Learning objectives
To familiarize the viewer with the imaging findings of congenital malformations of the cranio-cervical junction (CCJ) and discuss the place of MRI and CT scan in making the diagnosis of these disorders.
Background
The CCJ is a complex region of the axial skeleton located between the skull-base and the upper cervical spine,
along with its neural components [1].
Its stability is mainly based on strong complex ligamentous and bony structures that are also responsible for the majority of axial rotation (at the atlantoaxial complex) and flexion-extension movements (at the occiput-C1 joint) [2].
Congenital abnormalities of the CCJ include bony anomalies and Chiari malformations.
Chiari malformations are a heterogeneous group of abnormalities grouped under a common heading because they...
Findings and procedure details
Procedure details:
A descriptive,
retrospective study that included MRI and/or CT scans of 22 patients with a congenital CCJ anomaly.
A cerebro-spinal MRI was performed in all patients,
presenting with neurological symptoms such as intense headache,
torticollis or spinal cord compression,
but also as part of the exploration of a polymalformative syndrome.
MR images were acquired at 3Tesla with either a “spine” or a “head” coil.
Multiplanar sequences weighted in T1,
T2,
FLAIR and diffusion were performed.
A CT scan was performed in addition to...
Conclusion
Management of congenital craniocervical anomalies requires a deep analysis of the neural and bony anatomy of the CCJ.
Multiplanar imaging allows a precise anatomical study and a classification of these malformations.
MRI has become the study of choice for the majority of congenital abnormalities of theCCJ and has made the diagnosis faster and more accurate,
thereby enhancing the possibility of an early and case-tailored treatment.
Surgical treatment has a high rate of morbidity.
Treatment should be individualized based on the patient anatomy,
presence or absence...
References
1.
Dickman CA,
Lekovic GP.
Biomechanical considerations for stabilization of the craniovertebral junction.Clin Neurosurg 2005;52:205–13.
2.
Joaquim AF,
Ghizoni E,
Giacomini LA,
Tedeschi H,
Patel AA.
Basilar invagination:Surgical results.J Craniovertebr Junction Spine 2014;5:78-84.
3.
Cama A,
Tortori-Donati P,
Piatelli GL,
Fondelli MP,
Andreussi L.
Chiari complex in children--neuroradiological diagnosis,
neurosurgical treatment and proposal of a new classification (312 cases).
Eur J Pediatr Surg 1995;5:35-8.
4.
Goel A. Basilar invagination,
Chiari malformation,
syringomyelia:a review.
Neurol India 2009;57:235-46.
5.
Rossi A,
Gandolfo C,
Cama A,
Tortori-Donati P....