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Thintharua P, Chentanez V. Morphological analysis and morphometry of the occipital condyle and its relationship to the foramen magnum, jugular foramen, and hypoglossal canal: implications for craniovertebral junction surgery. Anat Cell Biol 2023; 56:61-68. [PMID: 36635090 PMCID: PMC9989787 DOI: 10.5115/acb.22.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 01/14/2023] Open
Abstract
Anatomical knowledge of the occipital condyle (OC) and its relationships to surrounding structures is important for avoiding injury during craniovertebral junction (CVJ) surgeries. This study was conducted to evaluate the morphology and morphometry of OC and its relationship to foramen magnum, jugular foramen (JF), and hypoglossal canal (HC). Morphometric parameters including length, width, height, and distances from the OC to surrounding structures were measured. The oval-like condyle was the most common OC shape, representing for 33.0% of all samples. The mean length, width and height of OC were 21.3±2.4, 10.5±1.4, and 7.4±1.1 mm, respectively. Moreover, OC was classified into three types based on its length. The most common OC length in both sexes was moderate length or type II (62.5%). The mean distance between anterior tips and posterior tips of OC to basion, and opisthion were 11.5±1.4, 39.1±3.3, 25.2±2.2, and 27.4±2.7 mm, respectively. The location of intracranial orifice of HC was commonly found related to middle 1/3 of OC in 45.0%. JF was related to the anterior 2/3 of OC in 81.0%, the anterior 1/3 of OC in 12.5%, and the entire OC length in 6.5%. These morphological analysis and morphometric data should be taken into consideration before performing surgical operation to avoid CVJ instability and neurovascular structure injury.
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Affiliation(s)
- Pakpoom Thintharua
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vilai Chentanez
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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The Benefits of Progressive Occipital Condylectomy in Enhancing the Far Lateral Approach to the Foramen Magnum. World Neurosurg 2020; 134:e144-e152. [DOI: 10.1016/j.wneu.2019.09.152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/17/2022]
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Champagne PO, Voormolen EH, Mammar H, Bernat AL, Krichen W, Penet N, Froelich S. Delayed Instrumentation Following Removal of Cranio-Vertebral Junction Chordomas: A Technical Note. J Neurol Surg B Skull Base 2019; 81:694-700. [PMID: 33381375 DOI: 10.1055/s-0039-1694053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022] Open
Abstract
Objective To investigate on the feasibility and safety of a new approach which consists of delaying instrumentation after destabilizing craniovertebral junction (CVJ) chordoma surgery, allowing proton beam radiotherapy to be performed in a metal-free tumoral cavity. Design This is a retrospective series of a prospectively maintained database. Participants Five consecutive patients operated on for a CVJ chordomas for which instrumentation after tumor resection was deferred to after radiotherapy treatment. Main Outcome Measures The main outcome consisted of measurements of the following parameters: C0-C2 angle, atlanto-dens interval (ADI), condylar gap, and the position of the dens relative to McGregor's line and coronal inclination, performed at 3 different times for all patients: before tumor surgery (baseline), before instrumentation surgery, and after instrumentation surgery. Results For all patients, CVJ parameters deteriorated during the delay period, but stayed within normal limits for most. Because of radiological instability, one patient necessitated instrumentation before receiving radiotherapy. All parameters except condylar gap were partially corrected after instrumentation. No new neurological symptom or evolving neck pain occurred during the delay period. Conclusion Delayed instrumentation of CVJ chordomas can be a safe alternative that might lead to improved subsequent radiotherapeutical treatment. Patient's selection and close clinical and radiological follow-up are mandatory for the success of this approach.
