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Radiologic Evaluation of Basilar Invagination Without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Analysis Based on a Study of 75 Patients.
World Neurosurg. 2016 Nov; 95:375-382.WN

Abstract

BACKGROUND

We evaluated the radiologic features of 75 patients with group B basilar invagination who exhibited no evidence of atlantoaxial instability based on the conventional parameter of an abnormal increase in the atlantodental interval. We specifically studied the variability and possible significance of the presence of cerebrospinal fluid (CSF) within and outside the confines of neural tissues.

MATERIALS AND METHODS

During the period January 2008-May 2015, we encountered 75 cases with group B basilar invagination. These patients were divided into 4 groups depending on cervical spinal imaging that showed the presence of syringomyelia (group B1), increased CSF volume in the extramedullary space or external syrinx (group B2), the presence of both syringomyelia and external syrinx (group B3), and no abnormality of CSF cavitation in the spinal canal (group B4).

RESULTS

Our cohort comprised 39 group B1 cases, 10 group B2 cases, 20 group B3 cases, and 6 group B4 cases. The neck size and posterior fossa height were simultaneously reduced, by 15.89% and 15%, respectively, but the length of the neural structures remained within the normal range. Excessive amounts of CSF were present within or outside the confines of neural structures, including the spinal cord, brainstem, and cerebellum.

CONCLUSIONS

In cases of basilar invagination, various musculoskeletal and neural alterations seem to have a common functional role in protecting the craniocervical cord and delaying or stalling neurologic dysfunction.

Authors+Show Affiliations

Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India; Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, India. Electronic address: atulgoel62@hotmail.com.Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

27544334

Citation

Goel, Atul, et al. "Radiologic Evaluation of Basilar Invagination Without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Analysis Based On a Study of 75 Patients." World Neurosurgery, vol. 95, 2016, pp. 375-382.
Goel A, Nadkarni T, Shah A, et al. Radiologic Evaluation of Basilar Invagination Without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Analysis Based on a Study of 75 Patients. World Neurosurg. 2016;95:375-382.
Goel, A., Nadkarni, T., Shah, A., Sathe, P., & Patil, M. (2016). Radiologic Evaluation of Basilar Invagination Without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Analysis Based on a Study of 75 Patients. World Neurosurgery, 95, 375-382. https://doi.org/10.1016/j.wneu.2016.08.026
Goel A, et al. Radiologic Evaluation of Basilar Invagination Without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Analysis Based On a Study of 75 Patients. World Neurosurg. 2016;95:375-382. PubMed PMID: 27544334.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiologic Evaluation of Basilar Invagination Without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Analysis Based on a Study of 75 Patients. AU - Goel,Atul, AU - Nadkarni,Trimurti, AU - Shah,Abhidha, AU - Sathe,Prashant, AU - Patil,Manoj, Y1 - 2016/08/17/ PY - 2016/04/23/received PY - 2016/08/05/revised PY - 2016/08/06/accepted PY - 2016/8/22/pubmed PY - 2017/9/12/medline PY - 2016/8/22/entrez KW - Atlantoaxial instability KW - Basilar invagination KW - Chiari 1 malformation KW - Syringomyelia SP - 375 EP - 382 JF - World neurosurgery JO - World Neurosurg VL - 95 N2 - BACKGROUND: We evaluated the radiologic features of 75 patients with group B basilar invagination who exhibited no evidence of atlantoaxial instability based on the conventional parameter of an abnormal increase in the atlantodental interval. We specifically studied the variability and possible significance of the presence of cerebrospinal fluid (CSF) within and outside the confines of neural tissues. MATERIALS AND METHODS: During the period January 2008-May 2015, we encountered 75 cases with group B basilar invagination. These patients were divided into 4 groups depending on cervical spinal imaging that showed the presence of syringomyelia (group B1), increased CSF volume in the extramedullary space or external syrinx (group B2), the presence of both syringomyelia and external syrinx (group B3), and no abnormality of CSF cavitation in the spinal canal (group B4). RESULTS: Our cohort comprised 39 group B1 cases, 10 group B2 cases, 20 group B3 cases, and 6 group B4 cases. The neck size and posterior fossa height were simultaneously reduced, by 15.89% and 15%, respectively, but the length of the neural structures remained within the normal range. Excessive amounts of CSF were present within or outside the confines of neural structures, including the spinal cord, brainstem, and cerebellum. CONCLUSIONS: In cases of basilar invagination, various musculoskeletal and neural alterations seem to have a common functional role in protecting the craniocervical cord and delaying or stalling neurologic dysfunction. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/27544334/Radiologic_Evaluation_of_Basilar_Invagination_Without_Obvious_Atlantoaxial_Instability__Group_B_Basilar_Invagination_:_Analysis_Based_on_a_Study_of_75_Patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(16)30692-1 DB - PRIME DP - Unbound Medicine ER -