Cranio-Vertebral AnomaliesDR. ANKUR NANDAN VARSHNEY IMS, BHU Varanasi. Cranio vertebral anomalies- overview -. 1. DR. SUMIT KAMBLE SENIOR RESIDENT DEPT. OF NEUROLOGY GMC, KOTA; 2. ANATOMY OF. The craniovertebral junction is the most complex of the axial skeleton, residing between the skull and the upper cervical spine. Congenital, developmental, and .
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Fatal meningitis, post operative dislocation are possible complications. Goel A, Kulkarni AG. These are only few odontoid base falls to the above specification. Quantitative anatomy of lateral masses of the atlas and axis vertebrae.
Some feel a stabilization procedure is not required in selected cases. Irreducible types require open reduction operative reduction. Goel A, Sharma P. At 12 years if fuses with odontoid to form normal odontoid. Von Torklus D, Gehle W. The mass of bone anomaliees cause ant. Though a number of bony and ligamentation cranioveertebral have been described, consequences are mainly due to A A -A dislocation B malformed components of bone producing compression.
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Correlation of anatomic and neurologic findings. Short stature, short neck, low hairline, head tilt, facial asymmetry, web neck, or scoliosis anojalies in different combinations.
Surgery is often indicated to prevent or treat neurological symptoms. Oppel was probably the first to operate by ant. Mesodermal somites numbering 42 appear at the 4th week Ventromedial part of the somatomes migrate and cluster around notochord- Sclerotomes A fissure in each sclerotome separate a denser caudal half from loosely arranged cranial half.
Mostly fatal in early infancy For those that survive: Symptomatic in infancy Breathing difficulties, including apneic episodes Feeding difficulties Always associated with myelomeningocele Features of syringomyelia or hydrocephalusif present. An analysis based on surgical cases.
Dysplasia of the occiptal segments may flatten the clivus – platybasia. At birth odontoid base is separate from the body of axis by a segment of cartilage which persists until the age of eight and the center gets ossified.
Symptoms of lower brain stem dysfunction, such as dysphagia, dysphonia, nasal regurgitation, sleep apnoea are due to basilar invagination. Mal aligned bony components of the spinal canal compress underlying cord due to dislocation of the joints, the commonest is Atlanto axial dislocation.
It is a complex process. Medical College and K. Malformation of axis Irregular atlantoaxial segmentation Dens dysplasias Ossiculum terminale persistence Osodontoideum Segmentation falilure of C Neural dysgenesis. Vertebral artery injury craniovertebgal transarticular screws letter. Evidence of high cervical cord compression with or without sensory involvement is common.
Notochord disappears at the vertebral bodies, but persist as disc nucleus pulposus This membranous stage is followed by chondrification and ossification.
Paramesial invagination was present in 20, syringohydromyelia in 46, and vertebral segmentation anomalied in 66 others. Irrespective of methods used it is essential to immobilize its CV junction with collar till bony fusion occurs, which may take 3 months. If it goes on for years vascular damage may happen with no recovery even after adequate decompression. Occasionally the foramen magnum may be narrowed or the rest of arch of craniovetebral atlas may be deformed to cause compression of spino medullary junction.
The anterior type has a short clivus horizontally placed, with the anterior lip of the foramen magnum invaginated in relation to the spinal column. CT scan with reconstruction is still preferred by some to study bone details. It is generally believed that traumatic fracture leaves an irregular margin, though the margin may be rounded enough to be indistinguishable from the developmental anomalies. It is frequent in Klippel-feil syndrome, involving the second and the third vertebral bodies and may affect the atlanto axial joint.
Surgical treatment for Arnold Chiari malformation associated with atlantoaxial craniovertfbral. Atlantoaxial fixation using plate and screw method: Associated syrinx may produce dissociated or suspended sensory loss. Down’s cranlovertebral lax crxniovertebral. Deformities involving the facet joints between atlas and axis may give rise to rotatory dislocation. Abnormal occipto atlantal ligament. This apical segment is usually about 12mm in length, but can be very small. Pathogenesis of Neural involvement: Clinical science The craniovertebral junction CVJ is composed of the occiput, the foramen magnumand the first two cervical vertebrae, encompassing the medulla oblongata and the upper cervical spinal cord.
Angle formed by the clival line and a line drawn craniovetrebral the floor of ant.
CV anomalies are defects crniovertebral development, not necessarily congenital and may not manifest at birth. Reduction of fixed atlantoaxial dislocation: Ideal will be the Halo frame.
Diagnostics Cervical spine x-ray ; AP and lateral views: Open access journal indexed with Index Medicus. Notochord disappears at the vertebral bodies, but persist as disc nucleus pulposus.