1
|
Silva KMS, Silva LM, Nascimento JJC, Soares ÁM, Bandeira WGL, Araújo-Neto SA, Medeiros JP. Effect of the Basilar Invagination (Type B) on Cervical Spine: A Case-control Study with MRI. World Neurosurg 2024:S1878-8750(24)01502-X. [PMID: 39222839 DOI: 10.1016/j.wneu.2024.08.133] [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: 03/24/2024] [Revised: 08/25/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To evaluate the effect of the basilar invagination (BI) type B on cervical spine. METHODS The research protocol used head magnetic resonance imaging (MRI) exams from 41 participants with BI type B and 158 controls. The criterion for BI was the distance of the odontoid apex to Chamberlain's line (DOCL) equal to or greater than 7 mm. The clivus length (CLI), clivus canal angle (CCA), Welcker's basal angle (WBA), Boogaard's angle (BOA), upper cervical lordosis angle (UCL), and total cervical lordosis angle (CL) were evaluated. The descriptive analysis, group comparisons, and correlations between skull base and cervical spine parameters were performed at the 95% CI. RESULTS Participants with BI type B showed shorter clivus length (CLI: 25.7 ± 7.3 mm); greater angulation of the skull base (WBA: 126.5 ± 10.4); greater inclination foramen magnum (BOA: 151.5 ± 14.5); decrease in the value of the CCA (131.6 ± 15); and greater angulations of UCL (17.9 ± 13.8) and CL (29.7 ± 19.9) in comparison to the control group (P < 0.05). Clivus length and CCA correlated inversely with UCL and CL, while BOA correlated directly with UCL and CL. The WBA did not correlate with CL (P < 0.05). CONCLUSIONS The deformation of skull base in the BI of type B caused, on average, a hyperlordosis of almost 30° in the C2-C6 segment. This change was approximately 17° in the C2-C4, with the clivus hypoplasia being a risk factor for cervical hyperlordosis.
Collapse
Affiliation(s)
- Karl Marx S Silva
- Center of Medical Sciences, Federal University of Pernambuco, Recife, Brazil
| | - Leandro M Silva
- Department of Anatomy, Postgraduate Program in Neuropsychiatry, Federal University of Pernambuco, Recife, Brazil
| | | | - Áquila M Soares
- Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Brazil
| | - Wigínio G L Bandeira
- Department of Morphology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Severino A Araújo-Neto
- Department of Internal Medicine, Center of Medical Sciences, Federal University of Paraíba, João Pessoa, Brazil
| | - Juliana P Medeiros
- Department of Histology and Embryology, Federal University of Pernambuco, Recife, Brazil
| |
Collapse
|
2
|
Oktay K, Mazhar Ozsoy K, Eralp Cetinalp N, Alnageeb A, Mammadov M, Erman T, Ildan F. Evaluation of Craniometric Parameters and Efficacy of Posterior Surgical Intervention Types in Basilar Invagination Patients. World Neurosurg 2024; 186:e251-e260. [PMID: 38537788 DOI: 10.1016/j.wneu.2024.03.120] [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: 02/11/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
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.
Collapse
Affiliation(s)
- Kadir Oktay
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey.