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Affiliation(s)
| | - Eduard H Voormolen
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Hamid Mammar
- Department of Radiation Oncology, Institut Curie- Centre de protonthérapie d'Orsay (CPO), Orsay, France
| | - Anne-Laure Bernat
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Walid Krichen
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Nicolas Penet
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
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Alshafai NS, Klepinowski T. The Far Lateral Approach to the Craniovertebral Junction: An Update. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:159-164. [PMID: 30610317 DOI: 10.1007/978-3-319-62515-7_23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Since 1972, when Hammon first described the far lateral approach (FLA) for treatment of vertebral artery aneurysms, it has undergone numerous modifications, including drilling of the occipital condyle, removal of the laminas of upper cervical vertebrae and so on. Also, the range of indications has increased exponentially. OBJECTIVE In this paper we discuss state-of-the-art advances in the FLA, such as promising minimally invasive variants where an endoscope is used, and many others. METHODS We reviewed all articles touching upon the FLA in the modern era (from the year 2000 onward) and selected those that presented a significant contribution to the development of the relevant approach. The database used was PubMed. RESULTS AND CONCLUSION We found several new caveats not mentioned in other reviews or book chapters. The FLA is an ever-changing field of battle where the common and ultimate goals are to minimize the risk of injuring the major vessel in the region-the vertebral artery-and to provide such an angle of attack upon the tumours in the anterior and anterolateral foramen magnum that it is feasible to ensure gross total resection. This paper is an update on the knowledge about this approach, which we feel is necessary.
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Affiliation(s)
| | - Tomasz Klepinowski
- Department of Neurosurgery, Collegium Medicum Jagiellonian University, Alshafai Neurosurgical Academy (ANA), Kraków, Poland
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Rizvi A, Iwanaga J, Oskouian RJ, Loukas M, Tubbs RS. Duplication of the Alar Ligaments: A Case Report. Cureus 2018; 10:e2893. [PMID: 30174999 PMCID: PMC6116888 DOI: 10.7759/cureus.2893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The alar ligament is one of the two strongest ligaments stabilizing the craniocervical junction. The literature describes many variations of the attachment, insertion, shape, and orientation of the alar ligament and an understanding of these variations is vital as they can lead to altered biomechanics or misinterpretation on imaging. Herein, we report, to our knowledge, the first case of duplication of the alar ligaments and discuss the anatomical variations present in the literature.
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Affiliation(s)
- Asad Rizvi
- St. Georges University School of Medicine, St. Georges, GRD
| | | | - Rod J Oskouian
- Neurosurgery, Swedish Neuroscience Institute, Seattle, USA
| | - Marios Loukas
- Anatomical Sciences, St. George's University, St. George's, GRD
| | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, USA
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Schumacher M, Yilmaz E, Iwanaga J, Oskouian R, Tubbs RS. Paramastoid Process: Literature Review of Its Anatomy and Clinical Implications. World Neurosurg 2018; 117:261-263. [PMID: 29929028 DOI: 10.1016/j.wneu.2018.06.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 11/24/2022]
Abstract
The paramastoid process is a rare variation found on the occipital bone as an extension of its jugular process. In the literature, this process has been called many names including the paraoccipital, paracondylar, or parajugular process. The paramastoid process can articulate with the lateral aspect of the transverse process of the atlas creating clinical consequences and potentially resulting in diminished range of motion of the head. Herein, we describe the anatomy, embryology, prevalence, imaging, and clinical consequences of the paramastoid process in order to improve our understanding of this rare anatomic variation.
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Affiliation(s)
| | - Emre Yilmaz
- Seattle Science Foundation, Seattle, Washington, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA
| | - Rod Oskouian
- Seattle Science Foundation, Seattle, Washington, USA
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, Grenada
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Nakov V, Spiriev T, Stavrev E. How I do it: surgical clipping of vertebrobasilar junction aneurysms through a far-lateral transcondylar approach. Acta Neurochir (Wien) 2018. [PMID: 29541887 DOI: 10.1007/s00701-018-3512-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vertebrobasilar junction aneurysms occur rarely, but have a higher rupture rate than supratentoral aneurysms, and higher morbidity and mortality. Their location ventral to the neuroaxis makes them a challenging surgical lesion. METHODS In this paper, we share our experience with the surgical technique for the management of these complex aneurysms. CONCLUSION An in-depth understanding of the anatomy of these aneurysms, careful preoperative planning, and a meticulous surgical technique, including knowledge of every detail of the procedure-positioning, an advanced skull base technique, and careful aneurysm dissection and clipping-is essential for a successful outcome of the surgery.
