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Choi JW, Qiao Y, Mehta TI, Wilson JN, Torigoe TH, Tsappidi S, Jonathan Zhang Y, Brown SC, Hui FK, Abruzzo T. Safety and efficacy of dynamic catheter-directed cerebral digital subtraction angiography for diagnosis of bowhunter syndrome spectrum disorders: A systematic review of the literature. Interv Neuroradiol 2024:15910199241236820. [PMID: 38477583 DOI: 10.1177/15910199241236820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Dynamic catheter-directed cerebral digital subtraction angiography (dcDSA) is the gold standard for diagnosing dynamic vascular occlusion syndromes such as bowhunter syndrome (BHS). Nonetheless, concerns about its safety exist and no standardized protocols have been published to date. METHODS We describe our methodology and insights regarding the use of dcDSA in patients with BHS. We also perform a systematic literature review to identify cases of typical and atypical presentations of BHS wherein dcDSA was utilized and report on any procedural complications related to dcDSA. RESULTS Our study included 104 cases wherein dcDSA was used for the diagnosis of BHS. There were 0 reported complications of dcDSA. DcDSA successfully established diagnosis in 102 of these cases. Thirty-eight cases were deemed atypical presentations of BHS. Fourteen patients endorsed symptoms during neck flexion/extension. In eight cases, there was dynamic occlusion of bilateral vertebral arteries during a single maneuver. Three patients had multiple areas of occlusion along a single vertebral artery (VA). An anomalous entry of the VA above the C6 transverse foramen was observed in four patients. One patient had VA occlusion with neutral head position and recanalization upon contralateral lateral head tilt. CONCLUSION Our study highlights the safety and diagnostic benefits of dcDSA in characterizing the broad spectrum of BHS pathology encountered in clinical practice. This technique offers a powerful means to evaluate changes in cerebral blood flow and cervical arterial morphology in real time, overcoming the constraints of static imaging methods. Our findings pave the way for further studies on dcDSA to enhance cross-sectional imaging methods for the characterization of BHS and other dynamic vascular occlusion syndromes.
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Affiliation(s)
- Joo Won Choi
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Yang Qiao
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, Houston, TX, USA
| | - Tej I Mehta
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jessica N Wilson
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Trevor H Torigoe
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Samuel Tsappidi
- Department of Neurointerventional Surgery, The Queen's Medical Center, Honolulu, HI, USA
| | - Y Jonathan Zhang
- Department of Neurointerventional Surgery, The Queen's Medical Center, Honolulu, HI, USA
- Department of Neurosurgery, The Queen's Medical Center, Honolulu, HI, USA
| | - Stacy C Brown
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
- Neuroscience Institute, The Queen's Medical Center, Honolulu, HI, USA
| | - Ferdinand K Hui
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
- Department of Neurointerventional Surgery, The Queen's Medical Center, Honolulu, HI, USA
- Neuroscience Institute, The Queen's Medical Center, Honolulu, HI, USA
| | - Todd Abruzzo
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
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Wright J, Cheung M, Siddiqui A, Lucas J, Calder A, Argyropoulou MI, Arthurs OJ, Caro-Dominguez P, Thompson D, Severino M, D'Arco F. Recommendations for neuroradiological examinations in children living with achondroplasia: a European Society of Pediatric Radiology and European Society of Neuroradiology opinion paper. Pediatr Radiol 2023; 53:2323-2344. [PMID: 37674051 DOI: 10.1007/s00247-023-05728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 09/08/2023]
Abstract
Children living with achondroplasia are at an increased risk of developing neurological complications, which may be associated with acute and life-altering events. To remediate this risk, the timely acquisition of effective neuroimaging that can help to guide clinical management is essential. We propose imaging protocols and follow-up strategies for evaluating the neuroanatomy of these children and to effectively identify potential neurological complications, including compression at the cervicomedullary junction secondary to foramen magnum stenosis, spinal deformity and spinal canal stenosis. When compiling these recommendations, emphasis has been placed on reducing scan times and avoiding unnecessary radiation exposure. Standardized imaging protocols are important to ensure that clinically useful neuroimaging is performed in children living with achondroplasia and to ensure reproducibility in future clinical trials. The members of the European Society of Pediatric Radiology (ESPR) Neuroradiology Taskforce and European Society of Neuroradiology pediatric subcommittee, together with clinicians and surgeons with specific expertise in achondroplasia, wrote this opinion paper. The research committee of the ESPR also endorsed the final draft. The rationale for these recommendations is based on currently available literature, supplemented by best practice opinion from radiologists and clinicians with subject-specific expertise.