| | - Kerem Mazhar Ozsoy
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
| | - Nuri Eralp Cetinalp
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
| | - Ammar Alnageeb
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
| | - Mansur Mammadov
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
| | - Tahsin Erman
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
| | - Faruk Ildan
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
| |
Collapse
|
3
|
Marulanda J, Retrouvey JM, Lee B, Sutton VR, Rauch F, Briner M. Cranio-cervical abnormalities in moderate-to-severe osteogenesis imperfecta - Genotypic and phenotypic determinants. Orthod Craniofac Res 2024; 27:237-243. [PMID: 37642979 PMCID: PMC11198608 DOI: 10.1111/ocr.12707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Cranio-cervical anomalies are significant complications of osteogenesis imperfecta (OI), a rare bone fragility disorder that is usually caused by mutations in collagen type I encoding genes. OBJECTIVE To assess cranio-cervical anomalies and associated clinical findings in patients with moderate-to-severe OI using 3D cone beam computed tomography (CBCT) scans. METHODS Cross-sectional analysis of CBCT scans in 52 individuals with OI (age 10-37 years; 32 females) and 40 healthy controls (age 10-32 years; 26 females). Individuals with a diagnosis of OI type III (severe, n = 11), type IV (moderate, n = 33) and non-collagen OI (n = 8) were recruited through the Brittle Bone Disorders Consortium. Controls were recruited through the orthodontic clinic of the University of Missouri-Kansas City (UMKC). RESULTS OI and control groups were similar in mean age (OI: 18.4 [SD: 7.2] years, controls: 18.1 [SD: 6.3] years). The cranial base angle was increased in the OI group (OI: mean 148.6° [SD: 19.3], controls: mean 130.4° [SD: 5.7], P = .001), indicating a flatter cranial base. Protrusion of the odontoid process into the foramen magnum (n = 7, 14%) and abnormally located odontoid process (n = 19, 37%) were observed in the OI group but not in controls. Low stature, expressed as height z-score (P = .01), presence of DI (P = .04) and being male (P = .04) were strong predictors of platybasia, whereas height z-score (P = .049) alone was found as positive predictor for basilar impression as per the Chamberlain measurement. CONCLUSION The severity of the phenotype in OI, as expressed by the height z-score, correlates with the severity of cranial base anomalies such as platybasia and basilar impression in moderate-to-severe OI. Screening for cranial base anomalies is advisable in individuals with moderate-to-severe OI, with special regards to the individuals with a shorter stature and DI.
Collapse
Affiliation(s)
- Juliana Marulanda
- Shriners Hospital for Children, Montreal, Quebec, Canada
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | | | - Brendan Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Frank Rauch
- Shriners Hospital for Children, Montreal, Quebec, Canada
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Michelle Briner
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| |
Collapse
|
4
|
Ottenhausen M, Greco E, Bertolini G, Gerosa A, Ippolito S, Middlebrooks EH, Serrao G, Bruzzone MG, Costa F, Ferroli P, La Corte E. Craniovertebral Junction Instability after Oncological Resection: A Narrative Review. Diagnostics (Basel) 2023; 13:1502. [PMID: 37189602 PMCID: PMC10137736 DOI: 10.3390/diagnostics13081502] [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: 02/27/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
The craniovertebral junction (CVJ) is a complex transition area between the skull and cervical spine. Pathologies such as chordoma, chondrosarcoma and aneurysmal bone cysts may be encountered in this anatomical area and may predispose individuals to joint instability. An adequate clinical and radiological assessment is mandatory to predict any postoperative instability and the need for fixation. There is no common consensus on the need for, timing and setting of craniovertebral fixation techniques after a craniovertebral oncological surgery. The aim of the present review is to summarize the anatomy, biomechanics and pathology of the craniovertebral junction and to describe the available surgical approaches to and considerations of joint instability after craniovertebral tumor resections. Although a one-size-fits-all approach cannot encompass the extremely challenging pathologies encountered in the CVJ area, including the possible mechanical instability that is a consequence of oncological resections, the optimal surgical strategy (anterior vs posterior vs posterolateral) tailored to the patient's needs can be assessed preoperatively in many instances. Preserving the intrinsic and extrinsic ligaments, principally the transverse ligament, and the bony structures, namely the C1 anterior arch and occipital condyle, ensures spinal stability in most of the cases. Conversely, in situations that require the removal of those structures, or in cases where they are disrupted by the tumor, a thorough clinical and radiological assessment is needed to timely detect any instability and to plan a surgical stabilization procedure. We hope that this review will help shed light on the current evidence and pave the way for future studies on this topic.