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Affiliation(s)
- Vladimir Nakov
- Department of Neurosurgery Acibadem City Clinic Tokuda Hospital, "Nikola Vaptsarov" Blvd. 51b, 1407, Sofia, Bulgaria
| | - Toma Spiriev
- Department of Neurosurgery Acibadem City Clinic Tokuda Hospital, "Nikola Vaptsarov" Blvd. 51b, 1407, Sofia, Bulgaria.
| | - Evgeni Stavrev
- Department of Neurosurgery Military Medical Academy, "Georgi Sofiiski str. No 3", 1606, Sofia, Bulgaria
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Transcondylar approach for resection of lateral medullary cavernous malformation. Acta Neurochir (Wien) 2018; 160:291-294. [PMID: 29086026 DOI: 10.1007/s00701-017-3372-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Resection of a medullary cavernous malformation requires aggressive exposure, but there is controversy on how much occipital condyle can be safely removed during the transcondylar approach. METHOD We describe and demonstrate the use of the transcondylar approach to a medullary cavernous malformation, with emphasis on adequate surgical exposure while preserving the atlanto-occipital joint. CONCLUSIONS Despite conservative handling of the occipital condyle, craniocervical stability may vary in patients after transcondylar surgery. A "dynamic" computer tomography, with views of the atlanto-occipital joint at each end-rotational extreme, may be the best postoperative assessment tool to evaluate the stability of the craniocervical junction.
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Cárdenas Ruiz-Valdepeñas E, Kaen A, Perez Prat G. How I do it? Cranial setup for cranial settling. Acta Neurochir (Wien) 2017; 159:1919-1923. [PMID: 28577039 DOI: 10.1007/s00701-017-3231-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/18/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Expanded endonasal endoscopic techniques allow us to treat several pathologies related to the odontoid process and craniocervical junction. Cases such as giant basilar invagination represent a surgical challenge. METHODS The authors provide technical nuances and describe how to complete an endoscopic endonasal odontoidectomy and release the craniocervical junction with the aim of restoring a correct sagittal balance in cases with giant basilar invagination. The study of cadaveric specimens adds clarifying dissections. CONCLUSIONS Endonasal endoscopic odontoidectomy and craniocervical junction joint release allow the treatment of irreducible basilar invagination and restoration of better sagittal balance before posterior cervical occipitocervical fusion.
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Affiliation(s)
| | - A Kaen
- Department of Neurological Surgery, Hospital Virgen Del Rocío, Avenida Manuel siurot s/n 41013, Sevilla, Spain
| | - G Perez Prat
- Department of Neurological Surgery, Hospital Virgen Del Rocío, Avenida Manuel siurot s/n 41013, Sevilla, Spain
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Youssef P, Loukas M, Chapman JR, Oskouian RJ, Tubbs RS. Comprehensive anatomical and immunohistochemical review of the innervation of the human spine and joints with application to an improved understanding of back pain. Childs Nerv Syst 2016; 32:243-51. [PMID: 26280631 DOI: 10.1007/s00381-015-2880-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/07/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pain of spinal origin contributes significantly to cervical, thoracic, and lower back pain presentations. Such pain originates in the nerve fibers supplying the joints or the surrounding ligaments and intervertebral discs. Although there has been little detailed discussion of spinal bony innervation patterns in the literature, the clinical implications of these patterns are anatomically and medically significant. METHODS The present review provides a detailed analysis of the innervation of the spine, identifying the unique features of each part via online search engines. CONCLUSIONS The clinical implications of these various studies lie in the importance of the innervation patterns for the mechanism of spinal pain. Immunohistochemical studies have provided further evidence regarding the nature of the innervation of the spine.
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Affiliation(s)
- Pamela Youssef
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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