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Affiliation(s)
- Jenny Wright
- Department of Radiology, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
| | - Moira Cheung
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Ata Siddiqui
- Department of Neuroradiology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Jonathan Lucas
- Paediatric Spinal Surgery, Evelina London Children's Hospital, London, UK
| | - Alistair Calder
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Maria I Argyropoulou
- Department of Clinical Radiology and Imaging, Medical School, University of Ioannina, Ioannina, Greece
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Pablo Caro-Dominguez
- Unidad de Radiologia Pediatrica, Servicio de Radiologia, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Dominic Thompson
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | | | - Felice D'Arco
- Department of Neuroradiology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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Gao D, Liu X, Cao Y, Yi Z, Gao X, Li Y, Cao C, Geng Z, Zhou L. Normal reference values for magnetic resonance imaging measurements of the fetal internal jugular veins in middle and late pregnancy. Pediatr Radiol 2023; 53:920-928. [PMID: 36976339 PMCID: PMC10156768 DOI: 10.1007/s00247-023-05594-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/29/2022] [Accepted: 01/10/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND At present, there is a lack of normal magnetic resonance imaging (MRI) morphometric reference values for fetal internal jugular veins during middle and late pregnancy. OBJECTIVE We used MRI to assess the morphology and cross-sectional area of the internal jugular veins of fetuses during middle and late pregnancy and to explore the clinical value of these parameters. MATERIALS AND METHODS The MRI images of 126 fetuses in middle and late pregnancy were retrospectively analysed to determine the optimal sequence for imaging the internal jugular veins. Morphological observation of the fetal internal jugular veins in each gestational week was carried out, lumen cross-sectional area was measured and the relationship between these data and gestational age was analysed. RESULTS The balanced steady-state free precession sequence was superior to other MRI sequences used for fetal imaging. The cross section of fetal internal jugular veins was predominantly circular in both the middle and late stages of pregnancy, however the prevalence of an oval cross section was significantly higher in the late gestational age group. The cross-sectional area of the lumen of the fetal internal jugular veins increased with increasing gestational age. Fetal jugular vein asymmetry was common, with the right jugular vein being dominant in the high gestational age group. CONCLUSION We provide normal reference values for fetal internal jugular veins measured by MRI. These values may form the basis for clinical assessment of abnormal dilation or stenosis.
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Affiliation(s)
- Duo Gao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping Western Road, Shijiazhuang, 050000, China
| | - Xin Liu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping Western Road, Shijiazhuang, 050000, China
| | - Yimin Cao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping Western Road, Shijiazhuang, 050000, China
| | - Zexi Yi
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping Western Road, Shijiazhuang, 050000, China
| | - Xiaobin Gao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping Western Road, Shijiazhuang, 050000, China
| | - Ying Li
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping Western Road, Shijiazhuang, 050000, China
| | - Cuili Cao
- Department of Anatomy, School of Basic Medical Sciences, Hebei Medical University, Hebei Province, 361 Zhongshan Eastern Road, Shijiazhuang, 050017, China
| | - Zuojun Geng
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping Western Road, Shijiazhuang, 050000, China
| | - Lixia Zhou
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, 215 Heping Western Road, Shijiazhuang, 050000, China.
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Kubota T, Adachi M, Kitaoka T, Hasegawa K, Ohata Y, Fujiwara M, Michigami T, Mochizuki H, Ozono K. Clinical Practice Guidelines for Achondroplasia. Clin Pediatr Endocrinol 2020; 29:25-42. [PMID: 32029970 PMCID: PMC6958518 DOI: 10.1297/cpe.29.25] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 12/04/2022] Open
Abstract
Achondroplasia (ACH) is a skeletal dysplasia that presents with limb shortening, short
stature, and characteristic facial configuration. ACH is caused by mutations of the
FGFR3 gene, leading to constantly activated FGFR3 and activation of its
downstream intracellular signaling pathway. This results in the suppression of chondrocyte
differentiation and proliferation, which in turn impairs endochondral ossification and
causes short-limb short stature. ACH also causes characteristic clinical symptoms,
including foramen magnum narrowing, ventricular enlargement, sleep apnea, upper airway
stenosis, otitis media, a narrow thorax, spinal canal stenosis, spinal kyphosis, and
deformities of the lower extremities. Although outside Japan, papers on health supervision
are available, they are based on reports and questionnaire survey results. Considering the
scarcity of high levels of evidence and clinical guidelines for patients with ACH,
clinical practical guidelines have been developed to assist both healthcare professionals
and patients in making appropriate decisions in specific clinical situations. Eleven
clinical questions were established and a systematic literature search was conducted using
PubMed/MEDLINE. Evidence-based recommendations were developed, and the guidelines describe
the recommendations related to the clinical management of ACH. We anticipate that these
clinical practice guidelines for ACH will be useful for healthcare professionals and
patients alike.
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Affiliation(s)
- Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Guidelines Development Committee for Achondroplasia
| | - Masanori Adachi
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan.,Guidelines Development Committee for Achondroplasia
| | - Taichi Kitaoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Guidelines Development Committee for Achondroplasia
| | - Kosei Hasegawa
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmacological Sciences, Okayama, Japan.,Guidelines Development Committee for Achondroplasia
| | - Yasuhisa Ohata
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Guidelines Development Committee for Achondroplasia
| | - Makoto Fujiwara
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Guidelines Development Committee for Achondroplasia
| | - Toshimi Michigami
- Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Osaka Prefectural Hospital Organization, Osaka, Japan.,Guidelines Development Committee for Achondroplasia
| | - Hiroshi Mochizuki
- Division of Endocrinology and Metabolism, Saitama Children's Medical Center, Saitama, Japan.,Guidelines Development Committee for Achondroplasia
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Guidelines Development Committee for Achondroplasia
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Nadel JL, Wilkinson DA, Garton HJL, Muraszko KM, Maher CO. Screening and surgery for foramen magnum stenosis in children with achondroplasia: a large, national database analysis. J Neurosurg Pediatr 2018; 23:374-380. [PMID: 30554178 DOI: 10.3171/2018.9.peds18410] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to determine the rates of screening and surgery for foramen magnum stenosis in children with achondroplasia in a large, privately insured healthcare network. METHODS Rates of screening and surgery for foramen magnum stenosis in children with achondroplasia were determined using de-identified insurance claims data from a large, privately insured healthcare network of over 58 million beneficiaries across the United States between 2001 and 2014. Cases of achondroplasia and screening and surgery claims were identified using a combination of International Classification of Diseases diagnosis codes and Current Procedural Terminology codes. American Academy of Pediatrics (AAP) practice guidelines were used to determine screening trends. RESULTS The search yielded 3577 children age 19 years or younger with achondroplasia. Of them, 236 met criteria for inclusion in the screening analysis. Among the screening cohort, 41.9% received some form of screening for foramen magnum stenosis, whereas 13.9% of patients were fully and appropriately screened according to the 2005 guidelines from the AAP. The screening rate significantly increased after the issuance of the AAP guidelines. Among all children in the cohort, 25 underwent cervicomedullary decompression for foramen magnum stenosis. The incidence rate of undergoing cervicomedullary decompression was highest in infancy (28 per 1000 patient-years) and decreased with age (5 per 1000 patient-years for all other ages combined). CONCLUSIONS Children with achondroplasia continue to be underscreened for foramen magnum stenosis, although screening rates have improved since the release of the 2005 AAP surveillance guidelines. The incidence of surgery was highest in infants and decreased with age.
