Development and growth of the craniocervical junction with special reference to topographical relationship between the occipital basion, the anterior arch of atlas, and the odontoid process of axis: A study using human fetuses

2020 ◽  
Author(s):  
Michitake Ishii ◽  
Kwang Ho Cho ◽  
Kei Kitamura ◽  
Masahito Yamamoto ◽  
Gen Murakami ◽  
...  
Keyword(s):  
Special Reference ◽  
Odontoid Process ◽  
Craniocervical Junction ◽  
Human Fetuses ◽  
Anterior Arch

scholarly journals Posterior odontoid process angulation in pediatric Chiari I malformation: an MRI morphometric external validation study

2015 ◽  
Vol 16 (2) ◽  
pp. 138-145 ◽  
Author(s):  
Travis R. Ladner ◽  
Michael C. Dewan ◽  
Matthew A. Day ◽  
Chevis N. Shannon ◽  
Luke Tomycz ◽  
...  
Keyword(s):  
External Validation ◽  
Age Groups ◽  
Odontoid Process ◽  
Line Length ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Posterior Fossa Decompression ◽  
Tonsillar Ectopia ◽  
Chiari I

OBJECT Osseous anomalies of the craniocervical junction are hypothesized to precipitate the hindbrain herniation observed in Chiari I malformation (CM-I). Previous work by Tubbs et al. showed that posterior angulation of the odontoid process is more prevalent in children with CM-I than in healthy controls. The present study is an external validation of that report. The goals of our study were 3-fold: 1) to externally validate the results of Tubbs et al. in a different patient population; 2) to compare how morphometric parameters vary with age, sex, and symptomatology; and 3) to develop a correlative model for tonsillar ectopia in CM-I based on these measurements. METHODS The authors performed a retrospective review of 119 patients who underwent posterior fossa decompression with duraplasty at the Monroe Carell Jr. Children’s Hospital at Vanderbilt University; 78 of these patients had imaging available for review. Demographic and clinical variables were collected. A neuroradiologist retrospectively evaluated preoperative MRI examinations in these 78 patients and recorded the following measurements: McRae line length; obex displacement length; odontoid process parameters (height, angle of retroflexion, and angle of retroversion); perpendicular distance to the basion-C2 line (pB–C2 line); length of cerebellar tonsillar ectopia; caudal extent of the cerebellar tonsils; and presence, location, and size of syringomyelia. Odontoid retroflexion grade was classified as Grade 0, > 90°; Grade I,85°–89°; Grade II, 80°–84°; and Grade III, < 80°. Age groups were defined as 0–6 years, 7–12 years, and 13–17 years at the time of surgery. Univariate and multivariate linear regression analyses, Kruskal-Wallis 1-way ANOVA, and Fisher’s exact test were performed to assess the relationship between age, sex, and symptomatology with these craniometric variables. RESULTS The prevalence of posterior odontoid angulation was 81%, which is almost identical to that in the previous report (84%). With increasing age, the odontoid height (p < 0.001) and pB–C2 length (p < 0.001) increased, while the odontoid process became more posteriorly inclined (p = 0.010). The pB–C2 line was significantly longer in girls (p = 0.006). These measurements did not significantly correlate with symptomatology. Length of tonsillar ectopia in pediatric CM-I correlated with an enlarged foramen magnum (p = 0.023), increasing obex displacement (p = 0.020), and increasing odontoid retroflexion (p < 0.001). CONCLUSIONS Anomalous bony development of the craniocervical junction is a consistent feature of CM-I in children. The authors found that the population at their center was characterized by posterior angulation of the odontoid process in 81% of cases, similar to findings by Tubbs et al. (84%). The odontoid process appeared to lengthen and become more posteriorly inclined with age. Increased tonsillar ectopia was associated with more posterior odontoid angulation, a widened foramen magnum, and an inferiorly displaced obex.

