Basilar invagination: a study based on 190 surgically treated patients

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Object. The authors analyzed the cases of 190 patients with basilar invagination that was diagnosed on the basis of criteria laid down in 1939 by Chamberlain to assess the appropriate surgical procedure.

Methods. Depending on the association with Chiari malformation, the anomaly of basilar invagination was classified into two groups. Eighty-eight patients who had basilar invagination but no associated Chiari malformation were assigned to Group I; the remainder of the patients, who had both basilar invagination and Chiari malformation, were assigned to Group II. The principal pathological characteristic was observed to be direct brainstem compression due to odontoid process indentation in Group I and a reduction in posterior cranial fossa volume in Group II.

Conclusions. Despite the anterior concavity of the brainstem in both groups, transoral surgery was the most suitable procedure for those patients in Group I and decompression of the foramen magnum was found to be appropriate for patients in Group II. After surgical decompression, a fixation procedure was found to be necessary in most Group I cases, but only in a small minority of Group II cases.

Article Information

Address reprint requests to: Atul Goel, M.Ch., Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai 400 012, India.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Magnetic resonance image obtained in an 8-year-old boy with Group I basilar invagination.

  • View in gallery

    Magnetic resonance image obtained in a 34-year-old man with Group II basilar invagination. Extensive syringomyelia is noted.

  • View in gallery

    Line drawing showing landmarks used for measurements. b = basal line; c = Chamberlain's line; t = tuberculum sellae—torcular herophili line; w = Wackenheim's clival line. The basal angle is the angle between lines b and w. The Klaus height index on plain radiography is the distance from the tip of the odontoid process to line t.

  • View in gallery

    Line drawing showing the parameters for measurement of the modified omega line. Line A is drawn along the hard palate. Line B is parallel to line A and passes through the center of the base of the axis. Line C extends from the center of the base of the axis along the tip of the odontoid process. The angle between line B and line C is the modified omega angle.

References

1.

Bharucha EPDastur HM: Craniovertebral anomalies. (A report on 40 cases.) Brain 87:4694801964Bharucha EP Dastur HM: Craniovertebral anomalies. (A report on 40 cases.) Brain 87:469–480 1964

2.

Bindal AKDunsker SBTew JM Jr: Chiari I malformation: classification and management. Neurosurgery 37:106910741995Bindal AK Dunsker SB Tew JM Jr: Chiari I malformation: classification and management. Neurosurgery 37:1069–1074 1995

3.

Bonney GWilliams JPR: Trans-oral approach to the upper cervical spine. J Bone Joint Surg (Br) 67:6916981985Bonney G Williams JPR: Trans-oral approach to the upper cervical spine. J Bone Joint Surg (Br) 67:691–698 1985

4.

Chamberlain WE: Basilar impression (platybasia). A bizarre developmental anomaly of the occipital bone and upper cervical spine with striking and misleading neurologic manifestations. Yale J Biol Med 11:4874961939Chamberlain WE: Basilar impression (platybasia). A bizarre developmental anomaly of the occipital bone and upper cervical spine with striking and misleading neurologic manifestations. Yale J Biol Med 11:487–496 1939

5.

Chiari H: Ueber Verderbungen des Kleinhirns infolge von Hydrocephalie des Grosshirns. Dtsch Med Wochenschr 17:117211751891Chiari H: Ueber Verderbungen des Kleinhirns infolge von Hydrocephalie des Grosshirns. Dtsch Med Wochenschr 17:1172–1175 1891

6.

Cogan DGBarrows LJ: Platybasia and the Arnold-Chiari malformation. Arch Ophthalmol 52:13291954Cogan DG Barrows LJ: Platybasia and the Arnold-Chiari malformation. Arch Ophthalmol 52:13–29 1954

7.

Crockard HA: Anterior approaches to lesions of the upper cervical spine. Clin Neurosurg 34:3894161988Crockard HA: Anterior approaches to lesions of the upper cervical spine. Clin Neurosurg 34:389–416 1988

8.

da Silva JA: Basilar impression and Arnold-Chiari malformation. Surgical findings in 209 cases. Neurochirurgia 35:1891951992da Silva JA: Basilar impression and Arnold-Chiari malformation. Surgical findings in 209 cases. Neurochirurgia 35:189–195 1992

9.

