Analysis of Measurement Accuracy for Craniovertebral Junction Pathology : Most Reliable Method for Cephalometric Analysis

Park

et al. 2021

Neurosurgical Focus

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OBJECTIVEThe authors sought to evaluate the usefulness of indocyanine green (ICG) angiography and Doppler sonography for monitoring the vertebral artery (VA) during craniovertebral junction (CVJ) surgery and compare the incidence of VA injury (VAI) between the groups with and without the monitoring of VA using ICG angiography and Doppler sonography.METHODSIn total, 344 consecutive patients enrolled who underwent CVJ surgery. Surgery was performed without intraoperative VA monitoring tools in 262 cases (control group) and with VA monitoring tools in 82 cases (monitoring group). The authors compared the incidence of VAI between groups. The procedure times of ICG angiography, change of VA flow velocity measured by Doppler sonography, and complication were investigated.RESULTSThere were 4 VAI cases in the control group, and the incidence of VAI was 1.5%. Meanwhile, there were no VAI cases in the monitoring group. The procedure time of ICG angiography was less than 5 minutes (mean [± SD] 4.6 ± 2.1 minutes) and VA flow velocity was 11.2 ± 4.5 cm/sec. There were several cases in which the surgical method had to be changed depending on the VA monitoring. The combined use of ICG angiography and Doppler sonography was useful not only to monitor VA patency but also to assess the quality of blood flow during CVJ surgery, especially in the high-risk group of patients.CONCLUSIONSThe combined use of ICG angiography and Doppler sonography enables real-time intraoperative monitoring of the VA by detecting blood flow and flow velocity. As the arteries get closer, they provide auditory and visual feedback to the surgeon. This real-time image guidance could be a useful tool, especially for high-risk patients and inexperienced surgeons, to avoid iatrogenic VAI during any CVJ surgery.

Section: Discussionmentioning

confidence: 73%

Intraoperative surveillance of the vertebral artery using indocyanine green angiography and Doppler sonography in craniovertebral junction surgeries

Park

et al. 2021

Neurosurgical Focus

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“…Previous studies have shown important of age and sex matching to eliminate the negative effects of a wide range of variations in terms of age and gender among the parameters,[ 15 30 ] so the control and patient groups were also matched in this study.…”

Section: Discussionmentioning

confidence: 99%

Cephalometric comparison of cesarean and normal births

et al. 2016

Objective:The aim of this study was to compare cephalometric variables of subjects with normal and cesarean births.Materials and Methods:Ninety age- and gender-matched patients, who were treated in Gaziantep University, Faculty of Dentistry Orthodontics Department were equally divided into normal and cesarean groups according to the birth methods reported by their mothers. To eliminate the negative effects of being different in terms of age and gender among parameters, control, and patient groups were matched in the present study. Pretreatment cephalometrics radiographs were used. Six measurements representing sagittal and vertical relationships were evaluated from pretreatment cephalograms using Dolphin Imaging Orthodontics Software was used in this issue by an orthodontist. Kolmogorov–Smirnov test, Student's t-test, and Mann–Whitney U-test were used for statistical comparisons.Results:A point-nasion-B point angle (ANB) and Wits values were higher in the normal group, while sella-nasion-A point angle, sella-nasion-B point angle, Frankfort horizontal-mandibular plane angle, and gonion-gnathion-SN plane angle values were higher in the cesarean group. However, the groups showed no significant differences (P > 0.05). ANB angle and Wits values showed high correlation.Conclusions:Within the study limitations, the results suggest that the birth method may not have a considerable effect on the development of the craniofacial skeletal system.

“…Ambiguous landmarks lead to low reliability or consistency for confirming basilar invagination (BI). [14][15][16] Accordingly, we must establish a more reliable and consistent method for diagnosing CVJ pathologies.Many methods for diagnosing BI and CVJ pathology may imply that choosing just one method in clinical circumstances is complicated. These measurements can show variable results due to multiple reasons.…”

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confidence: 99%

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confidence: 99%

“…However, no one-single method has been recommended to properly diagnose CVJ pathology due to the overlying structures on lateral plain radiographs. Ambiguous landmarks lead to low reliability or consistency for confirming basilar invagination (BI) [ 14 - 16 ]. Accordingly, we must establish a more reliable and consistent method for diagnosing CVJ pathologies.…”

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confidence: 99%

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Evaluation of Cervicomedullary Compression Around the Craniovertebral Junction: Commentary on “Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy”

Hong

2022

Neurospine

Self Cite

The craniovertebral junction (CVJ) is the region around the skull base and the upper cervical spine (atlas and axis), along with its neurovascular components, including the brain stem, spinal cord, vertebral artery, and venous plexus. [1][2][3][4][5][6] The stability of CVJ is dependent on a robust ligamentous complex and the shape of the bony structures, which are also responsible for much of the axial rotation (C1-2 joint) and flexion-extension movements (C0-1 and C1-2 joint). 7,8 CVJ pathologies are usually rare and can result in progressive deformity, myelopathy, severe neck pain, and functional disability, such as difficulty swallowing. 3,[9][10][11][12] The most common causes are rheumatoid arthritis, trauma, neoplasm, infection, and congenital bony malformation. These CVJ pathologies may alter the quality of life because of the neck pain, disabling headache, dysphagia, and myelopathy. 12,13 In most cases, standard radiographs, computed tomography, and magnetic resonance imaging typically conduct the proper diagnosis of CVJ pathology. However, no one-single method has been recom mended to properly diagnose CVJ pathology due to the overlying structures on lateral plain radiographs. Ambiguous landmarks lead to low reliability or consistency for confirming basilar invagination (BI). [14][15][16] Accordingly, we must establish a more reliable and consistent method for diagnosing CVJ pathologies.Many methods for diagnosing BI and CVJ pathology may imply that choosing just one method in clinical circumstances is complicated. These measurements can show variable results due to multiple reasons. First, anatomical landmarks may be ambiguous, thus leading the interpreter to measure different results. Second, measurement errors can be made by the interpreter himself or on the radiographs. The lack of confidence in anatomic landmarks can cause unreliable results, and it is hard to obtain absolute true-lateral radiographs in every patient.Variations in measurement may lead to a different type of treatment. Therefore, we need to determine how reliable and reproducible these measurements are. 16