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Affiliation(s)
| | - D Andrew Wilkinson
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Hugh J L Garton
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Karin M Muraszko
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cormac O Maher
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Ghali GZ, Zaki Ghali MG, Ghali EZ, Srinivasan VM, Wagner KM, Rothermel A, Taylor J, Johnson J, Kan P, Lam S, Britz G. Intracranial Venous Hypertension in Craniosynostosis: Mechanistic Underpinnings and Therapeutic Implications. World Neurosurg 2018; 127:549-558. [PMID: 30092478 DOI: 10.1016/j.wneu.2018.07.260] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/27/2018] [Accepted: 07/28/2018] [Indexed: 11/20/2022]
Abstract
Patients with complex, multisutural, and syndromic craniosynostosis (CSO) frequently exhibit intracranial hypertension. The intracranial hypertension cannot be entirely attributed to the craniocephalic disproportion with calvarial restriction because cranial vault expansion has not consistently alleviated elevated intracranial pressure. Evidence has most strongly supported a multifactorial interaction, including venous hypertension along with other pathogenic processes. Patients with CSO exhibit marked venous anomalies, including stenosis of the jugular-sigmoid complex, transverse sinuses, and extensive transosseous venous collaterals. These abnormal intracranial-extracranial occipital venous collaterals might represent anomalous development, with persistence and subsequent enlargement of channels normally present in the fetus, either as a primary defect or as nonregression in response to failure of the development of the jugular-sigmoid complexes. It has been suggested by some investigators that venous hypertension in patients with CSO could be treated directly via jugular foraminoplasty, venous stenting, or jugular venous bypass, although these options are not in common clinical practice. Obstructive sleep apnea, occurring as a consequence of midface hypoplasia, can also contribute to intracranial hypertension in patients with syndromic CSO. Thus, correction of facial deformities, as well as posterior fossa decompression, could also play important roles in the treatment of intracranial hypertension. Determining the precise mechanistic underpinnings underlying intracranial hypertension in any given patient with CSO requires individualized evaluation and management.
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Affiliation(s)
- George Zaki Ghali
- United States Environmental Protection Agency, Arlington, Virginia, USA; Department of Toxicology, Purdue University, West Lafayette, Indiana, USA
| | - Michael George Zaki Ghali
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA; Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA.
| | - Emil Zaki Ghali
- Department of Medicine, Inova Alexandria Hospital, Alexandria, Virginia, USA; Department of Urological Surgery, El Gomhoureya General Hospital, Alexandria, Egypt
| | - Visish M Srinivasan
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Kathryn M Wagner
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Alexis Rothermel
- Division of Plastic and Reconstructive Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jesse Taylor
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeremiah Johnson
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sandi Lam
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Gavin Britz
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA
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Bosemani T, Orman G, Hergan B, Carson KA, Huisman TAGM, Poretti A. Achondroplasia in children: correlation of ventriculomegaly, size of foramen magnum and jugular foramina, and emissary vein enlargement. Childs Nerv Syst 2015; 31:129-33. [PMID: 25249421 DOI: 10.1007/s00381-014-2559-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 09/11/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Achondroplasia is a skeletal dysplasia with diminished growth of the skull base secondary to defective enchondral bone formation. This leads to narrowing of the foramen magnum and jugular foramina, which further leads to ventricular dilatation and prominence of the emissary veins. The primary goal of our study was to determine a correlation between the degree of ventricular dilatation, jugular foramina and foramen magnum narrowing, as well as emissary vein enlargement. METHODS Conventional T2-weighted MR images were evaluated for surface area of the foramen magnum and jugular foramina, ventricular dilatation, and emissary veins enlargement in 16 achondroplasia patients and 16 age-matched controls. Ratios were calculated for the individual parameters using median values from age-matched control groups to avoid age as a confounder. RESULTS Compared to age-matched controls, in children with achondroplasia, the surface area of the foramen magnum (median 0.50 cm(2), range 0.23-1.37 cm(2) vs. 3.14 cm(2), 1.83-6.68 cm(2), p < 0.001) and jugular foramina (median 0.02 cm(2), range 0-0.10 cm(2) vs. 0.21 cm(2), 0.03-0.61 cm(2), p < 0.001) were smaller, whereas ventricular dilatation (0.28, 0.24-0.4 vs. 0.26, 0.21-0.28, p < 0.001) and enlargement of emissary veins (6, 0-11 vs. 0, p < 0.001) were higher. Amongst the patients, Spearman correlation and multiple regression analysis did not reveal correlation for severity between the individual parameters. CONCLUSIONS Our study suggests that in children with achondroplasia, (1) the variation in ventricular dilatation may be related to an unquantifiable interdependent relationship of emissary vein enlargement, venous channel narrowing, and foramen magnum compression and (2) stable ventricular size facilitated by interdependent factors likely obviates the need for ventricular shunt placement.
