Arcuate foramen: “Anatomical variation shape or adaptation legacy?”

Cossu, Giulia; Terrier, Louis-Marie; Destrieux, Christophe; Velut, Stéphane; François, P.; Zemmoura, Ilyess; Amelot, Aymeric

doi:10.1007/s00276-019-02186-y

Cited by 10 publications

(13 citation statements)

References 39 publications

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“…This may be due to ethnic differences of the cases or the fact that most of the other studies were performed on dry atlas or by radiological examination. As a matter of fact, it has been reported that there are various types of AF variation, that its prevalence varies according to regional and ethnic groups, and that it is seen most frequently in the Middle East and North America, at least in Indians, and can be overlooked in radiological examination (1,2,8,13,17,21). In our study, the high incidence of AF may be related to the fact that we conducted this study in North America.…”

Section: Discussionmentioning

confidence: 63%

“…Not only V3, but also vertebral venous plexus, perivascular sympathetic plexus and suboccipital nerve pass through the AF located on the sulcal part of the atlas (1,2). The fact that AF contains all these other neurovascular structures causes pressure on VA within the foramen.…”

Section: Discussionmentioning

confidence: 99%

“…The vertebral venous plexus, perivascular sympathetic plexus and suboccipital nerve pass along with the vertebral artery (VA) and it is defined by more than one name in the literature (1,2) (Appendix 1). This foramen, which is normally found in the first cervical vertebrae of primates and other lower vertebrates, has been reported in complete or incomplete types in humans, and its prevalence ranges from 5% to 68% (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Importance of Arcuate Foramen, A Variation of the Atlas: A Microsurgical Cadaveric Study and Review of the Literature

Keser¹,

Çıkla²,

Özaydın³

et al. 2019

Istanbul Med J

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Amaç: Arkuat foramen (AF) atlasın posterior arkındaki vertebral arter (VA) oluğunda (sulkus arteriae vertebralis) bulunan, prevalansı bölgesel ve etnik faktörler nedeni ile değişebilen osseöz bir varyasyondur. AF'nin içindeki yapılara bası oluşturarak vertebrobaziler yetmezlik bulgularına neden olduğu düşünülse de bu kliniği açıklayacak yeterli sayıda kadavra çalışması yoktur. Yöntemler: AF varyasyonun insidansını ve içinden geçen VA ile olan ilişkisini değerlendirmek için renkli silikon enjekte edilmiş ve rastgele olarak seçilmiş 10 kadavranın 20 tarafı Wisconsin Üniversitesi Nöroanatomi Laboratuvarı'nda mikroşirürjikal yöntem ile incelendi. Bulgular: Örneklerin %30'unda atlasta komplet tipte AF varyasyonu saptandı. Bu varyasyon iki olguda sağda tek taraflı iken bir olguda bilateraldi. AF'nin ortalama boyutları sağda D1=6 mm, D2=5,5 mm, solda D1=7,5 mm, D2=6,5 mm, VA'nın ortalama çapı ise foramen öncesi, foramen içi ve foramen sonrası sırası ile sağda 4 mm, 2,5 mm ve 3 mm, solda 6 mm, 4 mm ve 5 mm idi. Olguların hepsinde suboksipital sinir AF içerisinde VA'ya eşlik ediyordu. Sonuç: Bu varyasyonun yüksek insidansının olabileceğinin bilinmesi kraniyoservikal bileşke ameliyatlarından önce ameliyat stratejisinin belirlenmesini ve hayati tehlike yaratabilecek arter yaralanmalarının engellenmesini sağlayabilir. Ayrıca, AF boyutlarının VA'nın rahatlıkla geçişine uygun olmasına karşın foramen içinden geçen diğer yapılar nedeni ile arteryel bası oluşturduğunun görülmesi foramen dekompresyonu ile olguların çoğunun rahatlama nedenini de açıklayabilir. Anahtar Kelimeler: Arkuat foramen, atlas, kadavra çalışması, osseöz anomali, vertebral arter, vertebrobaziler yetmezlik Introduction: Arcuate foramen (AF) is an osseous variation located on the vertebral artery (VA) groove (sulcus arteriae vertebralis) at the posterior arch of the atlas. Its prevalence may vary due to regional and ethnic factors. Although it is thought that it causes compression of the structures inside AF and causes vertebrobasilar insufficiency, there are not enough cadaver studies to explain this clinical condition. Methods: To evaluate the incidence of AF variation and its relationship with VA, 20 sides of 10 randomly selected and silicone injected cadaveric heads were examined by microsurgical method at the University of Wisconsin Neuroanatomy Laboratory. Results: Complete AF variation in atlas was detected in 30% of the samples. This variation was unilateral on the right side in two cases and bilateral in one case. The mean dimensions of AF were D1=6 mm and D2=5.5 mm on the right, and D1=7.5 mm and D2=6.5 mm on the left. The mean pre-foraminal, foraminal and post-foraminal diameters of VA were 4 mm, 2.5 mm and 3 mm, respectively, on the right, and 6 mm, 4 mm and 5 mm, respectively, on the left. In all cases, the suboccipital nerve was accompanying VA in the AF. Conclusion: Being aware that this variation may have a high incidence may help to determine surgical strategy before craniocervical junction surgery and prevent life-threatening arterial injuries...