ENDOSCOPIC IMAGE‐GUIDED TRANSORAL APPROACH TO THE CRANIOVERTEBRAL JUNCTION: AN ANATOMIC STUDY COMPARING SURGICAL EXPOSURE AND SURGICAL FREEDOM OBTAINED WITH THE ENDOSCOPE AND THE OPERATING MICROSCOPE

2009 ◽  
Vol 64 (suppl_5) ◽  
pp. ons437-ons444 ◽  
Author(s):  
Promod Pillai ◽  
Mirza N. Baig ◽  
Chris S. Karas ◽  
Mario Ammirati
Keyword(s):  
Soft Palate ◽  
Image Guidance ◽  
Odontoid Process ◽  
Posterior Pharyngeal Wall ◽  
Craniovertebral Junction ◽  
Craniocervical Junction ◽  
Transoral Approach ◽  
Operating Microscope ◽  
Microscopic Approach ◽  
Pharyngeal Wall

Abstract OBJECTIVE The transoral approach is the most direct and commonly used method to access the ventral craniocervical junction. Recently, an endonasal, endoscopic approach to the craniovertebral junction was proposed. We reasoned that the coupling of the endoscope with the direct transoral approach and image guidance could result in a minimally invasive, simple approach to the ventral craniovertebral junction. We investigated the potential usefulness of such an approach in a cadaver model. METHODS A direct transoral approach to the craniovertebral junction was performed using computed tomography-based image guidance in 9 fresh adult head specimens. Endoscopic odontoidectomy was performed in 5 specimens. In the remaining 4 specimens, the surgical working area and surgical freedom associated with an endoscopic and a microscopic approach to the ventral craniovertebral junction were evaluated and compared. In these 4 specimens, we also measured and compared the exposure of the clivus provided by the endoscope and by the operating microscope without splitting the soft palate. RESULTS With variously angled endoscopic assistance and image guidance, it was possible to tailor the excision of the anterior arch of the atlas and to precisely identify the odontoid process and its related ligaments intraoperatively, resulting in a complete and controlled odontoidectomy. The surgical area exposed over the posterior pharyngeal wall was significantly improved using the endoscope (606.5 ± 127.4 mm3) compared with the operating microscope (425.7 ± 100.8 mm3), without any compromise of surgical freedom (P &lt; 0.05). The extent of the clivus exposed with the endoscope (9.5 ± 0.7 mm) without splitting the soft palate was significantly improved compared with that associated with microscopic approach (2.0 ± 0.4 mm) (P &lt; 0.05). CONCLUSION With the aid of the endoscope and image guidance, it is possible to approach the ventral craniovertebral junction transorally with minimal tissue dissection, no palatal splitting, and no compromise of surgical freedom. In addition, the use of an angled-lens endoscope can significantly improve the exposure of the clivus without splitting the soft palate. An endoscope-assisted transoral approach is a direct and powerful tool for the treatment of surgical pathology at the craniovertebral junction.

Inclination of the odontoid process in the pediatric Chiari I malformation

2003 ◽  
Vol 98 (1) ◽  
pp. 43-49 ◽  
Author(s):  
R. Shane Tubbs ◽  
John C. Wellons ◽  
Jeffrey P. Blount ◽  
Paul A. Grabb ◽  
W. Jerry Oakes
Keyword(s):  
Odontoid Process ◽  
Postoperative Outcome ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Magnetic Resonance Images ◽  
Posterior Aspect ◽  
Content Type ◽  
Chiari I ◽  
Fine Print

