Learning objectives
To discuss the normal and the variant anatomy involving the CVJ region and the various craniometric measurements used for the radiologic assessment of region.
To discuss various congenital and acquired anomalies involving CVJ.
Radiological workup of the craniovertebral anomalies.
Background
Anatomy of CVJ:
Articular anatomy: upper surfaces of C1 lateral masses are cup like or concave which fit in to the ball and socket configuration,
united by articular capsules surrounding the atlanto-occipital joint & by anterior & posterior atlanto-occipital membranes.
Atlas and axis- four synovial joints between atlas and axis
two median- front and back of dens (pivot variety)
two lateral-between opposing articular facets(plane variety),
rotation is up to 900 and approximately half occurs at A-A joint
Ligamentous anatomy: principal stabilising ligaments of C1(figure.1)
1.Transverse...
Findings and procedure details
Evaluation and assessment of CVJ anomalies is challenging and coming to accurate diagnosis plays a crucial role in the management.
Congenital,
developmental and acquired anomalies cause atlanto-axial instability or it can affect the vertebra basilar vascular system.
The various causes are broadly classified into
1.congenital
Malformation of the occipital bone
Clivus segmentation
Remanants around foramen magnum
Atals variants
Dens segmentation anomalies
Basilar invagination
Condylar hypoplasia
Assimilation of atlas
AsMalformations of atlas
Asimilation of atlas
Atlanto axial fusion
Aplasia of atlas arch
Malformation of axis
Irregular...
Conclusion
The CVJ is a common site for anatomic variants and acquired pathology.
Understanding of the important land marks and accurate assessment of the lines and angles is crucial in the evaluation of craniovertebral junction anomalies
Knowledge of the normal anatomy as well as the spectrum of bony variants,
acquired anomalies of this region is vital for the diagnosis and correct image interpretation and ulterior management.
References
Wendy etal,
Craniovertebral junction:Normal craniometry and congenital anomalies; Radiographics:1994:14:225-277
Krakener,
J.MRI assessment of normal ligamentous structures in the craniovertebral junction Neuroradiology.
2001 Dec;43(12):1089-97.
Goel A,Basilar invagination,Chiari malformation,syringomyelia:a review,Neurology India,
2009(3):235-246
Tassanawipas etal,
magnetic resonance imaging study of the craniocervical junction,
J Orth surg,
2005:13(3):228-231
Harris J,
The cervicocranium:its radiographic assessment,
Radiology 2001;218:337-351
Crockhard,
H.A.Craniovertebral junction anomalies in inherited disorders: part of the syndrome or caused by the disorder? Eur J Pediatr.
1995 Jul;154(7):504-12.
Review
ClarkeRA,KearsleyJH,WalshDA.
PatternedexpressioninfamilialKlippel-Feilsyndrome.Teratology,
1996;53:152-7
Wollowick Al,
et.al,
Rheumatoid arthritis in the cervical...