Medknow Publications on behalf of the Neurological Society of India
Vol. 57, No. 3, 2009, pp. 235-246
Bioline Code: ni09076
Full paper language: English
Document type: Special Article
Document available free of charge
Neurology India, Vol. 57, No. 3, 2009, pp. 235-246
© Copyright 2009 Neurology India.
Basilar invagination, Chiari malformation, syringomyelia: A review|
Institute and personal experience (over 25 years) of basilar invagination was reviewed. The database of the department included
3300 patients with craniovertebral junction pathology from the year 1951 till date. Patients with basilar invagination were categorized into two
groups based on the presence (Group A) or absence (Group B) of clinical and radiological evidence of instability of the craniovertebral junction.
Standard radiological parameters described by Chamberlain were used to assess the instability of the craniovertebral junction. The pathogenesis
and clinical features in patients with Group A basilar invagination appeared to be related to mechanical instability, whereas it appeared to
be secondary to embryonic dysgenesis in patients with Group B basilar invagination. Treatment by facetal distraction and direct lateral mass
fixation can result in restoration of craniovertebral and cervical alignment in patients with Group A basilar invagination. Such a treatment
can circumvent the need for transoral or posterior fossa decompression surgery. Foramen magnum bone decompression appears to be a rational
surgical treatment for patients having Group B basilar invagination. The division of patients with basilar invagination on the basis of presence
or absence of instability provides insight into the pathogenesis of the anomaly and a basis for rational surgical treatment.
Atlantoaxial, basilar invagination, Chiari malformation, craniovertebral, syringomyelia
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