Role of dynamic computed tomography scans in patients with congenital craniovertebral junction malformations

作     者：Otávio Turolo da Silva Enrico Ghizoni Helder Tedeschi Andrei Fernandes Joaquim 

作者机构：Department of Neurology Division of Neurosurgical State University of Campinas 

出 版 物：《World Journal of Orthopedics》 (世界骨科杂志（英文版）)

年 卷 期：2017年第8卷第3期

页      面：271-277页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Craniovertebral junction Dynamic imaging Basilar invagination Chiari malformation Treatment 

摘      要：AIM To evaluate the role of dynamic computed tomography(CT)scan imaging in diagnosing craniovertebral junction(CVJ)instability in patients with congenital CVJ *** Patients with symptomatic congenital CVJ malformations who underwent posterior fossa decompression and had a preoperative dynamic CT scan in flexion and extended position were included in this *** of the following craniometrical parameters were taken in flexed and extended neck position:Atlanto-dental interval(ADI),distance of the odontoid tip to the Chamberlain’s line,and the clivus-canal angle(CCA).Assessment of the facet joints congruence was also performed in both *** of the values obtained in flexion and extension were compared using a paired Student’s *** A total of ten patients with a mean age of 37.9 years were *** flexion imaging,the mean ADI was1.76 mm,the mean CCA was 125.4°and the mean distance of the odontoid tip to the Chamberlain’s line was+9.62 *** extension,the mean ADI was1.46 mm(P=0.29),the mean CCA was 142.2°(P0.01)and the mean distance of the odontoid tip to the Chamberlain’s line was+7.11 mm(P0.05).Four patients(40%)had facetary subluxation demonstrated in dynamic imaging,two of them with mobile subluxation(both underwent CVJ fixation).The other two patients with a fixed subluxation were not initially *** patient with atlantoaxial assimilation and C23 fusion without initial facet subluxation developed a latter CVJ instability diagnosed with a dynamic CT *** with basilar invagination had a lower CCA variation compared to the whole *** Craniometrical parameters,as well as the visualization of the facets location,may change significantly according to the neck *** imaging can provide additional useful information to the diagnosis of CVJ *** studies addressing the relationship between craniometrical changes and neck position are necessary.