scholarly journals OCCIPITALISATION OF ATLAS VERTEBRA AND ITS CLINICAL FRAMES OF REFERENCE- AN ANALYSIS

2021 ◽  
Vol 1 (1) ◽  
pp. 58-61
Author(s):  
Neelima P ◽  
Ravi Sunder R

Vertebral column is made of 33 vertebrae named as cervical, thoracic, lumbar, sacral and coccygeal vertebrae. Axial skeleton comprises of skull and vertebral column. 12 pairs of cranial nerves and 31 pairs of spinal nerves exit from the central nervous system which control the entire body. Malformations or fusion of vertebrae could be one of the etiologies of nerve compression syndromes. Vital structures emerge out through intervertebral foramina extending from cervical to coccygeal vertebrae. Occipitalisation of atlas, the first cervical vertebra is one of the emergencies leading to wide spectrum of presentations like chronic neck pain or foramen magnum syndrome or unconscious state due to compression of medulla oblongata. During routine examination of skull bones while teaching, one skull was found to exhibit assimilation of atlas. Photographs were captured and compared with normal skull. Thorough examination revealed incomplete occipitalisation of atlas. The anterior arch was completely fused but the posterior arch was bifid showing a split. The styloid process on right side seemed to be long and very close leading to compression of structures of styloid apparatus in addition. On observation, it was found to be a male skull. Fusion of vertebrae may be a congenital anomaly due to maldevelopment of somites in forming vertebrae. Skeletal element of caudal 4th occipital somite forms the occipital bone and when it is fused with the proximal 1st cervical somite leads to occipitalisation of atlas. Acquired conditions like atlantoaxial subluxation, chiari malformations or cervical vertebral fusion or foramen magnum abnormalities have been associated with assimilation of atlas. The present study reports occipitalisation of atlas which is incomplete with a bifid posterior arch. Prevalence of such anomalies may form the differential diagnosis of chronic headache or myelopathies.

2008 ◽  
Vol 65 (8) ◽  
pp. 648-652
Author(s):  
Marko Markovic ◽  
Iva Berisavac ◽  
Vladimir Bojovic ◽  
Bojan Kostic ◽  
Vuk Djulejic

Background. Herniation of the cerebellar tonsils through the foramen magnum into the cervical spinal canal with obliteration of the cerebellomedullary cistern is the primary feature of Arnold-Chiari type I malformation (ACM I). It is considered to be congenital malformation, although there have been reported cases of an acquired form. Case report. We presented a female patient, 45-year old, with ACM I without syringomyelia as a rare and unusual clinical image, as well as the effect of decompressive surgery in the treatment of this malformation. The patient was admitted to the Department of Neurosurgery with clinical signs of truncal ataxia worsening during the last six years. Moderate quadriparesis with predominant lower extremity involvement and the signs of the cranial nerves damages occured during the last seven months before admission, with progressive clinical course up to the date of admission. Neurosurgical treatment that included suboccipital medial craniectomy with resection of posterior arch C1 vertebrae and C2 laminectomy resulted in a significant clinical improvement and a much better quality of life. Conclusion. Posterior craniovertebral decompression with microsurgical reduction of the cerebellar tonsils and placement of an artificial dural graft is a treatment of choice in severe forms of ACM I without syringomyelia. .


2018 ◽  
Vol 16 (3) ◽  
pp. E81-E81
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Hitoshi Izawa ◽  
Yujiro Tanaka

