The apical ligament: anatomy and functional significance

2000 ◽  
Vol 92 (2) ◽  
pp. 197-200 ◽  
Author(s):  
R. Shane Tubbs ◽  
Paul Grabb ◽  
Alan Spooner ◽  
Wally Wilson ◽  
W. Jerry Oakes
Keyword(s):  
Functional Significance ◽  
Craniocervical Junction ◽  
Content Type ◽  
Adult Human ◽  
Significant Contributor ◽  
Human Cadavers ◽  
Study Support ◽  
Clinical Problems ◽  
Fine Print

Object. The authors conducted a study to describe the detailed anatomy of the apical ligament and to acknowledge or refute its historical description as a functionally significant contributor to craniocervical stability. Methods. In 20 adult human cadavers measurements of the apical ligament were obtained, and its detailed anatomy was observed. Ranges of motion were also assessed to discern the function of the apical ligament. Conclusions. Results of the study support the concept that the apical ligament is best described as a vestigial structure that offers no significant added stability to the craniocervical junction. In fact, this ligament was absent in 20% of the specimens examined. These data will aid physicians who frequently view images or manage clinical problems of the craniocervical junction because they may focus on other ligaments of this area and not the apical ligament.

Circumferential fracture of the skull base causing craniocervical dislocation

2002 ◽  
Vol 97 (1) ◽  
pp. 118-122 ◽  
Author(s):  
Ganesh Rao ◽  
Adam S. Arthur ◽  
Ronald I. Apfelbaum
Keyword(s):  
High Speed ◽  
Unusual Case ◽  
Motor Vehicle ◽  
Neurological Impairment ◽  
Craniocervical Junction ◽  
Motor Vehicle Accidents ◽  
Review Of The Literature ◽  
Content Type ◽  
Vehicle Accidents ◽  
Fine Print

✓ Fractures of the craniocervical junction are common in victims of high-speed motor vehicle accidents; indeed, injury to this area is often fatal. The authors present the unusual case of a young woman who sustained a circumferential fracture of the craniocervical junction. Despite significant trauma to this area, she suffered remarkably minor neurological impairment and made an excellent recovery. Her injuries, treatment, and outcome, as well as a review of the literature with regard to injuries at the craniocervical junction, are discussed.

Anatomical data on the craniocervical junction and their correlation with degenerative changes in 30 cadaveric specimens

2005 ◽  
Vol 3 (5) ◽  
pp. 379-385 ◽  
Author(s):  
Stefan A. König ◽  
Axel Goldammer ◽  
Hans-Ekkehart Vitzthum
Keyword(s):  
Articular Cartilage ◽  
Articular Surface ◽  
Craniocervical Junction ◽  
Degenerative Changes ◽  
Content Type ◽  
Articular Surfaces ◽  
Anatomical Data ◽  
Grade Ii ◽  
Grade Iii ◽  
Fine Print

>Object. The goal of this project was to measure vertebral dimensions at the craniocervical junction and to investigate degenerative changes in this region and their correlations with the anatomical data. These studies will assist in an understanding of biomechanical conditions in this region, which are clinically relevant in cases of cervicogenic headaches and vertigo. Methods. The authors examined 30 cadaveric specimens obtained from patients ranging in age from 24 to 88 years at death. Measurements of angles of the vertebrae were conducted using an imprint method. Microsections of osseous endplates and articular cartilage were graded according to their degrees of degeneration by using the Petersson classification (0, no sign of degeneration; I, superficial degeneration with several fragmentations; II, deeper degeneration with cartilaginous disintegration and penetrating ulceration; or III, complete cartilaginous degeneration with the appearance of subchondral bone in > 50% of the articular surface). The authors found Grade I changes in 100% of the occiput specimens. In the superior articular cartilage of C-1 no changes (Grade 0) were found in two specimens, whereas 6% of the specimens exhibited Grade II changes and 89% exhibited Grade I changes. In the inferior articular cartilage of C-1, 57% of the specimens displayed Grade I changes, 14% Grade II, and 20% Grade III changes. In the superior articular cartilage of C-2, 62.5% of the specimens displayed Grade I changes and 25% Grade II changes. At the occiput—C1 level the authors found a higher frequency of degeneration at the upper left articular surface of the atlas (Quadrants 1 and 3), and at the C1–2 level they found a higher frequency of degeneration at the upper left and upper right articular surfaces of the axis (Quadrants 2 and 3, respectively). Using the McNemar test, the authors investigated the frequency of affection of single quadrants in a left—right side comparison (lateral reversal). Significant differences were identified for Quadrant 2 of the upper left articular surface of C-2 and Quadrant 3 of the upper right articular surface of C-2. These results correlate with the analysis of single articular surfaces of the axis, but contradict the results for the atlas, in which no significant difference in the left—right side comparison was found. Conclusions. Severe degeneration in the atlantooccipital joints appears to be a rare condition, with no Grade II or III degeneration found in the occipital condyles and 6% Grade I, 89% Grade II, but no Grade III changes in the superior articular cartilage of the atlas. Degeneration of the inferior articular cartilage of C-1 and the superior articular cartilage of C-2 indicates that the atlantoaxial joint faces more intense mechanical exposure, which is increased at the upper joint surfaces.

