Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Anatomical Variant of Atlas : Arcuate Foramen, Occpitalization of Atlas, and Defect of Posterior Arch of Atlas

  • Received : 2015.01.07
  • Accepted : 2015.08.31
  • Published : 2015.12.28
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Abstract

Objective : We sought to examine anatomic variations of the atlas and the clinical significance of these variations. Methods : We retrospectively reviewed 1029 cervical 3-dimensional (3D) CT images. Cervical 3D CT was performed between November 2011 and August 2014. Arcuate foramina were classified as partial or complete and left and/or right. Occipitalization of the atlas was classified in accordance with criteria specified by Mudaliar et al. Posterior arch defects of the atlas were classified in accordance with criteria specified by Currarino et al. Results : One hundred and eight vertebrae (108/1029, 10.5%) showed an arcuate foramen. Bilateral arcuate foramina were present in 41 of these vertebrae and the remaining 67 arcuate foramina were unilateral (right 31, left 36). Right-side arcuate foramina were partial on 18 sides and complete on 54 sides. Left-side arcuate foramina were partial on 24 sides and complete on 53 sides. One case of atlas assimilation was found. Twelve patients (12/1029, 1.17%) had a defect of the atlantal posterior arch. Nine of these patients (9/1029, 0.87%) had a type A posterior arch defect. We also identified one type B, one type D, and one type E defect. Conclusion : Preoperative diagnosis of occipitalization of the atlas and arcuate foramina using 3D CT is of paramount importance in avoiding neurovascular injury during surgery. It is important to be aware of posterior arch defects of the atlas because they may be misdiagnosed as a fracture.

