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De Nova-García MJ, Sola RG, Burgueño-Torres L. Influence of the Severity of Osteogenesis Imperfecta on Cranial Measurements. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1029. [PMID: 37371261 DOI: 10.3390/children10061029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Osteogenesis Imperfecta (OI) is a disease that causes bone fragility and deformities, affecting both the cranial base and the craniocervical junction, and may lead to other neurological disorders. A retrospective cross-sectional study was carried out based on cephalometric analysis of the cranial base in a sample of patients with OI, in lateral skull radiographs and magnetic resonance imaging (MRI), comparing them with a sample of age-matched controls. When the different variables of the craniocervical junction were analyzed, significance was found in comparisons with the different age groups. All measurements of the variables studied stabilized as growth progressed. For most of the variables, the severity of the disease influences the measurements of the skull base, with statistically significant differences. Both age and severity of the disease are factors that directly influence the anatomy of the craniocervical junction in these patients and may serve as indicators in the early detection and prevention of other derived alterations.
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Affiliation(s)
| | - Rafael G Sola
- UAM Chair "Innovation in Neurosurgery", Department of Surgery, Autonomous University of Madrid, 28049 Madrid, Spain
| | - Laura Burgueño-Torres
- Dental Clinical Specialties Department, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain
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Jannelli G, Moiraghi A, Paun L, Tessitore E, Dayer R, Bartoli A. Severe Basilar impression in osteogenesis imperfecta treated with halo gravity traction, occipitocervicothoracic fusion, foramen magnum and upper cervical decompression and expansive duroplasty: a technical note. Childs Nerv Syst 2022; 38:991-995. [PMID: 35296931 PMCID: PMC9038892 DOI: 10.1007/s00381-022-05495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
Osteogenesis imperfecta (OI) is a rare bone disease due to an abnormal synthesis of 1-type collagen. OI is frequently associated with basilar impression (BI), defined by the elevation of the clivus and floor of the posterior fossa with subsequent migration of the upper cervical spine and the odontoid peg into the base of the skull. Bone intrinsic fragility leading to fractures and deformity, brainstem compression and impaired CSF circulation at cranio-vertebral junction (CVJ) makes the management of these conditions particularly challenging. Different surgical strategies, including posterior fossa decompression with or without instrumentation, transoral or endonasal decompression with posterior occipito-cervical fusion, or halo gravity traction with posterior instrumentation have been reported, but evidence about best modalities treatment is still debated. In this technical note, we present a case of a 16-years-old patient, diagnosed with OI and BI, treated with halo traction, occipito-cervico-thoracic fixation, foramen magnum and upper cervical decompression, and expansive duroplasty. We focus on technical aspects, preoperative work up and postoperative follow up. We also discuss advantages and limitations of this strategy compared to other surgical techniques.
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Affiliation(s)
- Gianpaolo Jannelli
- Department of Neurosurgery, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France ,Université de Paris, Sorbonne Paris Cité, Paris, France ,IMA-Brain, Institut de Psychiatrie Et Neurosciences de Paris, Inserm, U1266 Paris, France
| | - Luca Paun
- Department of Neurosurgery, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Enrico Tessitore
- Department of Neurosurgery, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Romain Dayer
- Departments of Pediatric Orthopedics, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Bartoli
- Department of Neurosurgery, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Henderson FC, Francomano CA, Koby M, Tuchman K, Adcock J, Patel S. Cervical medullary syndrome secondary to craniocervical instability and ventral brainstem compression in hereditary hypermobility connective tissue disorders: 5-year follow-up after craniocervical reduction, fusion, and stabilization. Neurosurg Rev 2019; 42:915-936. [PMID: 30627832 PMCID: PMC6821667 DOI: 10.1007/s10143-018-01070-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/28/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023]