Abstract The anterior foramen magnum area, ventral to the brainstem is one of the most difficult regions to access surgically, and the extent of osseous drilling through the far-lateral or transcondylar approach should be planned in each case based on the tumor extension.1,2 This video, reproduced after informed consent of the patient, demonstrates a case of a ventral foramen magnum neurenteric cyst surgically treated using the partial transcondylar approach. A 27-yr-old woman presented with gait disturbance, oscillopsia, and transient arm numbness. Neuroimaging revealed a ventral foramen magnum cystic tumor involving the basilar and bilateral vertebral arteries. The tumor extended inferiorly from the middle clivus to the C1 level, and occupied the whole premedullary cistern compressing the bilateral lower cranial nerves. The left partial transcondylar approach was performed with drilling the condylar fossa, superior part of the occipital condyle, C1 posterior arch, and posterior part of the jugular process to achieve the sufficient surgical view from the inferolateral side. The drilling of the occipital condyle was minimized so that the articular facet of the occipital condyle was preserved. The tumor on the bilateral side was completely removed as enabled by the sufficient surgical field without new neurological deficits. Three-dimensional reconstructed images based on the postoperative computed tomography scans demonstrated the appropriate extent of the osseous drilling.


2017 ◽  
Vol 43 (videosuppl2) ◽  
pp. Intro ◽  
Author(s):  
Gabriel Zada ◽  
Mustafa K Başkaya ◽  
Mitesh V. Shah

Meningiomas represent the most common primary intracranial neoplasm treated by neurosurgeons. Although multimodal treatment of meningiomas includes surgery, radiation-based treatments, and occasionally medical therapy, surgery remains the mainstay of treatment for most symptomatic meningiomas. Because of the intricate relationship of the dura mater and arachnoid mater with the central nervous system and cranial nerves, meningiomas can arise anywhere along the skull base or convexities, and occasionally even within the ventricular system, thereby mandating a catalog of surgical approaches that neurosurgeons may employ to individualize treatment for patients. Skull base meningiomas represent some of the most challenging pathology encountered by neurosurgeons, on account of their depth, invasion, vascularity, texture/consistency, and their relationship to bony anatomy, cranial nerves, and blood vessels. Resection of complex skull base meningiomas often mandates adequate bony removal to achieve sufficient exposure of the tumor and surrounding region, in order to minimize brain retraction and optimally identify, protect, control, and manipulate sensitive neurovascular structures. A variety of traditional skull base approaches has evolved to address complex skull base tumors, of which meningiomas are considered the paragon in terms of both complexity and frequency.In this supplemental video issue of Neurosurgical Focus, contributing authors from around the world provide instructional narratives demonstrating resection of a variety of skull base meningiomas arising from traditionally challenging origins, including the clinoid processes, tuberculum sellae, dorsum sellae, petroclival region, falco-tentorial region, cerebellopontine angle, and foramen magnum. In addition, two cases of extended endoscopic endonasal approaches for tuberculum sellae and dorsum sellae meningiomas are presented, representing the latest evolution in accessing the skull base for selected tumors. Along with key pearls for safe tumor resection, an equally important component of open and endoscopic skull base operations for meningiomas addressed by the contributing authors is the reconstruction aspect, which must be performed meticulously to prevent delayed cerebrospinal fluid leakage and/or infections. This curated assortment of instructional videos represents the authors’ optimal treatment paradigms pertaining to the selection of approach, setup, exposure, and principles to guide tumor resection for a wide spectrum of complex meningiomas.


2019 ◽  
Vol 80 (S 04) ◽  
pp. S352-S354
Author(s):  
Hischam Bassiouni

Abstract Objective Surgical treatment of foramen magnum (FM) meningiomas is challenging due to proximity of the tumor to critical neurovascular structures, namely, the lower brainstem/upper cervical cord, vertebral artery, PICA, and lower cranial nerves. Controversies in microsurgical resection of meningiomas in this location include the necessity for condyle drilling and the need for vertebral artery mobilization. However, a laminectomy or hemilaminectomy of the C1 posterior arch is usually routinely performed. We herein present microsurgical, endoscopic-controlled resection of a FM meningioma via a posterolateral retrocondylar suboccipital craniotomy with preservation of the integrity of the posterior arch of the atlas. Setting Our patient, a 57-year-old patient, suffered from right-sided hemiparesis due to a right-sided ventrolateral FM meningioma compromising the medulla oblongata and upper cervical cord. The tumor at the craniocervical junction was resected through a posterolateral suboccipital retrocondylar craniotomy. Results Radical resection of the FM meningioma was accomplished via a lateral suboccipital retrocondylar craniotomy with preservation of posterior arch of atlas integrity. The postoperative course was uneventful with full preservation of neurological function. Preoperative hemiparesis subsided completely after surgery. Conclusion Anterior-laterally located FM meningiomas can be safely and completely resected via a suboccipital retrocondylar craniotomy. A laminectomy or hemilaminectomy of the posterior arch of C1 is not routinely required for complete and safe resection of these tumors at the craniocervical junction. Neuroendoscopy is beneficial for control of complete tumor resection.The link to the video can be found at: https://youtu.be/DBk6qoJ6OzQ.