Collapse
Affiliation(s)
- Malte Ottenhausen
- Department of Neurological Surgery, University Medical Center Mainz, 55131 Mainz, Germany
| | - Elena Greco
- Department of Radiology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Giacomo Bertolini
- Head and Neck Department, Neurosurgery Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy
| | - Andrea Gerosa
- Head and Neck Department, Neurosurgery Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy
| | - Salvatore Ippolito
- Head and Neck Department, Neurosurgery Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy
| | - Erik H. Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Graziano Serrao
- Department of Health Sciences, San Paolo Medical School, Università Degli Studi di Milano, 20142 Milan, Italy
| | - Maria Grazia Bruzzone
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Costa
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| |
Collapse
|
5
|
Xiao Y, Wang B, Chen Y, Chen L, Lou Z, Gong Z. Risk Factors of Postoperative Cerebrospinal Fluid Leak After Craniovertebral Junction Anomalies Surgery: A Case-Control Study. Neurospine 2023; 20:255-264. [PMID: 37016872 PMCID: PMC10080451 DOI: 10.14245/ns.2244772.386] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/05/2022] [Indexed: 04/03/2023] Open
Abstract
Objective: To identify potential risk factors for cerebrospinal fluid (CSF) leakage after craniovertebral junction (CVJ) anomaly surgery and to provide a reference for clinical practice.Methods: Sixty-six patients who underwent elective CVJ anomaly surgery during a 6-year period (April 2013 to September 2019) were retrospectively included. Research data were collected from the patients’ medical records and imaging systems. Patients were divided into CSF leak and no CSF leak groups. Univariate tests were performed to identify potential risk factors. For statistically significant variables in the univariate tests, a logistic regression test was used to identify independent risk factors for CSF leakage.Results: The overall prevalence of CSF leakage was 13.64%. Univariate tests showed that a basion-dental interval (BDI) > 10 mm and occipitalized atlas had significant intergroup differences (p < 0.05). Multivariate analysis indicated that a BDI > 10 mm was an independent risk factor for CSF leakage, and patients with CVJ anomalies with a BDI > 10 mm were more likely to have postoperative CSF leaks (odds ratio, 14.67; 95% confidence interval, 1.48–30.88; p = 0.004).Conclusion: It is necessary to maintain vigilance during CVJ anomaly surgery in patients with a preoperative BDI > 10 mm to avoid postoperative CSF leaks.
Collapse
Affiliation(s)
- Yu Xiao
- Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bing Wang
- Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Corresponding Author Bing Wang Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan, China
| | - Yulian Chen
- Department of ENT, The First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Lingqiang Chen
- Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhenkai Lou
- Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhiqiang Gong
- Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| |
Collapse
|
6
|
Fiani B, Jarrah R, Shields J, Durrani S, Panico N, Mualem W, Nathani KR, Pasko K. A Comprehensive Overview of Pediatric Neoplasms at the Craniocervical Junction: Meningiomas, Schwannomas, and Chordomas. Cureus 2022; 14:e31083. [DOI: 10.7759/cureus.31083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/04/2022] [Indexed: 11/06/2022] Open
|
7
|
Chiapparelli E, Bowen E, Okano I, Salzmann SN, Reisener MJ, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Spinal Cord Medial Safe Zone for C2 Pedicle Instrumentation: An MRI Measurement Analysis. Spine (Phila Pa 1976) 2022; 47:E101-E106. [PMID: 34091562 DOI: 10.1097/brs.0000000000004137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE The aim of this study was to investigate the spinal cord safety margins for C2 instrumentation. SUMMARY OF BACKGROUND DATA Intraoperative spinal cord injury during C2 spine surgery is a rare, but potentially life-threatening complication. Preoperative planning for C2 instrumentation mainly focuses on C2 pedicle bony dimensions on CT and the vertebral artery location and few studies have evaluated C2 spinal cord safety margins. METHODS We measured two distances in C2 bilaterally: C2 pedicle to dura distance (P-D), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and the dural sac, and C2 pedicle to spinal cord (P-SC), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and spinal cord. We defined the distances >4 mm as safe for instrumentation. RESULT A total of 146 patients (mean age 71.2, 50.7% female) were included. The average distances were 5.5 mm for C2 left PD, 5.9 mm for C2 right P-D, 10.1 mm for C2 left P-SC, and 10.6 mm for C2 right P-SC. Twenty-eight (21.4%) patients had C2 P-D distances <4 mm and of those two (7%) patients had distances <2 mm. There were more female patients with C2 P-D distances under 4 mm compared to males. No patient had C2 P-SC distances <4 mm. CONCLUSION We demonstrated that around 20% of patients had C2 P-D distance <4 mm, but no patient had C2 P-SC distance <4 mm. Since a lateral misplacement can lead to a potentially fatal vertebral artery injury, medial screw trajectory is recommended for C2 pedicle instrumentation with consideration of these safety margins.Level of Evidence: 3.
