Tectorial membrane injury in adult and pediatric trauma patients: a retrospective review and proposed classification scheme

Fiester, Peter; Soule, Erik; Natter, Patrick; Rao, Dinesh

doi:10.1007/s10140-019-01710-2

Cited by 13 publications

(4 citation statements)

References 26 publications

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“…In recent literature, intact TM appears to be an important favorable prognostic factor in atlantooccipital dislocation which is considered to be a frequently fatal injury 12 . Fiester et al have proposed that the alteration of the supradental space (fat-filled space superior to the atlantoaxial joint, inferior to the basion of the clivus, and anterior to the TM) followed by injury of the TM may indicate a patient with significant CVJ instability [13][14][15][16] .…”

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confidence: 99%

An anatomical and radiological study of the tectorial membrane and its clinical implications

Lee

Cho

Kwon

et al. 2022

Sci Rep

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The radiological image of an intact tectorial membrane (TM) became an important favorable prognostic factor for craniovertebral instability. This study visualized the fascial layers of the TM and adjacent connective tissues with clinical significance by micro-CT and histological analysis. The TM firmly attached to the bony surface of the clivus, traversed the atlantoaxial joint posteriorly, and was inserted to the body of the axis showing wide distribution on the craniovertebral junction. The supradental space between the clivus, dens of the axis, anterior atlantooccipital membrane, and the TM contained profound venous networks within the adipose tissues. At the body of the axis, the compact TM layer is gradually divided into multiple layers and the deeper TM layers reached the axis while the superficial layer continued to the posterior longitudinal ligament of the lower vertebrae. The consistent presence of the fat pad and venous plexus in the supradental space and firm stabilization of the TM on the craniovertebral junction was demonstrated by high-resolution radiologic images and histological analysis. The evaluation of the TM integrity is a promising diagnostic factor for traumatic craniovertebral dislocation.

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confidence: 99%

An anatomical and radiological study of the tectorial membrane and its clinical implications

Lee

Cho

Kwon

et al. 2022

Sci Rep

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“…[1,4,7,8,18,23,24] In their small case series, Kimchi et al [16] found that patients with intact tectorial membranes have an improved prognosis. Recently, Fiester et al [9] proposed an MRI classification scheme for tectorial membrane injuries, which may empower MRI as a prognostic tool in carefully selected patients.…”

Section: Treatment Hospital Course and Post Hospital Follow-upmentioning

confidence: 99%

Successful non-operative management for atlanto-occipital dislocation resulting in spinal cord contusion in a patient with atlanto-occipital assimilation and severe Chiari I malformation

Davis

Kluckman

Mallory

et al. 2020

Surgical Neurology International

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Background: Atlanto-occipital dislocation (AOD) is a rare, highly morbid, and highly lethal injury that results from high-energy trauma and almost universally requires operative management for satisfactory outcomes. It can be difficult to identify the severity of injury at the time of presentation, and when diagnosis is delayed outcomes worsen significantly. Anatomic anomalies of the craniovertebral junction may further complicate its detection. When such anomalies are present either singly or in combination, they are known to cause space constraints which may increase the likelihood of spinal cord injury. Given that such anomalies and AOD are rare, few examples of patients with both are reported in the literature. Furthermore, it is not clear in what way patient management may be impacted in this context. Case Description: We will present a unique case of an 18-year-old patient with traumatic AOD and an intact neurologic examination who was found to have atlanto-occipital assimilation (AOA), platybasia, basilar invagination, and severe Chiari I malformation, who was treated effectively with non-operative management. Conclusion: Our case demonstrates the successful application of a non-operative treatment strategy in a carefully selected patient with AOD in the context of AOA.

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“…This latter group of authors noted that the PAOM extended along the posterior surface of the dura mater, ending at the level of C3 [ 9 ]. Despite the evidence demonstrated by these two teams of researchers, the PAOM continues to be erroneously defined as a dense band extending directly from the posterior arch of the atlas to the foramen magnum [ 8 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

The Posterior Atlantooccipital Membrane: The Anchor for the Myodural Bridge and Meningovertebral Structures

Scali¹,

Ohno²,

Enix³

et al. 2022

Cureus

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Introduction: Sheet plastination has provided evidence that the posterior atlantooccipital membrane attaches to the dura’s posterior sleeve at the cerebrospinal junction. These findings contradict the traditional anatomical description of this membrane extending from the atlas’ posterior arch to the foramen magnum. Methods: A total of 16 plastinated cadavers were studied to evaluate the in situ and gross configuration of the posterior atlantooccipital membrane. Fifteen cadavers underwent sheet plastination, and one head was hemisected and plastinated. In all specimens, stereomicroscopy was used to evaluate the posterior atlantooccipital membrane and related structures within the intervertebral and epidural spaces. Results: In all 16 specimens, the posterior atlantooccipital membrane extending from the occiput, merged with the craniocervical dura mater, and formed a membrane-dura complex that ended at the level of the third cervical vertebra. The superior and inferior myodural bridge coalesced with their respective vertebrodural ligaments and fused with the posterior atlantooccipital membrane at their respective interspaces. Conclusion: The median aspect of the posterior atlantooccipital membrane does not directly communicate with the posterior arch of the atlas. Instead, the posterior atlantooccipital membrane converges with the craniocervical dura mater and terminates at the level of the third cervical vertebra. This membrane-dura complex serves as a common attachment site for the myodural and vertebrodural structures.

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Tectorial membrane injury in adult and pediatric trauma patients: a retrospective review and proposed classification scheme

Cited by 13 publications

References 26 publications

An anatomical and radiological study of the tectorial membrane and its clinical implications

An anatomical and radiological study of the tectorial membrane and its clinical implications

Successful non-operative management for atlanto-occipital dislocation resulting in spinal cord contusion in a patient with atlanto-occipital assimilation and severe Chiari I malformation

The Posterior Atlantooccipital Membrane: The Anchor for the Myodural Bridge and Meningovertebral Structures

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