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Affiliation(s)
- Thangamadhan Bosemani
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Charlotte R. Bloomberg Children's Center, Sheikh Zayed Tower, Room 4174, 1800 Orleans Street, Baltimore, MD, 21287-0842, USA
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8
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Scott WW, Weprin BE, Swift DM. A unifying theory for the multifactorial origin of cerebellar tonsillar herniation and hydrocephalus in osteopetrosis. J Neurosurg Pediatr 2014; 14:665-73. [PMID: 25325415 DOI: 10.3171/2014.8.peds14190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Osteopetrosis is a rare congenital metabolic bone disease. There are very few reports in the literature associating cerebellar tonsillar herniation (CTH) and hydrocephalus requiring neurosurgical attention. The authors present cases of osteopetrosis requiring neurosurgical intervention from their practice and offer a detailed account of the literature. METHODS A retrospective review was conducted at the authors' institution, and all children with osteopetrosis requiring neurosurgical attention were identified. Medical charts and radiographic studies were reviewed. Data including age at presentation, sex, symptoms at presentation, age at follow-up, the presence of any neurological comorbidities, and surgical procedures performed were recorded. RESULTS Four patients were identified as having osteopetrosis requiring neurosurgical attention at the authors' institution between January 1, 2005, and January 1, 2014. There were 3 females and 1 male with an average age at presentation of 11.1 years; patients were observed for a mean of 4.4 years. All of the patients were identified as harboring jugular foraminal stenosis and CTH. Seventy-five percent of these patients developed hydrocephalus, and in those cases a triventricular pattern of dilation was noted. One patient developed syringomyelia. Three of the 4 patients underwent neurosurgical procedures. Cerebrospinal fluid diversion was performed in 2 patients via a ventriculoperitoneal shunt in one case and an endoscopic third ventriculostomy (ETV) in the other. The former patient required a proximal revision at 2 years for bony overgrowth at the site of the bur hole. Two patients underwent a suboccipital decompression. In patients undergoing CSF diversion, there was improvement in ventricle size. CONCLUSIONS Variable degrees of hindbrain crowding and/or CTH are mentioned throughout the literature, suggesting that this entity is nearly always present in this patient population. The progressive triventricular hydrocephalus seen in these cases results from a complex combination of both communicating and noncommunicating pathology, which may depend on the type of osteopetrosis, age at presentation, and the presence and degree of venous collateralization, and it appears that the hydrocephalus is more prevalent and more likely to be treated in infants and in the younger, school-aged population. The acquired hindbrain fullness in conjunction with the triventricular pattern of hydrocephalus has kept the authors enthusiastic regarding the use of ETV in these complicated cases.
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Affiliation(s)
- William W Scott
- Department of Pediatric Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
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9
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BOSEMANI THANGAMADHAN, ORMAN GUNES, CARSON KATHRYNA, MEODED AVNER, HUISMAN THIERRYAGM, PORETTI ANDREA. Diffusion tensor imaging of the brainstem in children with achondroplasia. Dev Med Child Neurol 2014; 56:1085-92. [PMID: 24825324 PMCID: PMC4194128 DOI: 10.1111/dmcn.12492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 11/28/2022]
Abstract
AIM The aims of this study were to compare, using diffusion tensor imaging (DTI) of the brainstem, microstructural integrity of the white matter in children with achondroplasia and age-matched participants and to correlate the severity of craniocervical junction (CCJ) narrowing and neurological findings with DTI scalars in children with achondroplasia. This study also aimed to assess the potential role of fibroblast growth factor receptor type 3 on white matter microstructure. METHOD Diffusion tensor imaging was performed using a 1.5T magnetic resonance scanner and balanced pairs of diffusion gradients along 20 non-collinear directions. Measurements were obtained from regions of interest, sampled in each pontine corticospinal tract (CST), medial lemniscus, and middle cerebellar peduncle, as well as in the lower brainstem and centrum semiovale, for fractional anisotropy and for mean, axial, and radial diffusivity. In addition, a severity score for achondroplasia was assessed by measuring CCJ narrowing. RESULT Eight patients with achondroplasia (seven males, one female; mean age 5y 6mo, range 1y 1mo-15y 1mo) and eight age- and sex-matched comparison participants (mean age 5y 2mo, range 1y 1mo-14y 11mo) were included in this study. Fractional anisotropy was lower and mean diffusivity and radial diffusivity were higher in the lower brainstem of patients with achondroplasia than in age-matched comparison participants. The CST and middle cerebellar peduncle of the participants showed increases in mean, axial, and radial diffusivity. Fractional anisotropy in the lower brainstem was negatively correlated with the degree of CCJ narrowing. No differences in the DTI metrics of the centrum semiovale were observed between the two groups. INTERPRETATION The reduction in fractional anisotropy and increase in diffusivities in the lower brainstem of participants with achondroplasia may reflect secondary encephalomalacic degeneration and cavitation of the affected white matter tracts as shown by histology. In children with achondroplasia, DTI may serve as a potential biomarker for brainstem white matter injury and aid in the care and management of these patients.