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Importance of Arcuate Foramen, A Variation of the Atlas: A Microsurgical Cadaveric Study and Review of the Literature

Keser¹,

Çıkla²,

Özaydın³

et al. 2019

Istanbul Med J

View full text Add to dashboard Cite

show abstract

“…So, under this condition, the pedicle screw of C 1 might be an alternative. PP is the osseous variation of vertebral artery V3 segment and it is also a risk factor for inserting a screw into the atlas 7,21–24 , especially for the pedicle screws, since the existence of PP does not make it easy to observe the upper wall of posterior arch of C 1 . For these reasons, when the variation of PP was observed, the entry point of C 1 fixation screws should be selected more cautiously in order to avoid the injury to the VA 25 .…”

Section: Discussionmentioning

confidence: 99%

Anatomical Variations of the Vertebral Artery: Analysis by Three‐Dimensional Computed Tomography Angiography in Chinese Population

Wang

Ren

Liang

et al. 2021

Orthopaedic Surgery

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Objective: To analyze the anatomical variations of V3 and V2 segments of the vertebral artery in the Chinese population.Methods: The current retrospective study was an observational, anatomical, radiological research. Between 1 January 2018 to 31 December 2019, the data of 589 continuous head-and-neck three-dimensional computed tomography angiography were observed and analyzed using the open-source software of Horos. There were 415 males and 174 females with an average age of 44.63 AE 2.5(18-74) years. The variations of the V3 segment were defined as persistent first intersegmental artery (PFIA) and paracondylar processes (PP). The variations of V2 segments were unusual vertebral artery entrance transverse foreman (UE-V2S) and midline migration (MM). The incidences of all variations were summarized and the gender, side characters were compared.Results: Among the patients, 4.34% (18/415) males and 4.60% (8/174) females were with the variation of PFIA.Meanwhile, 12.29% (51/415) males and 10.92% (19/174) females were with the variation of PP. Then 18.80% (78/415) males and 16.67% (29/174) females were with UE-V2S. All the variations above were not different in genders. As for the variation of MM, 3.86% (16/415) males and 8.62% (15/174) females were identified, and the difference of genders was significant for this type of variation (P < 0.05). The differences between each side were also observed and analyzed for all variations and no differences were found. Conclusion:There are several variations of V3 and V2 segments of the vertebral artery are associated with the cervical surgeries, most were without differences in genders and sides, except the variation of MM.

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“…24 These bony ponticle are more prevalent in Quadrupedal mammals, and are present in the form of complete bony ring supporting and maintaining their posture by use of cervical extensors and ligaments but as bipedal evolved superior articular facet took the responsibility of bearing weight of skull, natural selection may be held responsible for decreased prevalence of these ponticle in humans. 28 Friedrich found out that half the cases of nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome) were having Posterior ponticle on their lateral cervical radiographs and presence of this radiological finding may point to the diagnosis. Many odonatologist and dentist also report these ponticles as incidental finding on cephalograms.…”

Section: Discussionmentioning

confidence: 99%

Posterior and lateral ponticles of atlas: An osteological study at Fatima Jinnah Medical University, Lahore

Munawar¹,

Jafri²,

Qureshi³

et al. 2020

J Fatima Jinnah Med Univ

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Background: Among the cervical vertebrae, atlas is known to have many variations, posterior ponticle being the commonest. It may completely or incompletely covers the groove of vertebral artery leading to ischemia of posterior circulation. Therefore, vertebral artery is at greater risk of injury during neurological and spinal surgeries. Prevalence of posterior ponticles varies widely among different populations, for instance in Turkish population it was 10.8%, in American 22.1%, Kenyan 14.7%, Brazilian and Indian 16.7%. The prevalence of lateral ponticle in Kenyan population was reported to be 3.9% and in Indians it was 2%. However, the data regarding the prevalence of these ponticles is largely lacking in Pakistan. Therefore, this research was designed to determine the prevalence of posterior and lateral ponticle in atlas vertebrae of Pakistani population. Materials and methods: A total of 47 human atlas vertebrae of unknown age and gender from bone bank of Department of Anatomy Fatima Jinnah Medical University, Lahore were studied for the presence of complete and incomplete posterior and lateral ponticles. The bones studied were completely intact and did not have any pathology. Results: Total incidence of ponticles was 38 % in this study, of which 36% were posterior ponticles and 2% were lateral ponticles. Bilateral incomplete posterior ponticles/were found in 8 (17%) atlas vertebrae whereas bilateral complete posterior ponticles/foramen arcuale were found in only 1 (2%) atlas vertebrae. Unilateral incomplete posterior ponticle was identified on right side in 5 (11%) and left side in 2 (4%) atlas vertebrae. Unilateral complete posterior ponticle was found in only 1 (2%) atlas on the left side whereas no such finding was identified on right side in any vertebra. Unilateral complete lateral ponticle was found in only 1 (2%) atlas on the right side but not on left side. No bilateral complete lateral ponticle and incomplete unilateral or bilateral lateral ponticles were identified in this study. Conclusion: Presence of posterior and lateral ponticles pose a risk of vertebrobasilar vascular insufficiency and may cause variety of symptoms. Vertebral artery may be at risk during neurosurgical procedures when having a foramen arculae and may give a false impression of much wider posterior arch of atlas. Knowing the prevalence of this can help neurosurgeons, general surgeons, radiologists, and chiropractors in management of the patients.

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Arcuate foramen: “Anatomical variation shape or adaptation legacy?”

Cited by 10 publications

References 39 publications

The Importance of Arcuate Foramen, A Variation of the Atlas: A Microsurgical Cadaveric Study and Review of the Literature

The Importance of Arcuate Foramen, A Variation of the Atlas: A Microsurgical Cadaveric Study and Review of the Literature

Anatomical Variations of the Vertebral Artery: Analysis by Three‐Dimensional Computed Tomography Angiography in Chinese Population

Posterior and lateral ponticles of atlas: An osteological study at Fatima Jinnah Medical University, Lahore

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