Morphometric changes at the craniocervical junction during childhood

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OBJECTIVE

Current understanding of how the pediatric craniocervical junction develops remains incomplete. Measurements of anatomical relationships at the craniocervical junction can influence clinical and surgical decision-making. The purpose of this analysis was to quantitatively define clinically relevant craniocervical junction measurements in a population of children with CT scans that show normal anatomy.

METHODS

A total of 1458 eligible patients were identified from children between 1 and 18 years of age who underwent cervical spine CT scanning at a single institution. Patients were separated by both sex and age in years into 34 groups. Following this, patients within each group were randomly selected for inclusion until a target of 15 patients in each group had been reached. Each patient underwent measurement of the occipital condyle–C1 interval (CCI), pB–C2, atlantodental interval (ADI), basion-dens interval (BDI), basion-opisthion diameter (BOD), basion-axial interval (BAI), dens angulation, and canal diameter at C1. Mean values were calculated in each group. Each measurement was performed by two teams and compared for intraclass correlation coefficient (ICC).

RESULTS

The data showed that CCI, ADI, BDI, and dens angulation decrease in magnitude throughout childhood, while pB–C2, PADI, BAI, and BOD increase throughout childhood, with an ICC of fair to good (range 0.413–0.912). Notably, CCI decreases continuously on coronal CT scans, whereas on parasagittal CT scans, CCI does not decrease until after age 9, when it shows a continuous decline similar to measurements on coronal CT scans.

CONCLUSIONS

These morphometric analyses establish parameters for normal pediatric craniocervical spine growth for each year of life up to 18 years. The data should be considered when evaluating children for potential surgical intervention.

ABBREVIATIONS ADI = atlantodental interval; AOD = atlantooccipital dislocation; BAI = basion-axial interval; BDI = basion-dens interval; BOD = basion-opisthion diameter; CCI = occipital condyle–C1 interval; CM1 = Chiari malformation type I; ICC = intraclass correlation coefficient; Oc = occiput; PADI = posterior ADI; SAC = space available for the cord.
Article Information

Contributor Notes

Correspondence Cormac O. Maher: University of Michigan, Ann Arbor, MI. cmaher@med.umich.edu.INCLUDE WHEN CITING Published online June 21, 2019; DOI: 10.3171/2019.4.PEDS1968.

J.R.B. and A.K.B share first authorship of this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Anderson RCRagel BTMocco JBohman LEBrockmeyer DL: Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients. J Neurosurg 107 (1 Suppl):36422007

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Bollo RJRiva-Cambrin JBrockmeyer MMBrockmeyer DL: Complex Chiari malformations in children: an analysis of preoperative risk factors for occipitocervical fusion. J Neurosurg Pediatr 10:1341412012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Bonney PAMaurer AJCheema AADuong QGlenn CASafavi-Abbasi S: Clinical significance of changes in pB-C2 distance in patients with Chiari Type I malformations following posterior fossa decompression: a single-institution experience. J Neurosurg Pediatr 17:3363422016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Catalina-Herrera CJ: Study of the anatomic metric values of the foramen magnum and its relation to sex. Acta Anat (Basel) 130:3443471987

  • 5

    Cicchetti DV: Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6:2842901994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Gire JDRoberto RFBobinski MKlineberg EODurbin-Johnson B: The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation. Spine J 13:5105192013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Grabb PAMapstone TBOakes WJ: Ventral brain stem compression in pediatric and young adult patients with Chiari I malformations. Neurosurgery 44:5205281999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Hankinson TCTuite GFMoscoso DIRobinson LCTorner JCLimbrick DD Jr: Analysis and interrater reliability of pB-C2 using MRI and CT: data from the Park-Reeves Syringomyelia Research Consortium on behalf of the Pediatric Craniocervical Society. J Neurosurg Pediatr 20:1701752017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Kennedy BCD’Amico RSYoungerman BEMcDowell MMHooten KGCouture D: Long-term growth and alignment after occipitocervical and atlantoaxial fusion with rigid internal fixation in young children. J Neurosurg Pediatr 17:941022016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Khalsa SSSGeh NMartin BAAllen PAStrahle JLoth F: Morphometric and volumetric comparison of 102 children with symptomatic and asymptomatic Chiari malformation Type I. J Neurosurg Pediatr 21:65712018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Ladner TRDewan MCDay MAShannon CNTomycz LTulipan N: Evaluating the relationship of the pB-C2 line to clinical outcomes in a 15-year single-center cohort of pediatric Chiari I malformation. J Neurosurg Pediatr 15:1781882015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Lee HJKim JTShin MHChoi DYHong JT: Quantification of pediatric cervical spine growth at the cranio-vertebral junction. J Korean Neurosurg Soc 57:2762822015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Martinez-Del-Campo EKalb SSoriano-Baron HTurner JDNeal MTUschold T: Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle-C1 interval. J Neurosurg Spine 24:5355452016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Pang DNemzek WRZovickian J: Atlanto-occipital dislocation: part 1—normal occipital condyle–C1 interval in 89 children. Neurosurgery 61:5145212007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Pang DNemzek WRZovickian J: Atlanto-occipital dislocation—part 2: The clinical use of (occipital) condyle–C1 interval, comparison with other diagnostic methods, and the manifestation, management, and outcome of atlanto-occipital dislocation in children. Neurosurgery 61:99510152007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Phuntsok RMazur MDEllis BJRavindra VMBrockmeyer DL: Development and initial evaluation of a finite element model of the pediatric craniocervical junction. J Neurosurg Pediatr 17:4975032016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Piatt JH JrGrissom LE: Developmental anatomy of the atlas and axis in childhood by computed tomography. J Neurosurg Pediatr 8:2352432011

  • 18

    Ravindra VMRiva-Cambrin JHorn KPGinos JBrockmeyer RGuan J: A 2D threshold of the condylar-C1 interval to maximize identification of patients at high risk for atlantooccipital dislocation using computed tomography. J Neurosurg Pediatr 19:4584632017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Riascos RBonfante ECotes CGuirguis MHakimelahi RWest C: Imaging of atlanto-occipital and atlantoaxial traumatic injuries: What the radiologist needs to know. Radiographics 35:212121342015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Ridder TAnderson RCEHankinson TC: Ventral decompression in Chiari malformation, basilar invagination, and related disorders. Neurosurg Clin N Am 26:5715782015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Schmeltzler ABabin EWenger JJ: Measurement of the foramen magnum in children and adults. Neuroradiology 2:1621631971

  • 22

    Shrout PEFleiss JL: Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:4204281979

  • 23

    Tubbs RSGriessenauer CJLoukas MShoja MMCohen-Gadol AA: Morphometric analysis of the foramen magnum: an anatomic study. Neurosurgery 66:3853882010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Vachhrajani SSen ANSatyan KKulkarni AVBirchansky SBJea A: Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group. J Neurosurg Pediatr 14:4254332014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Wanebo JEChicoine MR: Quantitative analysis of the transcondylar approach to the foramen magnum. Neurosurgery 49:9349432001

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