2021 ◽  
Vol 3 (3) ◽  
pp. 284-287
Author(s):  
Serghei Covantev ◽  
◽  
Rasul Uzdenov ◽  
Kseniya Zabudskaya ◽  
Olga Belic ◽  
...  

The anatomy of the first vertebra, namely atlas, has significant clinical implications. Atlas is situated between the occipital bone and the second cervical vertebra (axis) and is one of the main points of head movement. Most congenital anomalies of the vertebra are diagnosed incidentally during imaging investigations and can be associated with cervical spine anomalies. The neurological symptoms may include weakness in the four limbs, acute neurologic deficits such as transient quadriparesis, paraparesis, Lhermitte's sign, chronic neck pain, and headache. This anomaly is also commonly seen in gonadal dysgenesis, Klippel-Feil syndrome, Arnold-Chiari malformations, and Turner and Down syndrome. Unlike other variations, which arise due to disturbances of ossification posterior midline clefts of the atlas, are different since they are a developmental failure of chondrogenesis. We therefore present an anatomical case and analysis of the literature about posterior arch clefts of atlas.


Author(s):  
Martin E. Atkinson

It is important to have a picture of the relationship of the brain and spinal cord to the bones of the skull and vertebral column that house and protect them and the protective layers of connective tissues known as the meninges that cover the CNS; these lie between the bones and brain and spinal cord. The brain is housed within the skull which will be described in much more detail in Section 4 . As you can appreciate by feeling your own skull, the top, front, sides, and back are smoothly curved. The surface of the brain is similarly curved and conforms to the shape of the bones. Note that, in reality, it is really the other way round—brain shape determines the shape of the bones of the skull vault forming the braincase. If the top of the braincase and the brain are removed to reveal the floor of the cranial cavity formed by the bones of the cranial base, it is anything but smooth. Viewed from the lateral aspect and going from anterior to posterior, it is like three descending steps. This structure is shown diagrammatically in Figure 15.1 and shows how different parts of the brain conform to these steps. The first step lies above the nasal and orbital cavities and is known as the anterior cranial fossa ; it houses the frontal lobes of the cerebral hemispheres. The second step is the middle cranial fossa and contains the temporal lobes of each cerebral hemisphere laterally and the midbrain and pons medially. The final step is the posterior cranial fossa where the rest of the brainstem and cerebellum lie. The floor of the posterior fossa is pierced by the foramen magnum through which the medulla oblongata and spinal cord become continuous. The spinal cord occupies the vertebral canal running in the vertebral column. As you can see in Figure 3.5 , in adults, the cord occupies the vertebral canal from the upper border of the first cervical vertebra, the atlas, down to the level of the disc between the first and second lumbar vertebrae.