Object. The quantitative analysis of odontoid process angulation has had scant attention in the Chiari I malformation population. In this study the authors sought to elucidate the correlation between posterior angulation of the odontoid process and patients with Chiari I malformation. Methods. Magnetic resonance images of the craniocervical junction obtained in 100 children with Chiari I malformation and in 50 children with normal intracranial anatomy (controls) were analyzed. Specific attention was focused on measuring the degree of angulation of the odontoid process and assigning a score to the various degrees. Postoperative outcome following posterior cranial fossa decompression was then correlated to grades of angulation. Other measurements included midsagittal lengths of the foramen magnum and basiocciput, the authors' institutions' previously documented pB—C2 line (a line drawn perpendicular to one drawn between the basion and the posterior aspect of the C-2 body), level of the obex from a midpoint of the McRae line, and the extent of tonsillar herniation. Higher grades of odontoid angulation (retroflexion) were found to be more frequently associated with syringomyelia and particularly holocord syringes. Higher grades of angulation were more common in female patients and were often found to have obices that were caudally displaced greater than three standard deviations below normal. Conclusions. These results not only confirm prior reports of an increased incidence of a retroflexed odontoid process in Chiari I malformation but quantitatively define grades of inclination. Grades of angulation were not found to correlate with postoperative outcome. It is the authors' hopes that these data add to our current limited understanding of the mechanisms involved in hindbrain herniation.

scholarly journals Congenital deformation of the posterior arch of the atlas: Subluxation of the atlanto-axial joint with temporary quadriplegia

2019 ◽  
Vol 7 ◽  
pp. 2050313X1882338
Author(s):  
Tobias M Ballhause ◽  
Mirko Velickovic ◽  
Darius M Thiesen ◽  
Marc Dreimann
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Congenital Malformation ◽  
Neurological Disorders ◽  
Odontoid Process ◽  
Craniocervical Junction ◽  
Posterior Arch ◽  
The Third ◽  
Congenital Origin ◽  
Atlanto Axial Joint

Instabilities of the craniocervical junction can be of rheumatic, traumatic, or congenital origin. The reported patient has a congenital malformation of the cervical spine, which is frequently observed in patients with Klippel–Feil syndrome. Her posterior arch of the atlas (C1) is hypoplastic and a chronic subluxation of the atlanto-axial joint would be possible. Although most common fusions in Klippel–Feil syndrome patients exist at C2/3, the majority of studies about Klippel–Feil syndrome deal with pediatric or adolescent individuals. Through extreme flexion of her neck, there was a compression of the spinal cord by the odontoid process. This led to a quadriplegia lasting about 10 min. Over the following weeks, all of her symptoms started to diminish. This situation turned out to be the third episode involving temporary neurological disorders in this 60-year-old female’s life.

Posterior transdural approach for odontoidectomy in a child: case report

2020 ◽  
Vol 25 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Jacob Archer ◽  
Meena Thatikunta ◽  
Andrew Jea
Keyword(s):  
Spinal Cord ◽  
Tube Feeding ◽  
Odontoid Process ◽  
Cord Compression ◽  
Basilar Invagination ◽  
Craniocervical Junction ◽  
Csf Leak ◽  
Prolonged Intubation ◽  
Soft Tissue Dissection ◽  
Transdural Approach

The transoral transpharyngeal approach is the standard approach to resect the odontoid process and decompress the cervicomedullary spinal cord. There are some significant risks associated with this approach, however, including infection, CSF leak, prolonged intubation or tracheostomy, need for nasogastric tube feeding, extended hospitalization, and possible effects of phonation. Other ventral approaches, such as transmandibular and circumglossal, endoscopic transcervical, and endoscopic transnasal, are also viable alternatives but are technically challenging or may still traverse the nasopharyngeal cavity. Far-lateral and posterior extradural approaches to the craniocervical junction require extensive soft-tissue dissection. Recently, a posterior transdural approach was used to resect retro-odontoid cysts in 3 adult patients. The authors present the case of a 12-year-old girl with Down syndrome and significant spinal cord compression due to basilar invagination and a retro-flexed odontoid process. A posterior transdural odontoidectomy prior to occiptocervical fusion was performed. At 12 months after surgery, the authors report satisfactory clinical and radiographic outcomes with this approach.