Collapse
|
8
|
Fiani B, Jarrah R, Sarno E, Kondilis A, Pasko K, Musch B. An investigation of craniocervical stability post-condylectomy. Surg Neurol Int 2021; 12:380. [PMID: 34513147 PMCID: PMC8422489 DOI: 10.25259/sni_456_2021] [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] [Received: 05/08/2021] [Accepted: 06/23/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Occipital condylectomy is often necessary to gain surgical access to various neurological pathologies. As the lateral limit of the craniovertebral junction (CVJ), partial condylectomy can lead to iatrogenic craniocervical instability. What was once considered an inoperable location is now the target of various complex neurosurgical procedures such as tumor resection and aneurysm clipping. Methods: In this study, we will review the anatomical structure of the CVJ and provide the first comprehensive assessment of studies investigating craniovertebral stability following condylectomy with the transcondylar surgical approaches. Furthermore, we discuss future considerations that must be evaluated to optimize the chances of preserving craniocervical stability postcondylectomy. Results: The current findings postulate upward of 75% of the occipital condyle can be resected without significantly affecting mobility of the CVJ. The current findings have only examined overall dimensions and have not established a significant correlation into how the shape of the occipital condyles can affect mobility. Occipitocervical fusion should only be considered after 50% condyle resection. In terms of indicators of anatomical stability, components of range of motion (ROM) such as the neutral zone (NZ) and the elastic zone (EZ) have been discussed as potential measures of craniocervical mobility. These components differ by the sense that the NZ has little ligament tension, whereas the EZ does represent ROM where ligaments experience tension. NZ is a more sensitive indicator of instability when measuring for instability postcondylectomy. Conclusion: Various transcondylar approaches have been developed to access this region including extreme-lateral and far-lateral condylectomy, with hopes of preserving as much of the condyle as possible and maintaining postoperative craniocervical stability.
