Prevalence of foramen arcuale and its clinical significance: a meta-analysis of 55,985 subjects

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The foramen arcuale (FA) is a bony bridge located over the vertebral artery on the posterior arch of the atlas. The presence of an FA can pose a risk during neurosurgery by providing a false impression of a broader posterior arch. The aim of this study was to provide the most comprehensive investigation on the prevalence of the FA and its clinically important anatomical features.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Major electronic databases were searched to identify all studies that reported relevant data on the FA and the data were pooled into a meta-analysis.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 127 studies (involving 55,985 subjects) were included. The overall pooled prevalence of a complete FA was 9.1% (95% CI 8.2%–10.1%) versus an incomplete FA, which was 13.6% (95% CI 11.2%–16.2%). The complete FA was found to be most prevalent in North Americans (11.3%) and Europeans (11.2%), and least prevalent among Asians (7.5%). In males (10.4%) the complete FA was more common than in females (7.3%) but an incomplete FA was more commonly seen in females (18.5%) than in males (16.7%). In the presence of a complete FA, a contralateral FA (complete or incomplete) was found in 53.1% of cases.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Surgeons should consider the risk for the presence of an FA prior to procedures on the atlas in each patient according to sex and ethnic group. We suggest preoperative screening with computerized tomography as the gold standard for detecting the presence of an FA.</jats:p></jats:sec>

Ponticulus posticus in a cohort of orthodontic children and adolescent patients with different sagittal skeletal anomalies: a comparative cone beam computed tomography investigation

“…It is bilateral in 5% and unilateral in 8% of cases. A meta-analysis study conducted by Pękala et al [30] reported that the overall prevalence of a complete foramen arcuale was 9.1% versus an incomplete foramen arcuale, which was 13.6%. The complete foramen arcuale was found to be most common in North Americans (11.3%) and Europeans (11.2%), and least prevalent among Asians (7.5%).…”

Cone beam computed tomography evaluation of ponticulus posticus in patients with cleft lip and palate: a retrospective radio-anatomic study

“…The prevalence of PP has been found to be 1-46%, using lateral cephalometric radiographs, CT, CBCT, cadaver or dried atlas specimens in different populations [3,4,15,29]. Meta-analysis studies conducted by Elliott and Tanweer [8] in 2014 and Pękala et al [23] in 2017 reported the mean prevalence of PP. In the study of Elliott and Tanweer [8] it was 19% for cadavers, 17% on CT images, 17% on lateral radiographs and 17% overall.…”

“…In the study of Elliott and Tanweer [8] it was 19% for cadavers, 17% on CT images, 17% on lateral radiographs and 17% overall. Pękala et al [23] reported that the overall prevalence of complete PP was 9.1% and partial PP was 13.6%. Generally, a statistically significant difference has not been found between males and females with regard to the prevalence of PP.…”

Clinical Anatomy and Medical Malpractice—A Narrative Review with Methodological Implications

“…It is a bony bridge located on the posterior arch of the atlas which encircles the vertebral artery. In a recent meta-analysis, the overall pooled prevalences of complete and incomplete foramen arcuale were 9.1% and 13.6%, respectively [ 12 ]. This variation increases the risk of (potentially fatal) injuries to the vertebral artery during the C1 lateral mass screw insertion for the treatment of atlantoaxial instability, as it can be overlooked and it can give a false impression of a broader posterior arch (e.g., [ 12 , 13 ]).…”

“…In a recent meta-analysis, the overall pooled prevalences of complete and incomplete foramen arcuale were 9.1% and 13.6%, respectively [ 12 ]. This variation increases the risk of (potentially fatal) injuries to the vertebral artery during the C1 lateral mass screw insertion for the treatment of atlantoaxial instability, as it can be overlooked and it can give a false impression of a broader posterior arch (e.g., [ 12 , 13 ]). It may be difficult to identify a foramen arcuale intraoperatively so that preoperative screening with CT has been “strongly” suggested as the gold standard for foramen arcuale identification; lateral radiographs show lower sensitivity with respect to CT and cadaveric dissections [ 12 ].…”