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Affiliation(s)
- THANGAMADHAN BOSEMANI
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore
| | - GUNES ORMAN
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore
| | - KATHRYN A CARSON
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore,Division of General Internal Medicine, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - AVNER MEODED
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore
| | - THIERRY A G M HUISMAN
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore
| | - ANDREA PORETTI
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore
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Schmidt MJ, Ondreka N, Sauerbrey M, Volk HA, Rummel C, Kramer M. Volume reduction of the jugular foramina in Cavalier King Charles Spaniels with syringomyelia. BMC Vet Res 2012; 8:158. [PMID: 22954070 PMCID: PMC3514347 DOI: 10.1186/1746-6148-8-158] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 07/28/2012] [Indexed: 11/10/2022] Open
Abstract
Background Understanding the pathogenesis of the chiari-like malformation in the Cavalier King Charles Spaniel (CKCS) is incomplete, and current hypotheses do not fully explain the development of syringomyelia (SM) in the spinal cords of affected dogs. This study investigates an unconventional pathogenetic theory for the development of cerebrospinal fluid (CSF) pressure waves in the subarachnoid space in CKCS with SM, by analogy with human diseases. In children with achondroplasia the shortening of the skull base can lead to a narrowing of the jugular foramina (JF) between the cranial base synchondroses. This in turn has been reported to cause a congestion of the major venous outflow tracts of the skull and consequently to an increase in the intracranial pressure (ICP). Amongst brachycephalic dog breeds the CKCS has been identified as having an extremely short and wide braincase. A stenosis of the JF and a consequential vascular compromise in this opening could contribute to venous hypertension, raising ICP and causing CSF jets in the spinal subarachnoid space of the CKCS. In this study, JF volumes in CKCSs with and without SM were compared to assess a possible role of this pathologic mechanism in the development of SM in this breed. Results Computed tomography (CT) scans of 40 CKCSs > 4 years of age were used to create three-dimensional (3D) models of the skull and the JF. Weight matched groups (7–10 kg) of 20 CKCSs with SM and 20 CKCSs without SM were compared. CKCSs without SM presented significantly larger JF -volumes (median left JF: 0.0633 cm3; median right JF: 0.0703 cm3; p < 0.0001) when compared with CKCSs with SM (median left JF: 0.0382 cm3; median right JF: 0.0434 cm3; p < 0.0001). There was no significant difference between the left and right JF within each group. Bland-Altman analysis revealed excellent reproducibility of all volume measurements. Conclusion A stenosis of the JF and consecutive venous congestion may explain the aetiology of CSF pressure waves in the subarachnoid space, independent of cerebellar herniation, as an additional pathogenetic factor for the development of SM in this breed.
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Affiliation(s)
- Martin Jürgen Schmidt
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University, Frankfurter Straße 108, 35392, Giessen, Germany.
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11
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Elsankari S, Czosnyka M, Lehmann P, Meyer ME, Deramond H, Balédent O. Cerebral Blood and CSF Flow Patterns in Patients Diagnosed for Cerebral Venous Thrombosis - An Observational Study. J Clin Imaging Sci 2012; 2:41. [PMID: 22919555 PMCID: PMC3424687 DOI: 10.4103/2156-7514.99158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 04/14/2012] [Indexed: 12/05/2022] Open
Abstract
Background and Purpose: Recent studies of the organization of the cerebral venous system in healthy subjects using phase contrast magnetic resonance imaging (PC-MRI) show its structural complexity and inter-individual variations. Our objective was to study the venous blood and CSF flows in cerebral venous thrombosis (CVT). Materials and Methods: PC-MRI sequences were added to brain MRI conventional protocol in 19 patients suspected of CVT, among whom 6 patients had CVT diagnosis confirmed by MR venography. Results were compared with 18 healthy age-matched volunteers (HV). Results: In patients without CVT (NoCVT) confirmed by venography, we found heterogeneous individual venous flows, and variable side dominance in paired veins and sinuses, comparable to those in healthy volunteers. In CVT patients, PC-MRI detected no venous flow in the veins and/or sinuses with thrombosis. Arterial flows were preserved. CSF aqueductal and cervical stroke volumes were increased in a patient with secondary cerebral infarction, and decreased in 4 patients with extended thrombosis in the superior sagittal and transverse sinuses. These results suggest the main role of the venous system in the regulation of the dynamic intracranial equilibrium. Conclusions: CVT produces highly individualized pattern of disturbance in venous blood drainage. Complementary to MRI venography, PC-MRI provides non-invasive data about venous blockage consequences on CSF flow disturbances.
