesenchymal derived structures of the cranium and face in subjects with DS was clearly evident. More severe platybasia than previously reported was found.
Topics: Adolescent; Alveolar Process; Anodontia; Case-Control Studies; Cephalometry; Child; Down Syndrome; Ethnicity; Female; Humans; Image Processing, Computer-Assisted; Incisor; Male; Mandible; Maxilla; Molar; Open Bite; Platybasia; Prognathism; Retrospective Studies; Rotation; Sella Turcica; Skull Base; Tooth Eruption
PubMed: 20578856
DOI: 10.2319/111709-650.1 -
European Spine Journal : Official... Aug 2010
Response to the expert's comment of P. Suchomel concerning grand rounds case entitled "Syringomyelia with irreducible atlantoaxial dislocation, basilar invagination and Chiari I malformation", Eur Spine J, Vol 19, no 3, 2010: pp 367-369 (by Shenglin Wang et al.).
Topics: Arnold-Chiari Malformation; Atlanto-Axial Joint; Humans; Joint Dislocations; Odontoid Process; Platybasia; Syringomyelia
PubMed: 20407793
DOI: 10.1007/s00586-010-1397-7 -
European Spine Journal : Official... Mar 2010
Expert's comment concerning Grand Rounds case entitled "Syringomyelia with irreducible atlantoaxial dislocation, basilar invagination and Chiari I malformation" (by Shenglin Wang, Chao Wang, Ming Yan, Haitao Zhou, Liang Jiang).
Topics: Adult; Arnold-Chiari Malformation; Atlanto-Axial Joint; Female; Humans; Joint Dislocations; Platybasia; Syringomyelia
PubMed: 20238471
DOI: 10.1007/s00586-009-1209-0 -
Revista de NeurologiaThe vascular compression of a nerve is known to be the most important cause of idiopathic trigeminal neuralgia (ITN) by most authors. However, several cases of skull...
INTRODUCTION
The vascular compression of a nerve is known to be the most important cause of idiopathic trigeminal neuralgia (ITN) by most authors. However, several cases of skull base deformities in patients with ITN have been reported in our bibliographic review. AIM. To compare the existence of platybasia between a group of patients with ITN and a randomized control group.
SUBJECTS AND METHODS
Twenty-five patients with ITN and twenty-five control subjects were X-rayed and their basal angles were measured and compared.
RESULTS
The basal angle measured to investigate the existence of platybasia is significantly greater in the ITN group than in the control group. Platybasia was found in 10 patients with ITN. However, only two cases of platybasia were reported in the control group. Therefore in our study we have found that the incidence of platybasia in patients with ITN is significantly increased.
CONCLUSION
Our data demonstrated that platybasia has an important role in the pathogenesis of the ITN by altering the normal anatomy of the nerves and vessels within the posterior fossa.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Platybasia; Radiography; Skull Base; Trigeminal Neuralgia
PubMed: 20013714
DOI: No ID Found -
European Spine Journal : Official... Mar 2010A 27-year-old woman presented with bilateral weakness of her all extremities for 5 years. She had a spastic gait and was unable to ambulate without assistance....
A 27-year-old woman presented with bilateral weakness of her all extremities for 5 years. She had a spastic gait and was unable to ambulate without assistance. Neurologic examination revealed increased deep tendon reflexes and positive pathologic reflexes. Radiographs showed occipitalization of the atlas, C2-C3 congenital fusion and fixed atlantoaxial dislocation with an atlanto-dental interval of 10 mm. MRI demonstrated cervicomedullary junction (CMJ) compression from the odontoid, a Chiari type I malformation, and syringomyelia extending from the foramen magnum to C5. The patient underwent transoral atlantoaxial release followed by posterior internal fixation from the occiput to the axis, which resulted in a significant improvement in motor function in all extremities. Post-operative images showed anatomical reduction of the atlantoaxial joint. However, an MRI performed 8 days following surgery showed a new retro-odontoid pannus had developed that was compressing the spinal cord at CMJ. A follow-up CT scan performed at 6 months post-operatively demonstrated a solid bony fusion between the occiput and C2, while an MRI at that time showed complete resolution of the retro-odontoid soft tissue mass with correction of the Chiari I malformation, and resolution of the syringomyelia. Final follow-up at 2-years revealed an excellent clinical outcome.
Topics: Adult; Arnold-Chiari Malformation; Atlanto-Axial Joint; Decompression, Surgical; Diagnosis, Differential; Female; Fracture Fixation, Internal; Gait; Humans; Joint Dislocations; Magnetic Resonance Imaging; Muscle Weakness; Platybasia; Recovery of Function; Spinal Fusion; Syringomyelia; Treatment Outcome
PubMed: 19941013
DOI: 10.1007/s00586-009-1208-1 -
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 -
Neurology India 2008A novel method of treatment of basilar invagination that involves distraction of the atlantoaxial joint using specially designed spiked spacers is described. Bone graft...
OBJECTIVE
A novel method of treatment of basilar invagination that involves distraction of the atlantoaxial joint using specially designed spiked spacers is described. Bone graft that is additionally placed within the appropriately prepared atlantoaxial joint and posterior to the arch of atlas and lamina of C2 provides bony fusion.
MATERIALS AND METHODS
Between December 2002 and April 2007, 11 patients underwent the discussed method of fixation at the Department of Neurosurgery, King Edward Memorial Hospital in Mumbai, India. All 11 patients had "congenital" basilar invagination and the symptoms were progressive in nature.
RESULTS
The mean follow-up period was 21 months (range 8-40 months). Neurological improvement and successful distraction with atlantoaxial stabilization and ultimate bone fusion was achieved in all the patients and was documented with dynamic radiography. There were no neurological, vascular, or infective complications.
CONCLUSIONS
We conclude that the described method of atlantoaxial joint distraction and fixation provides an alternative treatment strategy for cases with basilar invagination. "Joint distraction" as a stand-alone method could provide reduction of basilar invagination and firm stabilization in such cases.
Topics: Adolescent; Adult; Atlanto-Axial Joint; Bone Screws; Child; Disease Progression; Female; Humans; Magnetic Resonance Imaging; Male; Platybasia; Prospective Studies; Retrospective Studies; Spinal Cord Compression; Tomography, X-Ray Computed; Young Adult
PubMed: 18688138
DOI: 10.4103/0028-3886.41991