Congenital arthrogryposis associated with atlantoaxial subluxation and dysraphic abnormalities

2000 ◽  
Vol 93 (1) ◽  
pp. 130-132
Author(s):  
Wolf O. Luedemann ◽  
Marcos S. Tatagiba ◽  
Sami Hussein ◽  
Madjid Samii
Keyword(s):  
Traffic Accident ◽  
Craniocervical Junction ◽  
Atlantoaxial Subluxation ◽  
Arthrogryposis Multiplex Congenita ◽  
Good Clinical Outcome ◽  
Content Type ◽  
Dorsal Stabilization ◽  
A Minor ◽  
Transoral Decompression ◽  
Fine Print

✓ The authors report the case of a 27-year-old woman with an arthrogryposis multiplex congenita (AMC) associated with atlantoaxial subluxation. To the authors' knowledge, this is the first report of its kind. The authors review the literature with reference to dysraphic abnormalities associated with atlantoaxial subluxation and with AMC. The patient presented with severe tetraparesis following a minor traffic accident. She underwent a procedure in which transoral decompression and dorsal stabilization were performed and, postoperatively, made a good clinical outcome. The authors stress the need for diagnostic neuroimaging of the craniocervical junction in patients with AMC.

Dural arteriovenous shunts at the craniocervical junction

1998 ◽  
Vol 89 (5) ◽  
pp. 755-761 ◽  
Author(s):  
Hiroyuki Kinouchi ◽  
Kazuo Mizoi ◽  
Akira Takahashi ◽  
Yoshihide Nagamine ◽  
Keiji Koshu ◽  
...  
Keyword(s):  
Venous Drainage ◽  
Craniocervical Junction ◽  
Vertebral Angiography ◽  
Content Type ◽  
Arteriovenous Shunts ◽  
Dural Arteriovenous Shunts ◽  
Intradural Space ◽  
Tomography Scanning ◽  
Fine Print

Object. A retrospective analysis was conducted of 10 patients (three women and seven men) who were treated for spinal dural arteriovenous shunts (AVSs) located at the craniocervical junction. This analysis was performed to evaluate the characteristics of this unusual location in contrast with those of the more common thoracic and lumbar AVSs. Methods. Seven patients presented with subarachnoid hemorrhage (SAH) and one with slowly progressive quadriparesis and dyspnea due to myelopathy. The other two cases were detected incidentally and included a transverse—sigmoid dural AVS and a cerebellar arteriovenous malformation. Angiographic studies revealed that the spinal dural AVSs at the C-1 and/or C-2 levels were fed by the dural branches of the radicular arteries that coursed from the vertebral artery and drained into the medullary veins. Venous drainage was caudally directed in the patient with myelopathy. In contrast, the shunt flow drained mainly into the intracranial venous system in patients with SAH. Furthermore, in four of these patients a varix was found on the draining vein. In all patients, the draining vein was interrupted surgically at the point at which this vessel entered the intradural space, using intraoperative digital subtraction angiography to monitor flow. The postoperative course was uneventful in all patients and no recurrence was confirmed on follow-up angiographic studies obtained in seven patients at 6 months after discharge. Conclusions. If computerized tomography scanning shows SAH predominantly in the posterior fossa and no abnormalities are found on intracranial four-vessel angiographic study, proximal vertebral angiography should be performed to detect dural AVS at the craniocervical junction. The results of surgical intervention for this disease are quite satisfactory.