Collapse
Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, United States
| | - Ryan Jarrah
- College of Arts and Sciences, University of Michigan Flint, Flint, United States
| | - Erika Sarno
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States
| | - Athanasios Kondilis
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States
| | - Kory Pasko
- School of Medicine, Georgetown University, Washington, District of Columbia, United States
| | - Brian Musch
- College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, United States
| |
Collapse
|
9
|
Tanrisever S, Orhan M, Bahşi İ, Yalçin ED. Anatomical evaluation of the craniovertebral junction on cone-beam computed tomography images. Surg Radiol Anat 2020; 42:797-815. [PMID: 32221664 DOI: 10.1007/s00276-020-02457-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 03/10/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION There are many craniometric measurements that are used in evaluating craniovertebral junction (CVJ) pathologies such as basilar invagination, atlantoaxial dislocation and platybasia. Therefore, it is important to determine the normal reference range of the craniometric measurements. This study aims to determine the morphometric reference values of the bony structures in the CVJ from cone-beam computed tomography (CBCT) images of a group of South Eastern Anatolian population. MATERIALS AND METHODS The CBCT images of 300 individuals were retrospectively evaluated. 14 parameters on midsagittal and 2 parameters on the coronal plane were studied. The data were statistically evaluated. RESULTS Measurement results were found as follows; the distances between odontoid process (OP) and McGregor line as 0.31 ± 3.22 mm, OP and Chamberlain line 1.06 ± 3.22 mm, OP and McRae line 5.30 ± 1.59 mm, OP and Fischgold digastric line 8.70 ± 4.12 mm, OP and Fischgold bimastoid line - 5.15 ± 4.86 mm, length of McRae line 35.58 ± 2.52 mm, atlantodental interval 1.28 ± 0.48 mm, posterior atlantodental interval 19.54 ± 2.24 mm, basion axial interval 4.01 ± 1.83 mm, basion dental interval 4.92 ± 1.77 mm, length of Modified Ranawat line 28.66 ± 2.38 mm, length of Redlund-Johnell line 35.11 ± 4.09 mm, clivus canal angle 157.62° ± 11.85°, Welcher basal angle 130.83° ± 6.29°, craniocervical tilt 126.98° ± 12.24° and Powers ratio as 0.72 ± 0.06. CONCLUSION In this study, the morphometric values were evaluated according to age and gender in individuals who did not have any radiologic anomalies. The normal reference ranges may be useful for researchers who are researching pathology in this region. It is recommended to conduct further studies with different populations to determine the normal reference range.
Collapse
Affiliation(s)
- Sefkan Tanrisever
- Department of Anatomy, Faculty of Medicine, Gaziantep University, 27310, Gaziantep, Turkey
| | - Mustafa Orhan
- Department of Anatomy, Faculty of Medicine, Gaziantep University, 27310, Gaziantep, Turkey
| | - İlhan Bahşi
- Department of Anatomy, Faculty of Medicine, Gaziantep University, 27310, Gaziantep, Turkey.
| | - Eda Didem Yalçin
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| |
Collapse
|
10
|
Ma L, Guo L, Li X, Qin J, He W, Xiao X, Lu L, Xu Y, Wu Y. Clivopalate angle: a new diagnostic method for basilar invagination at magnetic resonance imaging. Eur Radiol 2019; 29:3450-3457. [PMID: 30820721 PMCID: PMC6554245 DOI: 10.1007/s00330-018-5972-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/15/2018] [Accepted: 12/14/2018] [Indexed: 11/25/2022]
Abstract
Objectives To investigate the diagnostic value of clivopalate angle (CPA) for basilar invagination (BI) at magnetic resonance imaging (MRI). Methods In this retrospective case-control study, CPA, clivodens angle (CDA), and clivoaxial angle (CXA) were measured on midsagittal MR images from 112 patients with BI (22 men; mean age, 43.9 years ± 13.1 years; range, 21–79 years) and 200 control subjects (57 men; mean age, 47.1 years ± 13.3 years; range, 20–80 years). Intraclass correlation coefficient (ICC), linear regression, Mann-Whitney U test, binary logistic regression, and receiver operating characteristic (ROC) curve were used for statistical analysis. Results Clivopalate angle showed better inter-observer agreement (ICC = 0.951) than CXA (0.867) or CDA (0.853). CPA significantly correlated with CXA (R = 0.811, p < 0.001) and CDA (R = 0.716, p < 0.001). Patients with BI had a significantly smaller CPA (45.9° ± 9.9°) than control subjects (61.9° ± 6.2°) (p < 0.001). With the optimal cutoff value of 53.5°, CPA had a sensitivity of 0.839 (94/112) and a specificity of 0.915 (183/200). The area under the ROC curve (AUC) was 0.937 (95% CI, 0.911–0.963) for CPA, which was similar to that of CXA (AUC, 0.957; 95% CI, 0.936–0.978) or CDA (AUC, 0.925; 95% CI, 0.892–0.957). The combination of CPA and CDA or CXA showed a higher diagnostic value than CDA or CXA alone. Conclusions The diagnostic performance of CPA was similar to that of CXA or CDA, but CPA might be more reliable in evaluation of BI. CPA provided complementary information to CXA and CDA. Key Points • Clivopalate angle has a high diagnostic value for basilar invagination. • Clivopalate angle demonstrates high inter-reader agreement than does clivoaxial angle or clivodens angle. • Clivopalate angle provides complementary information to clivoaxial angle and clivodens angle. Electronic supplementary material The online version of this article (10.1007/s00330-018-5972-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lichao Ma
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Liuji Guo
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Xiaodan Li
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Jie Qin
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Wenle He
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Xiang Xiao
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Lijun Lu
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Yikai Xu
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Yuankui Wu
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, People's Republic of China.