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Affiliation(s)
- Souraya Elsankari
- Department of Imaging and Biophysics, Amiens University Hospital, 80054 Amiens Cedex, France
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12
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Swift D, Nagy L, Robertson B. Endoscopic third ventriculostomy in hydrocephalus associated with achondroplasia. J Neurosurg Pediatr 2012; 9:73-81. [PMID: 22208325 DOI: 10.3171/2011.10.peds1169] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hydrocephalus in patients with achondroplasia is thought to be due to increased dural sinus venous pressure resulting from narrowing of the jugular foramen. In this setting, where hydrocephalus is presumed to be "vascular" in origin and therefore communicating, endoscopic third ventriculostomy (ETV) would seem contraindicated. The authors describe 3 patients in whom ETV was successfully performed, resulting in MR imaging-documented decreases in ventricle size. The patients were 11 months, 33 months, and 13 years at the time of surgery. All patients had serial preoperative MR images demonstrating progressive hydrocephalus in a "triventricular" pattern with a small fourth ventricle but an open aqueduct. All patients had undergone suboccipital decompression for foramen magnum stenosis prior to the treatment of hydrocephalus. Preoperative retrograde venography revealed variable pressure gradients across the jugular foramen. It is postulated that the increase in intracranial venous pressure resulting from jugular foramen stenosis may lead to disproportionate venous engorgement of the cerebellum and some degree of obstructive hydrocephalus amenable to ETV. The authors discuss the role of suboccipital decompression in the progression of hydrocephalus in patients with achondroplasia.
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Affiliation(s)
- Dale Swift
- Neurosurgeons for Children, Children’s Medical Center, Dallas, USA.
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13
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Dinçer A, Özek MM. Radiologic evaluation of pediatric hydrocephalus. Childs Nerv Syst 2011; 27:1543-62. [PMID: 21928020 DOI: 10.1007/s00381-011-1559-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 08/09/2011] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The aim of this review is to present the contemporary role of radiology in evaluating pediatric hydrocephalus. Although conventional brain imaging with ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) reveal the degree of ventricular enlargement and often the etiology of the hydrocephalus, the diagnosis and management of hydrocephalus present common problems in pediatric populations. DISCUSSION US, usually sufficient to assess and monitor ventricular size, is used most commonly in preterm infants who have germinal matrix hemorrhages and not able to tolerate transport to the radiology department. Although CT can demonstrate gross dilatation of ventricles, in most cases, it will be necessary to more closely define the nature of the obstruction, either functionally or anatomically. MRI is the best imaging modality to provide such functional and anatomic information. However, since identification of obstructive pathologic processes at any level through the cerebrospinal fluid (CSF) pathway in patients with hydrocephalus is of significant importance because it can change the treatment options, avoiding shunt insertion, a more sophisticated MRI approach is needed instead of obtaining a routine cranial MRI. Furthermore, the outcome after neuroendoscopic procedures is clearly related to patient selection under guidance of neuroimaging. CONCLUSION Therefore, the article focuses mainly on the effective usage of various MRI sequences in both diagnosis and follow-up of pediatric hydrocephalus, such as 3D CISS, cine PC, TSE, and GRE T2* sequences, to be able to investigate all possible obstructive pathology through the CSF pathway and to assess the efficiency of treatment in a standardized way.
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Affiliation(s)
- Alp Dinçer
- Department of Radiology, School of Medicine, Acibadem University, Inonu Cad. Okur Sok. No:21, Kozyatagı, Istanbul 34742, Turkey.
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14
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Modi HN, Suh SW, Hong JY, Yang JH. Magnetic resonance imaging study determining cord level and occupancy at thoracolumbar junction in achondroplasia - A prospective study. Indian J Orthop 2011; 45:63-8. [PMID: 21221226 PMCID: PMC3004083 DOI: 10.4103/0019-5413.73661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Thoracolumbar (TL) stenosis in achondroplasia is frequently reported, and becomes symptomatic in adulthood. Hence we conducted a prospective study to determine cord level and occupancy at TL junction in symptomatic or asymptomatic achondroplasis patients in comparision to normal population by magnetic resonance imaging (MRI). MATERIALS AND METHODS Cord level with its occupancy rate and TL kyphosis were measured on MRI and standing radiogram, respectively. We prospectively studied MRI of TL spine in 19 patients (7 males and 12 females) with achondroplasia. All the subjects were randomly selected from our outpatient clinic and divided into two groups: symptomatic and asymptomatic group. Symptomatic group had at least two of the following symptoms: back pain with spasticity and walking difficulty, radicular pain in upper thigh or girdle pain, tingling and numbness in the lower limbs, visible deformity at TL spine and brisk reflexes in lower extremities. Asymptomatic group was selected from those patients who visited in outpatient clinic for consultation of limb lengthening. The third group was taken as control that comprised 11 nonachondroplasia otherwise normal patients (8 males and 3 females) who presented to our outpatient clinic for back pain. RESULTS Results showed spinal cord level was higher in achondroplasia than nonachondroplasia (P=0.003); however, no difference in cord level between symptomatic and asymptomatic group (P=0.568). Comparing cord occupancy, no difference found among all three groups (P=0.20). Kyphosis was increasing from nonachondroplasia, asymptomatic and symptomatic patient groups (P<0.001). Average age was 22.4±14.2, 11.9±6.5, and 36.2±13.2 years in symptomatic, asymptomatic, and nonachondroplasia groups, respectively (P<0.001). CONCLUSION Our results indicated high level of spinal cord in achondroplasia patients compared to nonachondroplasia individuals. High prevalence of neurological symptoms at TL level in such patients can be associated with high cord level and developing progressive kyphosis at TL level along with degenerative process.