The straight sinus

1974 ◽  
Vol 41 (6) ◽  
pp. 724-727 ◽  
Author(s):  
R. C. Saxena ◽  
M. A. Q. Beg ◽  
A. C. Das
Keyword(s):  
Dura Mater ◽  
Posterior Cranial Fossa ◽  
Cerebral Vein ◽  
Content Type ◽  
Straight Sinus ◽  
Sagittal Sinus ◽  
India Ink ◽  
Human Cadavers ◽  
Cranial Fossa ◽  
Fine Print

✓ The dura mater of the posterior cranial fossa of 86 adult human cadavers has been examined grossly after the injection of India ink through the confluence of sinuses in order to visualize the extent, communications, and tributaries of the straight sinus. Variations from the textbook description of formation by the union of the inferior sagittal sinus and the great cerebral vein are described and discussed.

Quadrant anatomy of the articular pillars (lateral cervical mass) of the cervical spine

1995 ◽  
Vol 82 (6) ◽  
pp. 1011-1014 ◽  
Author(s):  
T. Glenn Pait ◽  
Phillip V. McAllister ◽  
Howard H. Kaufman
Keyword(s):  
Anatomical Landmarks ◽  
Cervical Mass ◽  
Content Type ◽  
Bony Landmarks ◽  
Fixation Devices ◽  
Human Cadavers ◽  
Lateral Mass Screws ◽  
Neurovascular Structures ◽  
Lateral Facet ◽  
Fine Print

✓ Knowledge of the relevant anatomy is important when developing a strategy for introducing screws into the lateral masses to secure internal fixation devices. This paper defines key bony landmarks and their relationship to critical neurovascular structures and identifies a location for safe placement of cervical articular pillar (lateral mass) screws. Measurements of anatomical landmarks in 10 spines from human cadavers aged 61 to 85 years were made by caliper and a metric ruler. Landmarks were the lateral facet line, rostrocaudal line, medial facet line, intrafacet line, and medial facet line—vertebral artery line. The average distances and ranges were recorded. Such great variance existed in measurements from spine to spine and within the same spine as to render averages clinically unreliable. Dissection revealed that division of the articular pillar into four quadrants leaves one, the superior lateral quadrant, under which there are no neurovascular structures; this may be considered the “safe quadrant” for placement of posterior screws and plates.

Inclination of the odontoid process in the pediatric Chiari I malformation

2003 ◽  
Vol 98 (1) ◽  
pp. 43-49 ◽  
Author(s):  
R. Shane Tubbs ◽  
John C. Wellons ◽  
Jeffrey P. Blount ◽  
Paul A. Grabb ◽  
W. Jerry Oakes
Keyword(s):  
Odontoid Process ◽  
Postoperative Outcome ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Magnetic Resonance Images ◽  
Posterior Aspect ◽  
Content Type ◽  
Chiari I ◽  
Fine Print

Object. The quantitative analysis of odontoid process angulation has had scant attention in the Chiari I malformation population. In this study the authors sought to elucidate the correlation between posterior angulation of the odontoid process and patients with Chiari I malformation. Methods. Magnetic resonance images of the craniocervical junction obtained in 100 children with Chiari I malformation and in 50 children with normal intracranial anatomy (controls) were analyzed. Specific attention was focused on measuring the degree of angulation of the odontoid process and assigning a score to the various degrees. Postoperative outcome following posterior cranial fossa decompression was then correlated to grades of angulation. Other measurements included midsagittal lengths of the foramen magnum and basiocciput, the authors' institutions' previously documented pB—C2 line (a line drawn perpendicular to one drawn between the basion and the posterior aspect of the C-2 body), level of the obex from a midpoint of the McRae line, and the extent of tonsillar herniation. Higher grades of odontoid angulation (retroflexion) were found to be more frequently associated with syringomyelia and particularly holocord syringes. Higher grades of angulation were more common in female patients and were often found to have obices that were caudally displaced greater than three standard deviations below normal. Conclusions. These results not only confirm prior reports of an increased incidence of a retroflexed odontoid process in Chiari I malformation but quantitatively define grades of inclination. Grades of angulation were not found to correlate with postoperative outcome. It is the authors' hopes that these data add to our current limited understanding of the mechanisms involved in hindbrain herniation.