Author(s):  
Pinar E. Ocak ◽  
Selcuk Yilmazlar

Abstract Objectives This study aimed to demonstrate resection of a craniovertebral junction (CVJ) meningioma via the posterolateral approach. Design The study is designed with a two-dimensional operative video. Setting This study is conducted at department of neurosurgery in a university hospital. Participants A 50-year-old woman who presented with lower cranial nerve findings due to a left-sided lower clival meningioma (Fig. 1). Main Outcome Measures Microsurgical resection of the meningioma and preservation of the neurovascular structures. Results The patient was placed in park-bench position and a left-sided retrosigmoid suboccipital craniotomy, followed by C1 hemilaminectomy and unroofing the lip of the foramen magnum, was performed. The dural incision extended from the suboccipital region down to the posterior arch of C2 (Fig. 2). The arachnoid overlying the tumor was incised, revealing the course of the cranial nerve (CN) XI on the dorsolateral aspect of the tumor. The left vertebral artery (VA) was encased by the tumor which was originating from the dura below the jugular foramen. The mass was resected in a piecemeal fashion eventually. At the end of the procedure, all relevant cranial nerves and adjacent vascular structures were intact. Postoperative magnetic resonance imaging (MRI) confirmed total resection and the patient was discharged home on postoperative day 3 safely. Conclusions Microsurgical resection of the lesions of the CVJ are challenging as this transition zone between the cranium and upper cervical spine has a complex anatomy. Since adequate exposure of the extradural and intradural segments of the VA can be obtained by the posterolateral approach, this approach can be preferred in cases with tumors anterior to the VA or when the artery is encased by the tumor.The link to the video can be found at: https://youtu.be/d3u5Qrc-zlM.


2019 ◽  
Vol 80 (S 04) ◽  
pp. S355-S357
Author(s):  
Robert T. Wicks ◽  
Xiaochun Zhao ◽  
Celene B. Mulholland ◽  
Peter Nakaji

Abstract Objective Foramen magnum meningiomas present a formidable challenge to resection due to frequent involvement of the lower cranial nerves and vertebrobasilar circulation. The video shows the use of a far lateral craniotomy to resect a foramen magnum meningioma. Design, Setting, and Participant A 49-year-old woman presented with neck pain and was found to have a large foramen magnum meningioma (Fig. 1A, B). Drilling of the posterior occipital condyle was required to gain access to the lateral aspect of the brain stem. The amount of occipital condyle resection varies by patient and pathology. Outcome/Result Maximal total resection of the tumor was achieved (Fig. 1B, C), and the patient was discharged on postoperative day 4 with no neurologic deficits. The technique for tumor microdissection (Fig. 2) is shown in the video. Conclusion Given the close proximity of foramen magnum meningiomas to vital structures at the craniocervical junction, surgical resection with careful microdissection and preservation of the overlying dura to prevent postoperative pseudomeningocele is necessary to successfully manage this pathology in those patients who are surgical candidates.The link to the video can be found at: https://youtu.be/Mds9N1x2zE0.


2006 ◽  
Vol 177 (2) ◽  
pp. 97-104 ◽  
Author(s):  
Marie Pincemaille-Quillevere ◽  
Eric Buffetaut ◽  
Frédéric Quillevere