| |
Collapse
|
11
|
Nidecker AE, Shen PY. Magnetic Resonance Imaging of the Craniovertebral Junction Ligaments: Normal Anatomy and Traumatic Injury. J Neurol Surg B Skull Base 2016; 77:388-95. [PMID: 27648395 DOI: 10.1055/s-0036-1584230] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The superb stability and flexibility of the craniovertebral junction (CVJ) are enabled by the ligaments that connect the occipital bone and the C1 and C2 vertebral bodies. Radiographically, these ligaments are best assessed with magnetic resonance imaging (MRI), which has excellent soft tissue contrast, but typically poor spatial resolution. With the advent of advanced MRI techniques, including volumetric sequences, high spatial resolution and contrast resolution can both be attained, allowing for detailed analysis of the ligaments, particularly in trauma settings. We have instituted a cervical spine trauma protocol which utilizes a high resolution (1-mm voxel) volumetric proton density sequence to detect injuries to the ligaments of the CVJ in all trauma patients who receive a cervical spine MRI in our emergency room. In this article, we review techniques for imaging the ligaments at the CVJ, the normal imaging anatomy and the function of the CVJ ligaments, and their appearance in cases of traumatic injury.
Collapse
Affiliation(s)
- Anna E Nidecker
- Department of Radiology, University of California-Davis Medical Center, Sacramento, California, United States
| | - Peter Y Shen
- Department of Radiology, University of California-Davis Medical Center, Sacramento, California, United States
| |
Collapse
|
12
|
Pinter NK, McVige J, Mechtler L. Basilar Invagination, Basilar Impression, and Platybasia: Clinical and Imaging Aspects. Curr Pain Headache Rep 2016; 20:49. [DOI: 10.1007/s11916-016-0580-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
13
|
Abstract
Craniovertebral dislocation is uncommon, but its diagnosis is important taking into account the potential severity of the neurologic complications. A number of causes are known; the most common are Down syndrome, rheumatoid arthritis, Paget's disease, other metabolic bone diseases, and craniocervical trauma. Down's syndrome is a relatively common clinical condition but craniovertebral subluxation is only observed in a small percentage of patients. About half of all cervical spine injuries affect the atlanto-occipital region and C2 vertebra. In rheumatoid arthritis, craniocervical dislocation occurs in up to 40% of patients with severe disease. In Paget's disease, involvement of the craniovertebral region occurs in about 30% of all cases. The clinical neurologic syndrome is characterized by local pain, features of upper spinal cord and medullary compression, positive Lhermitte phenomenon, syncope associated with neck flexion, vertebral artery obstruction or dissection leading to stroke, and asymmetrical lower cranial nerve palsies. Neuroimaging is essential to confirm the clinical diagnosis and to categorize severity. The treatment of this disorder is usually surgical, but traction and external immobilization is relevant in some cases. Specific conditions may require additional treatments such as radiotherapy, antibiotics, or chemotherapy.
Collapse
|