Dastur DKWadia NHDesai ADet al: Medullospinal compression due to atlanto-axial dislocation and sudden haematomyelia during decompression. Pathology, pathogenesis and clinical correlations. Brain 88:8979241965Dastur DK Wadia NH Desai AD et al: Medullospinal compression due to atlanto-axial dislocation and sudden haematomyelia during decompression. Pathology pathogenesis and clinical correlations. Brain 88:897–924 1965

10.

de Barros MCFarias WAtaíde Let al: Basilar impression and Arnold-Chiari malformation. A study of 66 cases. J Neurol Neurosurg Psychiatry 31:5966051968de Barros MC Farias W Ataíde L et al: Basilar impression and Arnold-Chiari malformation. A study of 66 cases. J Neurol Neurosurg Psychiatry 31:596–605 1968

11.

Dickman CALocantro JFessler RG: The influence of transoral odontoid resection on stability of the craniovertebral junction. J Neurosurg 77:5255301992Dickman CA Locantro J Fessler RG: The influence of transoral odontoid resection on stability of the craniovertebral junction. J Neurosurg 77:525–530 1992

12.

Di Lorenzo NFortuna AGuidetti B: Craniovertebral junction malformations. Clinicoradiological findings, long-term results, and surgical indications in 63 cases. J Neurosurg 56:6036081982Di Lorenzo N Fortuna A Guidetti B: Craniovertebral junction malformations. Clinicoradiological findings long-term results and surgical indications in 63 cases. J Neurosurg 56:603–608 1982

13.

Dolan KD: Cervicobasilar relationships. Radiol Clin North Am 15:1551661977Dolan KD: Cervicobasilar relationships. Radiol Clin North Am 15:155–166 1977

14.

Driesen W: [Findings at operation in the central nervous system in basilar impressions and related abnormalities of the atlantooccipital region.] Acta Neurochir 9:9681960 (Ger)Driesen W: [Findings at operation in the central nervous system in basilar impressions and related abnormalities of the atlantooccipital region.] Acta Neurochir 9:9–68 1960 (Ger)

15.

Fischer EG: Posterior fossa decompression for Chiari I deformity, including resection of the cerebellar tonsils. Childs Nerv Syst 11:6256291995Fischer EG: Posterior fossa decompression for Chiari I deformity including resection of the cerebellar tonsils. Childs Nerv Syst 11:625–629 1995

16.

Goel AAchawal S: The surgical treatment for Chiari malformation associated with atlantoaxial dislocation. Br J Neurosurg 9:67721995Goel A Achawal S: The surgical treatment for Chiari malformation associated with atlantoaxial dislocation. Br J Neurosurg 9:67–72 1995

17.

Goel AKarapurkar AP: Transoral plate and screw fixation of the craniovertebral region—a preliminary report. Br J Neurosurg 8:7437451994Goel A Karapurkar AP: Transoral plate and screw fixation of the craniovertebral region—a preliminary report. Br J Neurosurg 8:743–745 1994

18.

Goel ALaheri V: Plate and screw fixation for atlanto-axial subluxation. Technical report. Acta Neurochir 129:47531994Goel A Laheri V: Plate and screw fixation for atlanto-axial subluxation. Technical report. Acta Neurochir 129:47–53 1994

19.

Grawitz P: Beitrag zur Lehre von der basilaren Impression des Schädels. Arch Pathol Anat Physiol 80:4491880Grawitz P: Beitrag zur Lehre von der basilaren Impression des Schädels. Arch Pathol Anat Physiol 80:449 1880

20.

Greenberg AD: Atlanto-axial dislocations. Brain 91:6556841968Greenberg AD: Atlanto-axial dislocations. Brain 91:655–684 1968

21.

Hida KIwasaki YKoyanagi Iet al: Surgical indication and results of foramen magnum decompression versus syringosubarachnoid shunting for syringomyelia associated with Chiari I malformation. Neurosurgery 37:6736791995Hida K Iwasaki Y Koyanagi I et al: Surgical indication and results of foramen magnum decompression versus syringosubarachnoid shunting for syringomyelia associated with Chiari I malformation. Neurosurgery 37:673–679 1995

22.

