ODONTOID PROCESSES SOFTWARE
The distance above or below the CLV was measured using the Meazure 3.2 software and the image ruler. Images from the midline craniocervical MRI (or CT) were digitalized, and the CLV was traced from the hard palate to the opistion. To compare these findings with the odontoid process invagination in normal subjects (control group), images from 32 consecutive normal subjects were evaluated. The studied sample was based on primary craniovertebral junction malformations without any immediate evident inflammatory, bone, or connective tissue disease. Patients with invagination of the dens toward the base of the skull but not toward the inside of the foramen magnum were classified as BI2. Patients with BI were divided into two groups: Those with axis dens invagination into the foramen magnum were referred to as type I (BI1). Patients with CM had symptomatic cerebellar tonsil herniation and/or posterior fossa structure and cisterna magna compressions. Patients with CVJM were divided into three groups: CM patients, basilar invagination type 1 (BI1) patients and basilar invagination type 2 (BI2) patients. The measurements were performed by an observer who was unaware of other study data. Computed tomography (CT) scans were used only in specific cases, when necessary, to clarify details of bone anatomy. To study the degree of odontoid process invagination, we evaluated magnetic resonance imaging (MRI) scans of the craniocervical junction in T1 and T2 midline sagittal scan acquisitions from a CVJM patient sample consecutively treated by the authors between 19. This study was approved by the Research Ethics Committee (Instituto de Assistencia Médica ao Servidor Público Estadual - sp-caae07284212000005463). Keywords: Arnold–Chiari malformation, basilar impression, cephalometry, platybasia BI1 and BI2 presented with at least of 0.95 cm CLV and these violations were strongly correlated with a primary cranial angulation (clivus horizontalization) and an acute clivus canal angle (a secondary craniocervical angle). There was strong correlation between CLV and Boogard's angle (R = 0.82, P = 0.000) and the clivus canal angle (R = 0.7, P = 0.000).Ĭonclusions:CM's CLV is discrete and similar to the normal subjects. The mean CLV violation in the groups were: The control group, 0.16 ± 0.45 cm the CM group, 0.32 ± 0.48 cm the BI1 group, 1.35 ± 0.5 cm and the BI2 group, 1.98 ± 0.18 cm. Results:A total of 97 subjects were studied: 32 normal subjects, 41 CM patients, 9 basilar invagination type 1 (BI1) patients, and 15 basilar invagination type 2 (BI2) patients. Methods:We evaluated the CLV in a sample of CVJM, BI, CM patients and a control group of normal subjects and correlated their data with craniocervical angular craniometry. The authors sought to clarify the real importance of CLV in the spectrum of craniovertebral junction malformations (CVJM) and to identify possible pathophysiological relationships. The Chamberlain's line violation (CLV) is the most common method to identify BI. A more precise method to differentiate between these types of CVJM is desirable. Background:Craniometric studies have shown that both Chiari malformation (CM) and basilar invagination (BI) belong to a spectrum of malformations.
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