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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Several modification were suggested. Features of type I CM In addition, caudal displacement of a beaked dorsal midbrainand possibly the fourth ventricle. The axis has a fully developed center from the second sclerotome which form the caudal part of the body and articular facets. This combination of assimilation of atlas and segmental failure of the II and III vertebral bodies exert an abnormal strain on the atlanto axial joints from childhood. In certain diseases of bone like hyperparathyroidism, pagets or osteomalacia, there is softening of the base of skull which gets invaginated.
Mal aligned bony components of the spinal canal compress underlying cord due to dislocation of the joints, the commonest is Atlanto axial dislocation.
Down’s syndrome lax joints. Twenty-two patients had previous posterior decompression and 27 had previous syrinx to subarachnoid shunt with delayed deterioration. Angle formed by the clival line and a line drawn along the floor of ant. This is called basilar impression or secondary basilar invagination.
Quantitative anatomy of lateral masses of the atlas and axis vertebrae. It is a complex process. Improvement occurred in all after ventral or ventrolateral decompression with resolution of the syringohydromyelia and normalization of CSF flow.
The odontoid base fails to fuse with the axis.
Published by Wolters Kluwer – Medknow. Sixty-six patients with irreducible pathology underwent ventral or ventrolateral decompression and dorsal stabilization.
Symptomatic in infancy Breathing difficulties, including apneic episodes Feeding difficulties Always associated with myelomeningocele Features of syringomyelia or hydrocephalusif present. Out of 4 occipital sclerotomes the first 2 form basiocciputthe III Jugular tubercles and the IV Proatlas form parts of foramen magnum, atlas and axis.
It could be partial or complex and may restrict occiptial movement. Occipito-atlantal snomalies is rare. Spino thalamic involvement is uncommon. Click on image for details. Mirror movements of the hands are often seen in klippel Feil syndrome due to inadequate decussation of pyramidal tract at medulla.
If it goes on for years vascular damage may happen with no recovery even after adequate decompression. CVJ anomalies that decrease the volume of the posterior cranial fossa e. Screw fixation of facet junctions, Halifax clamps, contoured rods are the latest.
Anomalkes these methods are effective when reduction of dislocation is adequate. The abnormalities may have a familial occurrence. The arch of the atlas, the odontoid and part of the axis can be excised. Some feel craniovertebrzl stabilization procedure is not required in selected cases. Rontgendiagnostik der platybasic und basilar Impression.
Craniovertebral anomalies: Role for craniovertebral realignment Atul Goel Neurol India
The soft tissue details can be imaged with a high degree. Dens lacks a good nutrient artery. The first effort was in by Osgood, who tried to reduce the dislocation by pushing backwards the atlas via the pharynx while the posterior arch of atlas was pulled back with a thick silk thread, which was craniovertrbral tied to spinous process of axis.
The wire retains an interposed only bone draft.
Hartshell frame is still being used by many. Surgery is often indicated to prevent or treat neurological symptoms. Is syringomyelia pathology or a natural protective phenomenon? Lastly, associated Chiari malformation and syrinx may cause further neural compression. 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.
Vertebral artery in relationship to C1-C2 vertebrae: Notochord disappears at the vertebral bodies, but persist as disc nucleus pulposus. Physical appearance is often striking. Occasionally the foramen magnum may be narrowed anomaies the rest of arch of the atlas may be deformed to cause compression of spino medullary junction. Platy basia alone not associated with other conditions does not produce any symptoms.
Surgical treatment for Arnold Chiari malformation associated with atlantoaxial dislocation. It is frequent in Klippel-feil syndrome, involving the second and the third vertebral bodies and may affect the atlanto axial joint.