scholarly journals ODONTOID PROCESS HYPOPLASIA AND BIPARTITE ATLAS ASSOCIATED WITH ATLANTO-AXIAL INSTABILITY

2016 ◽  
Vol 15 (4) ◽  
pp. 330-333 ◽  
Author(s):  
Luis Miguel Sousa Marques ◽  
Clara Romero ◽  
José Gabriel Monteiro de Barros Cabral
Keyword(s):  
Imaging Techniques ◽  
Previous History ◽  
Three Dimensional ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Diagnostic Process ◽  
Fixation Techniques ◽  
Bipartite Atlas

ABSTRACT Surgical treatment of craniocervical junction pathology has evolved considerably in recent years with the implementation of short fixation techniques rather than long occipito-cervical fixation (sub-axial). It is often difficult and sometimes misleading to determine the particular bone and vascular features (high riding vertebral artery, for instance) using only the conventional images in three orthogonal planes (axial, sagittal and coronal). The authors describe a rare clinical case of congenital malformation of the craniovertebral junction consisting of hypoplasia/agenesis of the odontoid process and bipartite atlas associated with atlantoaxial instability which was diagnosed late in life in a patient with a previous history of rheumatologic disease. The authors refer to the diagnostic process, including new imaging techniques, and three-dimensional multiplanar reconstruction. The authors also discuss the surgical technique and possible alternatives.

scholarly journals Computed tomography evaluation of the normal craniocervical junction craniometry in 100 asymptomatic patients

2015 ◽  
Vol 38 (4) ◽  
pp. E5 ◽  
Author(s):  
Ulysses C. Batista ◽  
Andrei F. Joaquim ◽  
Yvens B. Fernandes ◽  
Roger N. Mathias ◽  
Enrico Ghizoni ◽  
...  
Keyword(s):  
Odontoid Process ◽  
Tertiary Hospital ◽  
Craniocervical Junction ◽  
Ct Scans ◽  
Upper Cervical Spine ◽  
Plain Radiographs ◽  
Basal Angle ◽  
Normal Ranges ◽  
Asymptomatic Patients ◽  
The Mean

OBJECT Most of the craniometric relationships of the normal craniocervical junction (CCJ), especially those related to angular craniometry, are still poorly studied and based on measurements taken from simple plain radiographs. In this study, the authors performed a craniometric evaluation of the CCJ in a population without known CCJ anomalies. The purpose of the study was to evaluate the normal CCJ craniometry based on measurements obtained from CT scans. METHOD The authors analyzed 100 consecutive CCJ CT scans obtained in adult patients who were admitted at their tertiary hospital for treatment of non-CCJ conditions between 2010 and 2012. A total of 17 craniometrical measurements were performed, including the relation of the odontoid with the cranial base, the atlantodental interval (ADI), the clivus length, the clivus-canal angle (CCA)—the angle formed by the clivus and the upper cervical spine, and the basal angle. RESULTS The mean age of the 100 patients was 50.6 years, and the group included 52 men (52%) and 48 women (48%). In 5 patients (5%), the tip of the odontoid process was more than 2 mm above the Chamberlain line, and in one of these 5 patients (1% of the study group). it was more than 5 mm above it. One patient had a Grabb-Oakes measurement above 9 mm (suggesting ventral cervicomedullary encroachment). The mean ADI value was 1.1 mm. The thickness of the external occipital protuberance ranged from 7.42 to 22.36 mm. The mean clivus length was 44.74 mm, the mean CCA was 153.68° (range 132.32°–173.95°), and the mean basal angle was 113.73° (ranging from 97.06°–133.26°). CONCLUSIONS The data obtained in this study can be useful for evaluating anomalies of the CCJ in comparison with normal parameters, potentially improving the diagnostic criteria of these anomalies. When evaluating CCJ malformations, one should take into account the normal ranges based on CT scans, with more precise bone landmarks, instead of those obtained from simple plain radiographs.

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