The denticulate ligament: anatomy and functional significance

2001 ◽  
Vol 94 (2) ◽  
pp. 271-275 ◽  
Author(s):  
R. Shane Tubbs ◽  
George Salter ◽  
Paul A. Grabb ◽  
W. Jerry Oakes
Keyword(s):  
Spinal Cord ◽  
Functional Significance ◽  
Spinal Canal ◽  
Cervical Region ◽  
Content Type ◽  
Functional Studies ◽  
Applied Tension ◽  
Limited Degree ◽  
Formalin Fixed ◽  
Fine Print

Object. The authors conducted a study to examine the detailed anatomy of the denticulate ligaments and to assess their classic role in spinal cord stability within the spinal canal. Methods. Detailed observation of the denticulate ligaments in 12 adult cadavers was performed. Stress was applied in all major planes to discern when the ligaments would become taut, and at the same time, gross motion of the cord was observed at sites distal to the stresses applied. Tension necessary for avulsion of the ligaments in various areas of the spinal cord was also measured. Conclusions. These results show that the denticulate ligaments do not inhibit cord motion to such discrete areas of the cord as was once thought. The authors have determined that the ligaments are stronger in the cervical region and that they decrease in strength as the spinal cord descends. These findings are demonstrative of the denticulate ligaments being more resistant to caudal compared with cephalad stresses in the cord. Anterior and posterior motion is constrained by these ligaments but to a limited degree, especially as one descends inferiorly along the cord. Further embryological and functional studies of these ligaments is needed in non—formalin fixed tissues.

Surgical anatomy of the dorsal scapular nerve

2005 ◽  
Vol 102 (5) ◽  
pp. 910-911 ◽  
Author(s):  
R. Shane Tubbs ◽  
Elizabeth C. Tyler-Kabara ◽  
Alan C. Aikens ◽  
Justin P. Martin ◽  
Leslie L. Weed ◽  
...  
Keyword(s):  
Trapezius Muscle ◽  
Spinal Nerve ◽  
Surgical Anatomy ◽  
Anterior Border ◽  
Content Type ◽  
Levator Scapulae ◽  
Human Cadavers ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

Object. There is a paucity of literature regarding the surgical anatomy of the dorsal scapular nerve (DSN). The aim of this study was to elucidate the relationship of this nerve to surrounding anatomical structures. Methods. Ten formalin-fixed human cadavers (20 sides) were dissected, and measurements made between the DSN and related structures. The nerve pierced the middle scalene muscle at a mean distance of 3 cm from its origin from the cervical spine and was more or less centrally located at this exit site. It lay a mean distance of 1.5 cm medial to the vertebral border of the scapula between the serratus posterior superior, posterior scalene, and levator scapulae muscles. It was found to have a mean distance of 2.5 cm medial to the spinal accessory nerve as it traveled on the anterior border of the trapezius muscle. The nerve intertwined the dorsal scapular artery in all specimens and was found along the anterior border of the rhomboid muscles. On 19 sides the DSN originated solely from the C-5 spinal nerve, and on one side it arose from the C-5 and C-6 spinal nerves. Conclusions. Knowledge of the anatomy of the DSN will aid the surgeon who wishes to explore and decompress this structure.

Traumatic intracerebellar hematomas

1982 ◽  
Vol 56 (5) ◽  
pp. 691-694 ◽  
Author(s):  
Eugenio Pozzati ◽  
Claudio Grossi ◽  
Roberto Padovani
Keyword(s):  
Clinical Course ◽  
Head Injuries ◽  
Medical Complications ◽  
Content Type ◽  
Limited Size ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Study Support ◽  
Results Of Surgery ◽  
Fine Print

✓ Seven patients with “isolated” traumatic intracerebellar hematomas due to closed head injuries are presented. Computerized tomography parameters useful in the correct management of these hematomas include: location (hemisphere or midline), size, and appearance of the posterior fossa cisterns (intact or obliterated). Three patients with hemispheric hematomas were treated conservatively and recovered. One patient with a midline hematoma was managed conservatively and died. Three hematomas (one hemispheric and two midline) were operated on. The immediate results of surgery were good, but two patients died later due to medical complications. The results of this study support the concept that large hematomas (3 cm or greater) generally need surgery and that hemispheric hematomas of limited size (less than 3 cm) may be treated conservatively. The clinical course and prognosis of midline hematomas is grave, and evacuation of accessible hematomas should be considered early in the course of the disease.

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