Abstract
A great deal of literature has drawn attention to the "complex Chiari," wherein the presence of instability or ventral brainstem compression prompts consideration for addressing both concerns at the time of surgery. This report addresses the clinical and radiological features and surgical outcomes in a consecutive series of subjects with hereditary connective tissue disorders (HCTD) and Chiari malformation. In 2011 and 2012, 22 consecutive patients with cervical medullary syndrome and geneticist-confirmed hereditary connective tissue disorder (HCTD), with Chiari malformation (type 1 or 0) and kyphotic clivo-axial angle (CXA) enrolled in the IRB-approved study (IRB# 10-036-06: GBMC). Two subjects were excluded on the basis of previous cranio-spinal fusion or unrelated medical issues. Symptoms, patient satisfaction, and work status were assessed by a third-party questionnaire, pain by visual analog scale (0-10/10), neurologic exams by neurosurgeon, function by Karnofsky performance scale (KPS). Pre- and post-operative radiological measurements of clivo-axial angle (CXA), the Grabb-Mapstone-Oakes measurement, and Harris measurements were made independently by neuroradiologist, with pre- and post-operative imaging (MRI and CT), 10/20 with weight-bearing, flexion, and extension MRI. All subjects underwent open reduction, stabilization occiput to C2, and fusion with rib autograft. There was 100% follow-up (20/20) at 2 and 5 years. Patients were satisfied with the surgery and would do it again given the same circumstances (100%). Statistically significant improvement was seen with headache (8.2/10 pre-op to 4.5/10 post-op, p < 0.001, vertigo (92%), imbalance (82%), dysarthria (80%), dizziness (70%), memory problems (69%), walking problems (69%), function (KPS) (p < 0.001). Neurological deficits improved in all subjects. The CXA average improved from 127° to 148° (p < 0.001). The Grabb-Oakes and Harris measurements returned to normal. Fusion occurred in 100%. There were no significant differences between the 2- and 5-year period. Two patients returned to surgery for a superficial wound infections, and two required transfusion. All patients who had rib harvests had pain related that procedure (3/10), which abated by 5 years. The results support the literature, that open reduction of the kyphotic CXA to lessen ventral brainstem deformity, and fusion/stabilization to restore stability in patients with HCTD is feasible, associated with a low surgical morbidity, and results in enduring improvement in pain and function. Rib harvest resulted in pain for several years in almost all subjects.
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Affiliation(s)
- Fraser C Henderson
- Doctor's Community Hospital, Lanham, MD, USA.
- The Metropolitan Neurosurgery Group, LLC, Silver Spring, MD, USA.
| | | | - M Koby
- Doctor's Community Hospital, Lanham, MD, USA
| | - K Tuchman
- The Metropolitan Neurosurgery Group, LLC, Silver Spring, MD, USA
| | - J Adcock
- Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore, MD, USA
| | - S Patel
- Medical University of South Carolina, Charleston, SC, USA
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Cobanoglu M, Bauer JM, Campbell JW, Shah SA. Basilar impression in osteogenesis imperfecta treated with staged halo traction and posterior decompression with short-segment fusion. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 9:212-215. [PMID: 30443144 PMCID: PMC6187899 DOI: 10.4103/jcvjs.jcvjs_63_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Basilar impression is a cranial base abnormality associated with osteogenesis imperfecta (OI) with serious neurologic implications but controversial treatment options. Combined anterior and posterior decompression with long-segment posterior fusion is often recommended. We report a patient with OI (Sillence type III) with basilar impression treated with halo traction followed by posterior surgery. The patient was a 12-year-old female with a presentation of hiccups and change in upper extremity function. Diagnostic imaging revealed syringomyelia, compensated hydrocephalus, basilar impression, and Chiari type I malformation. The patient was treated with halo traction followed by posterior decompression fusion from the occipital bone to C2. Bone fusion and improved syrinx were evident on images during the 5 years of follow-up. Five years after surgery, syrinx recurred and the fourth ventricular catheter was revised. The treatment with halo traction followed by posterior-only surgery of basilar impression associated with OI resulted in a good postoperative outcome.