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Affiliation(s)
- Hitesh N Modi
- Department of Orthopedics, Korea University Guro Hospital, South Korea
| | - Seung-Woo Suh
- Department of Orthopedics, Korea University Guro Hospital, South Korea,Address for correspondence: Prof. Seung-Woo Suh, Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul 152-703, South Korea E-mail:
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Guro Hospital, South Korea
| | - Jae-Hyuk Yang
- Department of Orthopedics, Korea University Guro Hospital, South Korea
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Kopuz C, Aydin ME, Kale A, Demir MT, Corumlu U, Kaya AH. The termination of superior sagittal sinus and drainage patterns of the lateral, occipital at confluens sinuum in newborns: clinical and embryological implications. Surg Radiol Anat 2010; 32:827-33. [PMID: 20182724 DOI: 10.1007/s00276-010-0628-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 01/22/2010] [Indexed: 11/28/2022]
Abstract
Drainage patterns of dural venous sinuses at confluens sinuum are variable and clinically significant. It has been generally investigated in adults; however, we thought that neonatal cadaver study might be more informative in views of embryological and clinical. A total of 33 skull bases of neonatal cadavers were resected to identify termination patterns of lateral sinus (LS), superior sagittal sinus (SSS) and occipital sinus (OS) at the confluens sinuum. Termination patterns of these sinuses were classified into six types: the SSS showed continuity with right transverse sinus (TS) (with OSs) (30.3%) (Type I); or multiple OSs (21.2%) (Type II). The SSS continued with left TS (with OSs) (12.1% (Type III); or with multiple OSs (6.1%) (Type IV). The SSS shows continuity with both TS (9.1%) (Type V). SSS symmetrically bifurcated, the confluens sinuum has a large OS (21.2%) (Type VI). Understanding of the cerebral venous drainage and large variation of the posterior fossa dural sinuses is crucially important for planning surgical intervention to some tumors in the neck which may require ligation of the internal jugular vein.
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Affiliation(s)
- Cem Kopuz
- Department of Anatomy, Faculty of Medicine, Ondokuz Mayis University, Körfez Mah. Atatürk Bulvari No:112, Kurupelit, Samsun, Turkey.
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16
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Modi HN, Suh SW, Song HR, Yang JH. Lumbar nerve root occupancy in the foramen in achondroplasia: a morphometric analysis. Clin Orthop Relat Res 2008; 466:907-13. [PMID: 18259829 PMCID: PMC2504658 DOI: 10.1007/s11999-008-0142-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 01/16/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Lumbar stenosis is common in patients with achondroplasia because of narrowing of the neural canal. However, it is unclear what causes stenosis, narrowing of the central canal or foramina. We performed a morphometric analysis of the lumbar nerve roots and intervertebral foramen in 17 patients (170 nerve roots and foramina) with achondroplasia (eight symptomatic, nine asymptomatic) and compared the data with that from 20 (200 nerve roots and foramina) asymptomatic patients without achondroplasia presenting with low back pain without neurologic symptoms. The measurements were made on left and right parasagittal MRI scans of the lumbar spine. The foramen area and root area were reduced at all levels from L1 to L5 between the patients with achondroplasia (Groups I and II) and the nonachondroplasia group (Group III). The percentage of nerve root occupancy in the foramen between Group I and Group II as compared with the patients without achondroplasia was similar or lower. This implied the lumbar nerve root size in patients with achondroplasia was smaller than that of the normal population and thus there is no effective nerve root compression. Symptoms of lumbar stenosis in achondroplasia may be arising from the central canal secondary to degenerative disc disease rather than a true foraminal stenosis. LEVEL OF EVIDENCE Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hitesh N. Modi
- Department of Orthopedics, Korea University Guro Hospital, # 80, Guro-Dong, Guro-Gu, Seoul 152-703 Korea
| | - Seung Woo Suh
- Department of Orthopedics, Korea University Guro Hospital, # 80, Guro-Dong, Guro-Gu, Seoul 152-703 Korea
| | - Hae-Ryong Song
- Department of Orthopedics, Korea University Guro Hospital, # 80, Guro-Dong, Guro-Gu, Seoul 152-703 Korea
| | - Jae Hyuk Yang
- Department of Orthopedics, Korea University Guro Hospital, # 80, Guro-Dong, Guro-Gu, Seoul 152-703 Korea
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Conway RL, Pressman BD, Dobyns WB, Danielpour M, Lee J, Sanchez-Lara PA, Butler MG, Zackai E, Campbell L, Saitta SC, Clericuzio CL, Milunsky JM, Hoyme HE, Shieh J, Moeschler JB, Crandall B, Lauzon JL, Viskochil DH, Harding B, Graham JM. Neuroimaging findings in macrocephaly-capillary malformation: a longitudinal study of 17 patients. Am J Med Genet A 2008; 143A:2981-3008. [PMID: 18000912 DOI: 10.1002/ajmg.a.32040] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Here, we report the neuroimaging findings and neurological changes in 17 unpublished patients with Macrocephaly-Capillary Malformation (M-CM). This syndrome has been traditionally known as Macrocephaly-Cutis Marmorata Telangiectatica Congenita (M-CMTC), but we explain why M-CM is a more accurate term for this overgrowth syndrome. We analyzed the 17 patients with available brain MRI or CT scans and compared their findings with features identified by a comprehensive review of published cases. White matter irregularities with increased signal on T2-weighted images were commonly observed findings. A distinctive feature in more than half the patients was cerebellar tonsillar herniation associated with rapid brain growth and progressive crowding of the posterior fossa during infancy. In four such cases, we confirmed that the tonsillar herniation was an acquired event. Concurrently, with the development of these findings, ventriculomegaly (frequently obstructive) and dilated dural venous sinuses were observed in conjunction with prominent Virchow-Robin spaces in many of those in whom cerebellar tonsil herniation had developed. We postulate that this constellation of unusual features suggests a dynamic process of mechanical compromise in the posterior fossa, perhaps initiated by a rapidly growing cerebellum, which leads to congestion of the venous drainage with subsequently compromised cerebrospinal fluid reabsorption, all of which increases the posterior fossa pressure and leads to acquired tonsillar herniation. We make a distinction between congenital Chiari I malformation and acquired cerebellar tonsil herniation in this syndrome. We also observed numerous examples of abnormal cortical morphogenesis, including focal cortical dysplasia, polymicrogyria which primarily involved the perisylvian and insular regions, and cerebral and/or cerebellar asymmetric overgrowth. Other findings included a high frequency of cavum septum pellucidum or vergae, thickened corpus callosum, prominent optic nerve sheaths and a single case of venous sinus thrombosis. One patient was found to have a frontal perifalcine mass resembling a meningioma at age 5 years. This is the second apparent occurrence of this specific tumor in M-CM.