Klaus E: Rontgendiagnostik der platybasic und basilaren Impression. Fortschr Rontgenstr 86:4604691957Klaus E: Rontgendiagnostik der platybasic und basilaren Impression. Fortschr Rontgenstr 86:460–469 1957

23.

Kohno KSakaki SShiraishi Tet al: Successful treatment of adult Arnold-Chiari malformation associated with basilar impression and syringomyelia by transoral anterior approach. Surg Neurol 33:2842871990Kohno K Sakaki S Shiraishi T et al: Successful treatment of adult Arnold-Chiari malformation associated with basilar impression and syringomyelia by transoral anterior approach. Surg Neurol 33:284–287 1990

24.

Levy WJMason LHahn JF: Chiari malformation presenting in adults: a surgical experience in 127 cases. Neurosurgery 12:3773901983Levy WJ Mason L Hahn JF: Chiari malformation presenting in adults: a surgical experience in 127 cases. Neurosurgery 12:377–390 1983

25.

Logue VEdwards MR: Syringomyelia and its surgical treatment—an analysis of 75 patients. J Neurol Neurosurg Psychiatry 44:2732841981Logue V Edwards MR: Syringomyelia and its surgical treatment—an analysis of 75 patients. J Neurol Neurosurg Psychiatry 44:273–284 1981

26.

Malis LICohen IGross SW: Arnold-Chiari malformation. Arch Surg 63:7837981951Malis LI Cohen I Gross SW: Arnold-Chiari malformation. Arch Surg 63:783–798 1951

27.

Marín-Padilla M: Cephalic axial skeletal-neural dysraphic disorders: embryology and pathology. Can J Neurol Sci 18:1531691991Marín-Padilla M: Cephalic axial skeletal-neural dysraphic disorders: embryology and pathology. Can J Neurol Sci 18:153–169 1991

28.

McGregor M: The significance of certain measurements of the skull in the diagnosis of basilar impression. Br J Radiol 21:1711811948McGregor M: The significance of certain measurements of the skull in the diagnosis of basilar impression. Br J Radiol 21:171–181 1948

29.

McRae DL: Bony abnormalities in the region of the foramen magnum: correlation of anatomic and neurologic findings. Acta Radiol 40:3353541953McRae DL: Bony abnormalities in the region of the foramen magnum: correlation of anatomic and neurologic findings. Acta Radiol 40:335–354 1953

30.

Menezes AH: Primary craniovertebral anomalies and hindbrain herniation syndrome (Chiari I): data base analysis. Pediatr Neurosurg 23:2602691995Menezes AH: Primary craniovertebral anomalies and hindbrain herniation syndrome (Chiari I): data base analysis. Pediatr Neurosurg 23:260–269 1995

31.

Menezes AHVanGilder JCGraf CJet al: Craniovertebral abnormalities. A comprehensive surgical approach. J Neurosurg 53:4444551980Menezes AH VanGilder JC Graf CJ et al: Craniovertebral abnormalities. A comprehensive surgical approach. J Neurosurg 53:444–455 1980

32.

Peyton WTPeterson HO: Congenital deformities in the region of the foramen magnum: basilar impression. Radiology 38:1311441942Peyton WT Peterson HO: Congenital deformities in the region of the foramen magnum: basilar impression. Radiology 38:131–144 1942

33.

Phillips DG: Basilar impression. J Neurol Neurosurg Psychiatry 18:58671955Phillips DG: Basilar impression. J Neurol Neurosurg Psychiatry 18:58–67 1955

34.

Pillay PKAwad IALittle JRet al: Symptomatic Chiari malformation in adults: a new classification based on magnetic resonance imaging with clinical and prognostic significance. Neurosurgery 28:6396451991Pillay PK Awad IA Little JR et al: Symptomatic Chiari malformation in adults: a new classification based on magnetic resonance imaging with clinical and prognostic significance. Neurosurgery 28:639–645 1991

35.

Ray BS; Platybasia with involvement of the central nervous system. Ann Surg 116:2312501942Ray BS; Platybasia with involvement of the central nervous system. Ann Surg 116:231–250 1942

36.

Saez RJOnofrio BMYanagihara T: Experience with Arnold-Chiari malformation, 1960 to 1970. J Neurosurg 45:4164221976Saez RJ Onofrio BM Yanagihara T: Experience with Arnold-Chiari malformation 1960 to 1970. J Neurosurg 45:416–422 1976

37.