Abstract Since the 19th century, the Campanian and Maastrichtian continental deposits of southern France have yielded numerous dinosaur remains [Le Loeuff, 1991; 1998; Buffetaut et al., 1997; Laurent et al., 1991; Allain and Suberbiola, 2003]. The ornithopod remains that have not been referred to the hadrosaurids have been systematically attributed to Rhabdodon [Buffetaut and Le Loeuff, 1991; Buffetaut et al., 1996; Garcia et al., 1999; Pincemaille-Quillévéré, 2002]. This genus, initially named by Matheron [1869] after its discovery in the lower Maastrichtian of La Nerthe (Bouches-du-Rhône), belongs to the Euornithopoda [sensu Sereno, 1999]. Rhabdodon represents the most common element of the dinosaur assemblages from the late Cretaceous of southern France [e.g. Allain and Suberbiola, 2003]. Nevertheless, since the localities have only provided some fragmentary material [Pincemaille-Quillévéré, 2002], the global morphology of this dinosaur and its phylogenetic placement within the euornithopods are still debated. The cranial morphology of Rhabdodon is particularly poorly understood due to the rarity of cranial remains preserved in the localities of southern France [Matheron, 1869; Garcia et al., 1999; Buffetaut et al., 1999; Pincemaille-Quillévéré, 2002]. Buffetaut et al. [1999] first mentioned the discovery of a braincase (M4) referred to Rhabdodon, at Massecaps, a locality close to the village of Cruzy (Hérault, France). More recently, a new braincase (MN25) has been discovered at Montplô Nord, another locality close to Cruzy (specimens M4 and MN25 are conserved in the Museum of Cruzy). Both these localities have revealed a diverse and abundant vertebrate fauna suggesting a late Campanian to early Maastrichtian age [Buffetaut et al., 1999]. These braincases are described here in an attempt to detect potential autapomorphic characters in Rhabdodon, and compared to a more complete braincase of Tenontosaurus, an euornithopod from the Lower Cretaceous of North America, considered as the sister group of Rhabdodon [Weishampel et al., 1998; 2003; Garcia et al., 1999; Pincemaille-Quillévéré, 2002], in order to determine the potential differences and synapomorphies between the occiputs of the two genera. Finally, the braincases from Cruzy are compared to those of the other euornithopods described in the literature. Specimen M4 (figs. 1–4) is incomplete but exceptionally well preserved. This braincase belongs to a juvenile individual, as shown by the numerous visible suture lines between the different cranial elements. Specimen MN25 (fig. 5) is badly deformed and attributable to an adult individual. Until now, all the ornithopods from the Upper Cretaceous of southern France have been referred either to hadrosaurs or to Rhabdodon. The Hadrosauridae show a low nuchal crest and their exoccipitals meet and form a bar on the dorsal border of the foramen magnum, excluding the supraoccipital from this border. Specimens M4 and MN25 do not present any nuchal crest and the supraoccipital participates in the dorsal border of the foramen magnum. Both braincases M4 and MN25 are therefore attributable to Rhabdodon. Specimens M4 and MN25 have been compared to the occiput of a juvenile Tenontosaurus tilletti (fig. 6 : MCZ 4205, conserved in the Museum of Comparative Zoology, Harvard University). This reveals that Tenontosaurus and Rhabdodon share numerous characters : (1) the exoccipitals form the lateral borders of the foramen magnum, its ventral border being occupied by the basioccipital; (2) the occipital condyle is partly constituted by the exoccipitals, and in the same proportions; (3) the supraoccipital is rostrally oriented; (4) the suture line located between the prootic and the laterosphenoid shows the same outline; (5) the cresta prootica starts within the paroccipital process and extends onto the opisthotic; (6) the cresta prootica is transversal and non-horizontal; (7) the distribution of the cranial nerves is homologuous along the lateral surface of the braincase. Nevertheless, the braincase of Tenontosaurus differs from that of Rhabdodon in several significant respects : (1) the exoccipitals are dorsally connected, excluding the supraoccipital from the dorsal border of the foramen magnum; (2) two small dorsal humps are present at the level of the suture of the exoccipitals; (3) the supraoccipital is excluded from the dorsal border of the foramen magnum, which gives it a triangular shape; (4) the paroccipital processes are short, laterally flattened, and wing-shaped, and are more mediodorsally oriented than in Rhabdodon; (5) the cresta prootica follows a concave line and ends up on the prootic, at the level of the opening of the trigeminal nerve; (6) the external curve of the laterosphenoids is stronger; (7) the suture between the basioccipital and the opisthotic is very clear. The first of these unshared characters suggests that Rhabdodon belongs to Norman’s [1984] ‘hypsilophodontoid’ clade and Tenontosaurus to the more evolved ‘iguanodontoid’ clade. The fusion of the exoccipitals on the dorsal border of the foramen magnum, together with other cranial adaptations, may have reduced the stress caused by a more elaborate mastication. Rhabdodon appears to have had a more primitive type of mastication. The strip formed by the reunion of the exoccipitals is less expanded dorsoventrally in Tenontosaurus tilletti than in the ‘iguanodontoid’ and ‘hadrosauroid’ clades. Tenontosaurus may therefore represent an intermediate group between the ‘hypsilophodontoid’ and ‘iguanodontoid’ clades.


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