Keywords:
Neuroradiology brain, Neuroradiology spine, Paediatric, CT, Surgery, Computer Applications-Virtual imaging, Computer Applications-3D, Trauma, Congenital, Athletic injuries
Authors:
R. Alvarez Pérez, G. Elizondo - Riojas, R. Pinales Razo, R. E. Elizondo Omaña, E. Ramos Dávila, F. J. Barrera Flores; Monterrey/MX
DOI:
10.26044/ecr2019/C-2424
Aims and objectives
Craniocervical instability is an uncommon condition [1] that involves a limitation in the range of motion of the occipitoatlantoaxial region.
[2] It can be caused by congenital malformations,
genetic disorders,
tumors,
postsurgical changes or trauma to the base of the skull.
[1-5] Complications vary from paralysis,
respiratory dysfunction to even life-threatening conditions.
[1,4]
There has not been a consensus on the ideal treatment of craniocervical instability,
however there are several alternatives. One option is the surgical fusion of the occipitoatlantal joint by mean of a posterior fixation using a "midline occipital keel plate" and fixing it to transpedicular screws in underlying vertebrae.
However,
this procedure is not feasible in patients with bone resection of the occipital bone,
trauma or cases of suboccipital craniectomy.
[4]
Another procedure in these situations is the "screw and rod" technique.
[4] In this procedure,
a pair of screws are inserted into each occipital condyle and then fixed to another pair of screws in underlying cervical vertebrae.
This technique is complex and high risk due to the proximity of diverse anatomical structures of importance.
[5] In pediatric patients it is particularly difficult to perform due to the size of the condyles,
absence of complete ossification bodies,
as well as the lack of adequate equipment in size and shape for this age group.
[2] Due to this,
a morphological study of the occipital condyles prior to the operation is important.
[4-5]
Various morphometric studies of the occipital condyles have been made,
finding significant population differences,
therefore a preoperative imaging study is mandatory.
[3] However there are few studies regarding pediatric population,
one of them found a significant difference between different age groups within the pediatric population and confirmed the possibility of performing surgery in this population.
[2]
The purpose of the study was to compare the morphology of the occipital condyles between age groups,
estimate the growth pattern of the condyles and determine the feasibility of surgery in the pediatric population.