Arcuate Foramen: Anatomy, Embryology, Nomenclature, Pathology, and Surgical Considerations

Ahn, Jay Hong; Duran, Melissa; Syldort, Samantha; Rizvi, Asad; D’Antoni, Anthony V.; Johal, Jaspreet; Iwanaga, Joe; Oskouian, Rod J.; Tubbs, R. Shane

doi:10.1016/j.wneu.2018.07.038

Cited by 23 publications

(14 citation statements)

References 42 publications

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“…Hoenig and Schoener (1992) reported that posterior ponticle represented 37% of the CVA of the group with cleft and was the most common CVA of their study. Differently, in the present study, any variant of posterior ponticle (partial or total) could be observed in 7.28% of the sample (5.82% UCLP to 10.41% BCLP), a lower value even compared to incidences reported in patients without cleft (Ahn et al, 2018). Since the posterior ponticle is originated through ossification of the posterior atlanto-occipital ligament, the lower incidence can be explained by the age range of the present sample and the possibility of mineralization later in life.…”

Section: Discussioncontrasting

confidence: 92%

Three-Dimensional Assessment of Cervical Vertebrae Anomalies in Patients With Cleft Lip and Palate

Barbosa

Pimenta

Tyndall

et al. 2020

The Cleft Palate Craniofacial Journal

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Objective: To evaluate the occurrence of cervical vertebrae anomalies (CVA) in patients with unilateral (UCLP) and bilateral cleft lip and palate (BCLP) using cone beam computed tomography (CBCT) examinations. Design: Retrospective assessment of CBCT images. Descriptive statistics were calculated. Fisher exact test or χ2 test was performed to evaluate the differences among each CVA between sex and type of cleft. Setting: School of Dentistry. Participants: One hundred fifty-one patients with cleft lip and palate (103 UCLP/48 BCLP). Interventions: No relevant intervention. Main Outcome Measures: Cone beam computed tomography images were assessed for the presence or absence of 12 most commonly observed CVA: spina bifida, dehiscence, cleft of the posterior arch, cleft of the anterior arch, fusion between cervical vertebrae, block fusion, occipitalization, narrowing of the intervertebral space, posterior ponticle, os odontoideum, ossiculum terminale, and subdental cartilaginous remnants. Results: The presence of subdental cartilaginous remnants was the most frequently observed alteration—found in 81.45% of the sample—and it was the only CVA with statistically significant frequencies in the individuals with BCLP. Considering only the other CVA, 22.51% presented 1 and 5.29% presented 2 or more CVA. Conclusions: Patients with cleft lip and palate may present an overall high incidence of CVAs. However, when comparing the distribution of the CVAs among sex and types of cleft, the only significant difference noted was a higher incidence of subdental cartilaginous remnants among patients with BCLP.

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Section: Discussioncontrasting

confidence: 92%

Three-Dimensional Assessment of Cervical Vertebrae Anomalies in Patients With Cleft Lip and Palate

Barbosa

Pimenta

Tyndall

et al. 2020

The Cleft Palate Craniofacial Journal

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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: 62%

“…It has been reported that the only advantage of this variation is the low risk of fracture, and it has also been reported that it usually leads to dissection by stretching the VA, vertebrobasilar ischemia during strong interventions in the cervical spine, complications in cases where C1-C2 stabilization is required, and Barre Lieou syndrome mostly by causing neurovascular compression (1,5,7,14,15,18,19,(22)(23)(24)(25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Atlanto-occipital ligament calcification: a novel imaging finding in pediatric rotational vertebral artery occlusion

Harrar

Diab

et al. 2019

Pediatr Radiol

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Arcuate Foramen: Anatomy, Embryology, Nomenclature, Pathology, and Surgical Considerations

Cited by 23 publications

References 42 publications

Three-Dimensional Assessment of Cervical Vertebrae Anomalies in Patients With Cleft Lip and Palate

Three-Dimensional Assessment of Cervical Vertebrae Anomalies in Patients With Cleft Lip and Palate

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

Atlanto-occipital ligament calcification: a novel imaging finding in pediatric rotational vertebral artery occlusion

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