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Affiliation(s)
- Mutlu Cobanoglu
- Department of Orthopaedics, Nemours/Alfred I. Dupont Hospital for Children, Wilmington, Delaware, USA.,Department of Orthopedics and Traumatology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Jennifer M Bauer
- Department of Orthopaedics, University of Washington, Seattle Children's Hospital, Seattle WA, USA
| | - Jeffrey W Campbell
- Department of Neurosurgery, Nemours/Alfred I. Dupont Hospital for Children, Wilmington, Delaware, USA
| | - Suken A Shah
- Department of Orthopaedics, Nemours/Alfred I. Dupont Hospital for Children, Wilmington, Delaware, USA
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Doruk E, Ozay R, Sekerci Z, Durmaz HA, Gunes SO, Hanalioglu S, Sorar M. Cervico-medullary compression ratio: A novel radiological parameter correlating with clinical severity in Chiari type 1 malformation. Clin Neurol Neurosurg 2018; 174:123-128. [PMID: 30236638 DOI: 10.1016/j.clineuro.2018.09.016] [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: 04/03/2018] [Revised: 09/06/2018] [Accepted: 09/09/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Chiari malformation type 1 (CM-1) is associated with cough headache, intracranial hypertension, cerebellar and spinal cord symptoms/signs. Herniated cerebellar tonsil length (HCTL) is widely used radiological parameter to determine the severity of CM-1, but with limited utility due to its weak correlation with some clinico-radiological findings. In this study, we aimed to evaluate a novel, practical parameter (cervico-medullary compression ratio; "CMCR") for its relationship with clinico-radiological findings in CM-1. PATIENTS AND METHODS Thirty-five adult patients (17 F, 18 M) with CM-1 were included in this retrospective study. Head CT and craniospinal MR images were assessed. CMCR was calculated as the ratio of herniated cerebellar tonsil surface area to foramen magnum surface area, and HCTL was measured. These two parameters were correlated with clinical and radiological findings. RESULTS The mean CMCR was 0.60 ± 0.15 and mean HCTL was 8.91 ± 3.4 mm with no significant difference between gender and age groups for both parameters. For cough headache (0.64 ± 0.14 vs 0.52 ± 0.15, p = 0.043) and syringomyelia (0.67 ± 0.11 vs 0.56 ± 0.16, p = 0.039), only CMCR; for intracranial hypertension (CMCR: 0.64 ± 0.14 vs 0.55 ± 0.16, p = 0.049; HCTL: 9.66 ± 3.59 mm vs 7.79 ± 3.03 mm; p = 0.045) and cerebellar symptoms (CMCR: 0.65 ± 0.14 vs 0.54 ± 0.16, p = 0.048; HCTL: 10.4 ± 3.5 mm vs 7.4 ± 2.8 mm, p = 0.041), both CMCR and HTCL were significantly different between patients with and without respective findings. However, neither CMCR nor HTCL was different between patients with and without spinal cord symptoms and hydrocephalus. CONCLUSION CMCR is a superior numerical parameter than HCTL for the assessment of clinical severity in CM-1 cases and needs further validation with larger studies.
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Affiliation(s)
- Ebru Doruk
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey; Ministry of Health, Health Sciences University, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Rafet Ozay
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey.
| | - Zeki Sekerci
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey; Medipol University Hospital, Department of Neurosurgery, Istanbul, Turkey
| | - Hasan Ali Durmaz
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Serra Ozbal Gunes
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Sahin Hanalioglu
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey
| | - Mehmet Sorar
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey
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Ríos-Rodenas M, de Nova J, Gutiérrez-Díez MP, Feijóo G, Mourelle MR, Garcilazo M, Ortega-Aranegui R. A cephalometric method to diagnosis the craniovertebral junction abnormalities in osteogenesis imperfecta patients. J Clin Exp Dent 2015; 7:e153-8. [PMID: 25810828 PMCID: PMC4368004 DOI: 10.4317/jced.52126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 09/12/2014] [Indexed: 01/29/2023] Open
Abstract
Osteogenesis imperfecta (OI) is a hereditary bone fragility disorder that in most patients is caused by mutations affecting collagen type I. Their typical oral and craneofacial characteristics (Dentinogenesis imperfecta type I and class III malocclusion), involve the dentist in the multidisciplinary team that treat these patients. It is usual to perform lateral skull radiographs for the orthodontic diagnosis. In addition, this radiograph is useful to analyse the junctional area between skull base and spine, that could be damaged in OI. Pathology in the craneovertebral junction (CVJ) is a serious complication of OI with a prevalence ranging from rare to 37%. To diagnosis early skull base anomalies in these patients, previously the neurological symptoms have been appear, we make a simple cephalometric analysis of the CVJ. This method has four measurements and one angle. Once we calculate the values of the OI patient, we compare the result with the mean and the standard deviations of an age-appropriate average in healthy controls. If the patient has a result more than 2,5 SDs above the age-appropriate average in healthy controls, we should to refer the patient to his/her pediatrician or neurologist. These doctors have to consider acquiring another diagnostic images to be used to determine cranial base measurements with more reliability. Thereby, dentists who treat these patients, must be aware of the normal radiological anatomy of the cervical spine on the lateral cephalogram. Key words:Osteogenesis imperfecta, craniovertebral junction, cephalometric.
