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Atlantal hemi-rings and craniocervical instability: identification, clinical characteristics, and management.
MedLine Citation:
PMID:  21961540     Owner:  NLM     Status:  In-Data-Review    
Object Congenital craniovertebral anomalies are relatively common, but anomalies leading to overt craniocervical instability may be difficult to recognize and treat. The authors present a series of patients with atlantal hemi-rings, a disorder resulting in congenital craniovertebral instability. Presentation, treatment, imaging, and follow-up data obtained in patients with atlantal hemi-rings were assessed to identify factors relevant to craniocervical instability. Methods Nineteen patients were identified with atlantal hemi-rings, defined as a bony discontinuity of the C-1 ring in conjunction with lateral displacement of the C-1 lateral masses (as seen on coronal CT scans). Clinical and radiological characteristics were analyzed, including patient age at presentation, extent of occipitocervical motion, amount of C-1 lateral mass displacement, associated craniocervical anomalies, integrity of the transverse ligament, and neurological status. Results The mean patient age at presentation was 22 months (range birth to 9 years). The mean amount of occipitocervical translation seen on dynamic imaging was 9 mm (range 2-20 mm). Four patients required occipitocervical fusion at presentation. The remaining 15 patients were monitored for a mean of 20 months, and 9 ultimately underwent fusion. Surgery was also recommended for 4 of the remaining 6 children. Conclusions This report describes the radiological and clinical characteristics of patients with atlantal hemirings and craniocervical instability. The authors believe that this anomaly is the underlying cause of progressive instability in a significant proportion of patients with craniocervical abnormalities. The presence of atlantal hemi-rings should prompt immediate and thorough neurosurgical evaluation.
Douglas L Brockmeyer; Meghan M Brockmeyer; Taryn Bragg
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  8     ISSN:  1933-0715     ISO Abbreviation:  J Neurosurg Pediatr     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  357-62     Citation Subset:  IM    
Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and.
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