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Jeong ST, Song HR, Keny SM, Telang SS, Suh SW, Hong SJ. MRI study of the lumbar spine in achondroplasia. A morphometric analysis for the evaluation of stenosis of the canal. ACTA ACUST UNITED AC 2006; 88:1192-6. [PMID: 16943471 DOI: 10.1302/0301-620x.88b9.17758] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We carried out an MRI study of the lumbar spine in 15 patients with achondroplasia to evaluate the degree of stenosis of the canal. They were divided into asymptomatic and symptomatic groups. We measured the sagittal canal diameter, the sagittal cord diameter, the interpedicular distance at the mid-pedicle level and the cross-sectional area of the canal and spinal cord at mid-body and mid-disc levels. The MRI findings showed that in achondroplasia there was a significant difference between the groups in the cross-sectional area of the body canal at the upper lumbar levels. Patients with a narrower canal are more likely to develop symptoms of spinal stenosis than others.
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Affiliation(s)
- S-T Jeong
- 1Department of Orthopaedics, Gyeong-Sang National, University, Jinju, Korea
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Keny SM, Suh SW, Song HR, Vaidya SV, Machavarapu MM. Morphometric Determinants of the Sagittal Dimensions of the Cervical Spinal Canal in Achondroplasia. ACTA ACUST UNITED AC 2006; 19:523-7. [PMID: 17021417 DOI: 10.1097/01.bsd.0000211218.28566.99] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was undertaken to evaluate the accuracy of the Torg ratio for predicting the spinal canal stenosis in achondroplasia, by trying to establish its correlation with the corresponding effective sagittal canal diameter (ESCD) and dural sac ratio (DSR) on the MRI of the cervical spine. Lateral radiographs and the sagittal and axial MRI study of the cervical spine from C3 to C7 level were carried out in 18 asymptomatic achondroplasia subjects. A total of 90 levels were evaluated on the lateral radiographs and on the mid sagittal T2 MR images. On statistic analysis, the highest correlation coefficient for the Torg ratio compared with the ESCD was 0.74 at C6 level and the least was 0.45 at the C5 level. The highest correlation coefficient between the Torg ratio and the DSR was 0.79 at C3 level and the least was 0.42 at the C5 level. The highest coefficient of determination for the ESCD was 54% at C6 which translates into a poor correlation. The highest coefficient of determination for the DSR was 62 at C3 level, indicating a variable correlation. These results clearly show that the Torg ratio is of limited value in the assessment of the true sagittal spinal canal diameter in achondroplasia and its reliability as an indicator of severe cervical canal stenosis is questionable.
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Affiliation(s)
- Swapnil M Keny
- Department of Orthopedics, Korea University, Guro Hospital, Guro-Dong, Guro-Gu, Seoul, South Korea
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Abstract
INTRODUCTION This article addresses the relevance of venous hypertension to children born with, in particular, the "syndromic" forms of craniosynostosis. The development of the human cerebral venous system is summarised and the patterns of anomalous venous drainage seen in children with complex forms of craniosynostosis associated with raised intracranial pressure are described. AETIOLOGY The aetiology of these abnormal patterns is discussed under the general headings of "The constriction theory", "A primary role for FGFR mutations" and "Persistence of the foetal pattern of intracranial venous drainage."Venous hypertension (along with hydrocephalus, cranio-cerebral disproportion and airway obstruction) has an important role in the aetiology of raised intracranial pressure in severely affected children. TREATMENT The inter-relationship between these factors is explained and then the treatment of those children whose raised intracranial pressure is considered to be due predominantly to venous hypertension is described.
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Abstract
Achondroplasia is the most common condition associated with disproportionate short stature. Substantial information is available concerning the natural history and anticipatory health supervision needs in children with this dwarfing disorder. Most children with achondroplasia have delayed motor milestones, problems with persistent or recurrent middle-ear dysfunction, and bowing of the lower legs. Less often, infants and children may have serious health consequences related to hydrocephalus, craniocervical junction compression, upper-airway obstruction, or thoracolumbar kyphosis. Anticipatory care should be directed at identifying children who are at high risk and intervening to prevent serious sequelae. This report is designed to help the pediatrician care for children with achondroplasia and their families.
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