Schmidt HFisher E: Ueber zwei verschiedene Foramen der primären basilären Impression. Fortschr Rontgenstr 88:60661958Schmidt H Fisher E: Ueber zwei verschiedene Foramen der primären basilären Impression. Fortschr Rontgenstr 88:60–66 1958

38.

Shukla RNag DGupta NNet al: Congenital atlanto-axial dislocation: a clinical and radiological study. J Assoc Physicians India 32:6977001984Shukla R Nag D Gupta NN et al: Congenital atlanto-axial dislocation: a clinical and radiological study. J Assoc Physicians India 32:697–700 1984

39.

Smoker WR: Craniovertebral junction: normal anatomy, craniometry, and congenital anomalies. Radiographics 14:2552771994Smoker WR: Craniovertebral junction: normal anatomy craniometry and congenital anomalies. Radiographics 14:255–277 1994

40.

Spillane JDPallis CHJones AM: Developmental abnormalities in the region of the foramen magnum. Brain 80:11471957Spillane JD Pallis CH Jones AM: Developmental abnormalities in the region of the foramen magnum. Brain 80:11–47 1957

41.

Stevens JMChong WKBarber Cet al: A new appraisal of abnormalities of the odontoid process associated with atlanto-axial subluxation and neurological disability. Brain 117:1331481994Stevens JM Chong WK Barber C et al: A new appraisal of abnormalities of the odontoid process associated with atlanto-axial subluxation and neurological disability. Brain 117:133–148 1994

42.

Stovner LJBergan UNilsen Get al: Posterior cranial fossa dimensions in the Chiari I malformation: relation to pathogenesis and clinical presentation. Neuroradiology 35:1131181993Stovner LJ Bergan U Nilsen G et al: Posterior cranial fossa dimensions in the Chiari I malformation: relation to pathogenesis and clinical presentation. Neuroradiology 35:113–118 1993

43.

Thiebaut FWackenheim AVrousos C: [New median sagittal pneumostratigraphical findings concerning the posterior fossa.] J Radiol Electrol 42:171961 (Fre)Thiebaut F Wackenheim A Vrousos C: [New median sagittal pneumostratigraphical findings concerning the posterior fossa.] J Radiol Electrol 42:1–7 1961 (Fre)

44.

VanGilder JCMenezes AHDolan KA: The Craniovertebral Junction and Its Abnormalities. Mount Kisco, NY: Futura1987 pp 2968VanGilder JC Menezes AH Dolan KA: The Craniovertebral Junction and Its Abnormalities. Mount Kisco NY: Futura 1987 pp 29–68

45.

Virchow R: Untersuchungen über die Entwicklung des Schädelgründes. Berlin: Reimer1857Virchow R: Untersuchungen über die Entwicklung des Schädelgründes. Berlin: Reimer 1857

46.

Von Torklus DGehle W: The Upper Cervical Spine: Regional Anatomy Pathology and Traumatology. A Systematic Radiological Atlas and Textbook. New York: Grune & Stratton1972 pp 198Von Torklus D Gehle W: The Upper Cervical Spine: Regional Anatomy Pathology and Traumatology. A Systematic Radiological Atlas and Textbook. New York: Grune & Stratton 1972 pp 1–98

47.

Wackenheim A: [Radiological diagnosis of congenital forms, intermittent forms and progressive forms of stenosis of the spinal canal at the level of the atlas.] Acta Radiol Diagn 9:4814861969 (Fr)Wackenheim A: [Radiological diagnosis of congenital forms intermittent forms and progressive forms of stenosis of the spinal canal at the level of the atlas.] Acta Radiol Diagn 9:481–486 1969 (Fr)

48.

Wadia NH: Myelopathy complicating congenital atlanto-axial dislocation. (A study of 28 cases.) Brain 90:4494721967Wadia NH: Myelopathy complicating congenital atlanto-axial dislocation. (A study of 28 cases.) Brain 90:449–472 1967

49.

Williams B: A critical appraisal of posterior fossa surgery for communicating syringomyelia. Brain 101:2232501978Williams B: A critical appraisal of posterior fossa surgery for communicating syringomyelia. Brain 101:223–250 1978

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