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References

  1. Ahmad FU, Wang MY : Lateral mass of C1 fixation and ponticulus-posticus. World Neurosurg 82 : e145-e146, 2014 https://doi.org/10.1016/j.wneu.2014.02.011
  2. Al-Motabagani MA, Surendra M : Total occipitalization of the atlas. Anat Sci Int 81 : 173-180, 2006, https://doi.org/10.1111/j.1447-073X.2006.00129.x
  3. Bailey DK : The normal cervical spine in infants and children. Radiology 59 : 712-719, 1952 https://doi.org/10.1148/59.5.712
  4. Cakmak O, Gurdal E, Ekinci G, Yildiz E, Cavdar S : Arcuate foramen and its clinical significance. Saudi Med J 26 : 1409-1413, 2005
  5. Currarino G, Rollins N, Diehl JT : Congenital defects of the posterior arch of the atlas : a report of seven cases including an affected mother and son. AJNR Am J Neuroradiol 15 : 249-254, 1994
  6. Cushing KE, Ramesh V, Gardner-Medwin D, Todd NV, Gholkar A, Baxter P, et al. : Tethering of the vertebral artery in the congenital arcuate foramen of the atlas vertebra : a possible cause of vertebral artery dissection in children. Dev Med Child Neurol 43 : 491-496, 2001 https://doi.org/10.1017/S0012162201000901
  7. Erbengi A, Oge HK : Congenital malformations of the craniovertebral junction : classification and surgical treatment. Acta Neurochir (Wien) 127 : 180-185, 1994 https://doi.org/10.1007/BF01808763
  8. Garg A, Gaikwad SB, Gupta V, Mishra NK, Kale SS, Singh J : Bipartite atlas with os odontoideum : case report. Spine (Phila Pa 1976) 29 : E35-E38, 2004 https://doi.org/10.1097/01.BRS.0000106487.89648.88
  9. Geipel P : [Studies on the fissure formation of the atlas and epistropheus. IV]. Zentralbl Allg Pathol 94 : 19-84, 1955
  10. Gupta S, Goel A : Quantitative anatomy of the lateral masses of the atlas and axis vertebrae. Neurol India 48 : 120-125, 2000
  11. Harrower G : Variations in the region of the foramen magnum. J Anat 57 (Pt 2) : 178-192, 1923
  12. Hong JT, Jang WY, Kim IS, Yang SH, Sung JH, Son BC, et al. : Posterior C1 stabilization using superior lateral mass as an entry point in a case with vertebral artery anomaly : technical case report. Neurosurgery 68 (1 Suppl Operative) : 246-249; discussion 249, 2011
  13. Huang MJ, Glaser JA : Complete arcuate foramen precluding C1 lateral mass screw fixation in a patient with rheumatoid arthritis : case report. Iowa Orthop J 23 : 96-99, 2003
  14. Kassim NM, Latiff AA, Das S, Ghafar NA, Suhaimi FH, Othman F, et al. : Atlanto-occipital fusion : an osteological study with clinical implications. Bratisl Lek Listy 111 : 562-565, 2010
  15. Klimo P Jr, Blumenthal DT, Couldwell WT : Congenital partial aplasia of the posterior arch of the atlas causing myelopathy : case report and review of the literature. Spine (Phila Pa 1976) 28 : E224-E228, 2003
  16. Koutsouraki E, Avdelidi E, Michmizos D, Kapsali SE, Costa V, Baloyannis S : Kimmerle's anomaly as a possible causative factor of chronic tension-type headaches and neurosensory hearing loss : case report and literature review. Int J Neurosci 120 : 236-239, 2010 https://doi.org/10.3109/00207451003597193
  17. Lamberty BG, Zivanovic S : The retro-articular vertebral artery ring of the atlas and its significance. Acta Anat (Basel) 85 : 113-122, 1973 https://doi.org/10.1159/000143987
  18. Li S, Li W, Sun J : [Operative treatment for cervical vertigo caused by foramen arcuale]. Zhonghua Wai Ke Za Zhi 33 : 137-139, 1995
  19. Limousin CA : Foramen arcuale and syndrome of Barre-Lieou. Its surgical treatment. Int Orthop 4 : 19-23, 1980
  20. Manjunath KY : Posterior bridging of the atlas vertebra in south Indians. Indian J Med Sci 55 : 488-490, 2001
  21. Menezes AH : Craniocervical developmental anatomy and its implications. Childs Nerv Syst 24 : 1109-1122, 2008 https://doi.org/10.1007/s00381-008-0600-1
  22. Mitchell J : The incidence of the lateral bridge of the atlas vertebra. J Anat 193 (Pt 2) : 283-285, 1998 https://doi.org/10.1046/j.1469-7580.1998.19320283.x
  23. Mudaliar RP, Shetty S, Nanjundaiah K, Kumar JP, Kc J : An osteological study of occipitocervical synostosis : its embryological and clinical significance. J Clin Diagn Res 7 : 1835-1837, 2013
  24. Paraskevas G, Papaziogas B, Tsonidis C, Kapetanos G : Gross morphology of the bridges over the vertebral artery groove on the atlas. Surg Radiol Anat 27 : 129-136, 2005 https://doi.org/10.1007/s00276-004-0300-9
  25. Penning L : Functional pathology of cervical spine, ed 1. London : Excerpta medica foundation, 1968, Vol. 4, pp76
  26. Piper JG, Traynelis VC : Congenital malformations of the craniovertebral junction in Dickman CA, Spetzler RF, Sonntag VKH (eds) : Surgery of the craniovertebral junction. New York : Thieme Medical Publishers, 1998, pp123-149
  27. Richardson EG, Boone SC, Reid RL : Intermittent quadriparesis associated with a congenital anomaly of the posterior arch of the atlas. Case report. J Bone Joint Surg Am 57 : 853-854, 1975 https://doi.org/10.2106/00004623-197557060-00025
  28. Sagiuchi T, Tachibana S, Sato K, Shimizu S, Kobayashi I, Oka H, et al. : Lhermitte sign during yawning associated with congenital partial aplasia of the posterior arch of the atlas. AJNR Am J Neuroradiol 27 : 258-260, 2006
  29. Sakai K, Tsutsui T : Bow hunter's stroke associated with atlantooccipital assimilation--case report. Neurol Med Chir (Tokyo) 39 : 696-700, 1999 https://doi.org/10.2176/nmc.39.696
  30. Sharma A, Gaikwad SB, Deol PS, Mishra NK, Kale SS : Partial aplasia of the posterior arch of the atlas with an isolated posterior arch remnant : findings in three cases. AJNR Am J Neuroradiol 21 : 1167-1171, 2000
  31. Skrzat J, Mroz I, Jaworek JK, Walocha J : A case of occipitalization in the human skull. Folia Morphol (Warsz) 69 : 134-137, 2010
  32. Split W, Sawrasewicz-Rybak M : [Clinical symptoms and signs in Kimmerle anomaly]. Wiad Lek 55 : 416-422, 2002
  33. Torreman M, Verhagen IT, Sluzewski M, Kok AJ, van Rooij WJ : Recurrent transient quadriparesis after minor cervical trauma associated with bilateral partial agenesis of the posterior arch of the atlas. Case report. J Neurosurg 84 : 663-665, 1996 https://doi.org/10.3171/jns.1996.84.4.0663
  34. Travan L, Saccheri P, Sabbadini G, Crivellato E : Bilateral arcuate foramen associated with partial defect of the posterior arch of the atlas in a medieval skeleton : case report and review of the literature. Looking backward to go forward. Surg Radiol Anat 33 : 495-500, 2011 https://doi.org/10.1007/s00276-010-0760-z
  35. Tubbs RS, Shoja MM, Shokouhi G, Farahani RM, Loukas M, Oakes WJ : Simultaneous lateral and posterior ponticles resulting in the formation of a vertebral artery tunnel of the atlas : case report and review of the literature. Folia Neuropathol 45 : 43-46, 2007
  36. Wang S, Wang C, Liu Y, Yan M, Zhou H : Anomalous vertebral artery in craniovertebral junction with occipitalization of the atlas. Spine (Phila Pa 1976) 34 : 2838-2842, 2009 https://doi.org/10.1097/BRS.0b013e3181b4fb8b
  37. Wight S, Osborne N, Breen AC : Incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache. J Manipulative Physiol Ther 22 : 15-20, 1999 https://doi.org/10.1016/S0161-4754(99)70100-4
  38. Wysocki J, Bubrowski M, Reymond J, Kwiatkowski J : Anatomical variants of the cervical vertebrae and the first thoracic vertebra in man. Folia Morphol (Warsz) 62 : 357-363, 2003
  39. Young JP, Young PH, Ackermann MJ, Anderson PA, Riew KD : The ponticulus posticus : implications for screw insertion into the first cervical lateral mass. J Bone Joint Surg Am 87 : 2495-2498, 2005 https://doi.org/10.2106/JBJS.E.00184

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