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Affiliation(s)
- Mercedes Ríos-Rodenas
- Profesora asociada de Odontopediatría (Universidad Alfonso X El Sabio). Investigadora Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Joaquín de Nova
- Profesor Titular de Odontopediatría (Universidad Complutense de Madrid (UCM)). Responsable Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - María-Pilar Gutiérrez-Díez
- Especialista en Endocrinología Pediátrica. Unidad de Osteogénesis Imperfecta (Hospital Universitario de Getafe (Madrid)). Investigadora Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Gonzalo Feijóo
- Investigador Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Maria-Rosa Mourelle
- Profesora Contratada Doctora de la UCM. Investigadora Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Mario Garcilazo
- Investigador Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Ricardo Ortega-Aranegui
- Profesor asociado (UCM). Investigador Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
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Imagama S, Wakao N, Kitoh H, Matsuyama Y, Ishiguro N. Factors related to surgical outcome after posterior decompression and fusion for craniocervical junction lesions associated with osteogenesis imperfecta. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20 Suppl 2:S320-5. [PMID: 21384204 DOI: 10.1007/s00586-011-1734-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 01/27/2011] [Accepted: 02/20/2011] [Indexed: 02/02/2023]
Abstract
Treatment for craniocervical junction lesions associated with osteogenesis imperfecta (OI) has been described, but there are divergent views on operative procedures and preoperative and postoperative therapies due to the small number of cases. It has been suggested that a major procedure such as combined anterior and posterior surgery with concomitant ventriculoperitoneal (VP) shunting is required for OI associated with basilar impression (BI). However, here we report a case with a good outcome after posterior decompression fusion only. The patient was a 29-year-old woman with OI (Sillence type-IA) who had neurological symptoms of vertigo, nausea, and shaking during walking. Diagnostic imaging revealed hydrocephalus, severe BI, and Chiari type-II malformation. Preoperative Halo traction led to improvement in symptoms, and posterior decompression fusion from the occipital bone to C6 was subsequently performed. Lateral mass screws and Nesplon cables as sublaminar wiring for reinforcement for fusion were used in the operation. The patient wore a Halo vest for 4 weeks postoperatively. She experienced no symptoms postoperatively. Bone fusion and improved hydrocephalus were clear on images at 3 years after surgery, and the postoperative course has been good. In craniocervical junction lesions associated with OI, instability with compression of the nerve and bone fragility in multiple sites can become problematic. Anterior odontoid resection and posterior fusion are required for OI with BI to give ideal decompression on images. However, the results of this case suggest that a good postoperative outcome can be achieved by performing not the combination of anterior odontoid resection and VP shunting, but only with posterior decompression fusion, especially for OI cases of Sillence type-I.
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Affiliation(s)
- Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi 466-8550, Japan.
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Monti E, Mottes M, Fraschini P, Brunelli P, Forlino A, Venturi G, Doro F, Perlini S, Cavarzere P, Antoniazzi F. Current and emerging treatments for the management of osteogenesis imperfecta. Ther Clin Risk Manag 2010; 6:367-81. [PMID: 20856683 PMCID: PMC2940745 DOI: 10.2147/tcrm.s5932] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Indexed: 11/23/2022] Open
Abstract
Osteogenesis imperfecta (OI) is the most common bone genetic disorder and it is characterized by bone brittleness and various degrees of growth disorder. Clinical severity varies widely; nowadays eight types are distinguished and two new forms have been recently described although not yet classified. The approach to such a variable and heterogeneous disease should be global and therefore multidisciplinary. For simplicity, the objectives of treatment can be reduced to three typical situations: the lethal perinatal form (type II), in which the problem is survival at birth; the severe and moderate forms (types III-IX), in which the objective is 'autonomy'; and the mild form (type I), in which the aim is to reach 'normal life'. Three types of treatment are available: non-surgical management (physical therapy, rehabilitation, bracing and splinting), surgical management (intramedullary rod positioning, spinal and basilar impression surgery) and medical-pharmacological management (drugs to increase the strength of bone and decrease the number of fractures as bisphosphonates or growth hormone, depending on the type of OI). Suggestions and guidelines for a therapeutic approach are indicated and updated with the most recent findings in OI diagnosis and treatment.
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Affiliation(s)
- Elena Monti
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Monica Mottes
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Paolo Fraschini
- Istituto Di Ricovero e Cura a Carattere Scientifico, ‘E. Medea’, Associazione La Nostra Famiglia, Bosisio Parini (LC), Italy
| | | | - Antonella Forlino
- Department of Biochemistry “A. Castellani”, University of Pavia, Italy
| | - Giacomo Venturi
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Francesco Doro
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Silvia Perlini
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Paolo Cavarzere
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
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