Embryology of the craniocervical junction and posterior cranial fossa, part I: Development of the upper vertebrae and skull

Shoja, Mohammadali Mohajel; Ramdhan, Rebecca C.; Jensen, Chad J.; Chern, Joshua J.; Oakes, W. Jerry; Tubbs, R. Shane

doi:10.1002/ca.23049

Cited by 49 publications

(24 citation statements)

References 89 publications

(177 reference statements)

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“…Many different explanations of the pathogenesis of Chiari malformations have been proposed, but because a wide variety of anomalies can arise, no definitive account has yet been agreed [10]. Nevertheless, extensive evidence demonstrates that reduction of the posterior cranial fossa volume contributes to hindbrain herniation and the development of a Chiari 1 malformation in many cases [11,12]. Such decreases in volume have been associated with developmental abnormalities disrupting the rotation of the tentorium cerebelli and petrous bone during the embryonic, fetal, and postnatal periods, leading to an overcrowded posterior cranial fossa [11].…”

Section: Discussionmentioning

confidence: 99%

Chiari 1.5 malformation, accessory odontoid synchondrosis, and ventral compression: case report

et al. 2021

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The pathogenesis of Chiari 1 malformations has been explained in several different ways, but extensive evidence suggests a relationship between loss of volume within the posterior cranial fossa and Chiari 1 presentations. It is important to be able to differentiate Chiari 1.5 from Chiari 1 malformations as they have similar clinical presentations, but the latter have progressed further and are characterized by caudal herniations of the brain stem through the foramen magnum. Despite the similarities of presentation, Chiari 1.5 malformations have greater rates of complications following posterior decompression surgeries, which are typically performed to relieve ventral compression. An improved understanding of the odontoid synchondroses could lead to better understanding of Chiari malformations and lead to improved treatment of patients with these presentations. Here we present a rare case of an accessory odontoid synchondrosis in a patient with a Chiari 1.5 malformation and ventral compression.

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Section: Discussionmentioning

confidence: 99%

Chiari 1.5 malformation, accessory odontoid synchondrosis, and ventral compression: case report

et al. 2021

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“…Without compression from the dens, incomplete degeneration might occur. Currently there is no information on the association of the disk with anomalies of the craniocervical junction, such as Chiari malformations and neurocentral synchondrosis [8][9][10][11][12]. Therefore, further detailed examinations of the relationship between bone anomalies and the persistent disk-like structure would be warranted.…”

Section: Discussionmentioning

confidence: 99%

A temporary disc-like structure at the median atlanto-axial joint in human fetuses

et al. 2019

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During observations of mid-term and late-stage fetuses, we found a joint disk-like structure at the anterior component of the median atlanto-axial joint. At mid-term, the disk-like structure was thick (0.1-0.15 mm) relative to the sizes of bones surrounding the joint. However, it did not completely separate the joint cavity, and was absent in the inferior and/or central part of the cavity. This morphology was similar to the so-called fibroadipose meniscoid of the lumbar zygapophysial joint that is usually seen in adults. In mid-term fetuses, there was evidence suggesting that a mesenchymal tissue plate was separated from a roof of the joint cavity. In late-stage fetuses, the thickness (less than 0.15 mm) was usually the same as, or less than that at mid-term, and the disk-like structure was often flexed, folded and fragmented. Therefore, in contrast to the zygapophysial meniscoid as a result of aging, the present disk-like structure was most likely a temporary product during the cavitation process. It seemed to be degenerated in late-stage fetuses and possibly also in newborns. Anomalies at the craniocervical junction such as Chiari malformations might accompany this disk-like structure at the median atlanto-axial joint even in childhood.

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“…According to Roth, the development of early embryonic neural growth precedes the development of the vertebral column, which grows in a craniocaudal fashion. Reversal of this natural process would result in abnormal formations of the skull base and deformation of the margin of the foramen magnum, occiput, and cervical vertebrae [7]. Basilar invaginations can be categorized into two separate groups, with or without Chiari malformations.…”

Section: Figure 2: Klippel-feil Syndromementioning

confidence: 99%

Anatomical Variations That Can Lead to Spine Surgery at the Wrong Level: Part I, Cervical Spine

Shah¹,

Halalmeh²,

Sandio³

et al. 2020

Cureus

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Spine surgery at the wrong level is an adversity that many spine surgeons will encounter in their career, and it falls under the wrong-site surgery sentinel events reporting system. The cervical spine is the second most common location in the spine at which surgery is performed at the wrong level. Anatomical variations of the cervical spine are one of the most important incriminating risk factors. These anomalies include craniocervical junction abnormalities, cervical ribs, hemivertebrae, and block/fused vertebrae. In addition, patient characteristics, such as tumors, infection, previous cervical spine surgery, obesity, and osteoporosis, play an important role in the development of cervical surgery at the wrong level. These were described, and several effective techniques to prevent this error were provided. A thorough review of the English-language literature was performed in the database PubMed between 1981 and 2019 to review and summarize these risk factors. Compulsive attention to these factors is essential to ensure patient safety. Therefore, the surgeon must carefully review the patient's anatomy and characteristics through imaging and collaborate with radiologists to reduce the likelihood of performing cervical spine surgery at the wrong level.

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Embryology of the craniocervical junction and posterior cranial fossa, part I: Development of the upper vertebrae and skull

Cited by 49 publications

References 89 publications

Chiari 1.5 malformation, accessory odontoid synchondrosis, and ventral compression: case report

Chiari 1.5 malformation, accessory odontoid synchondrosis, and ventral compression: case report

A temporary disc-like structure at the median atlanto-axial joint in human fetuses

Anatomical Variations That Can Lead to Spine Surgery at the Wrong Level: Part I, Cervical Spine

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