The well-known neurological disturbances associated with caudal displacement of the cerebellar tonsils through the fora men magnum (Chiari malformation) have lead to many radiological studies of the region. With MRI, routine sagittal and parasagittal views of the craniovertebral junction have shown that the position of the cerebellar tonsils is variable, and in many otherwise healthy individuals, the inferior tonsillar margins lie within the fora men magnum itself. In some cases, this topography is associated with little signal from the surrounding cerebra-spinal fluid (CSF), indicating reduction of the cerebellomedullary cistern and, therefore, crowding of neural structures within the confines of the fora men. The objective of this study has been to examine the spatial relationship between the contents of the foramen magnum ie. the medulla and cerebellar tonsils, using a normal sample comprising 120 volunteers. Instead of the conventional measurements of distance, a ratio, the Foramen Magnum Index (FMI), has been determined, derived from the relative surface areas (pixels) of neural parenchyma and CSF, over axially and sagittaly-defined boundaries of the fora men. The FMI, with a 95th centile of 0.77, exhibits appropriate statistical correlation with tonsillar position below the level of the foramen, and is therefore considered specific. As a quantitative means of assessing the cerebellomedullary cistern, the FMI also identifies certain subjects whose tonsils are at the foramen, in whom the cistern is small with resultant neural crowding.

Introduction Achondroplasia is associated with foramen magnum stenosis (FMS) which can lead to sudden unexpected death in infants. There is no wide consensus regarding the best management of FMS. Aim The study aimed to describe the prevalence of FMS in a population of children with achondroplasia and to evaluate screening and neurosurgical interventions of FMS in regard to its effects and complications. Material and Methods This is a retrospective cohort study including all children with achondroplasia assessed or treated at Karolinska University Hospital between September 2005 to June 2020. Severity of FMS was graded using MRI Achondroplasia Foramen Magnum Score (AFMS). AFMS was correlated to neurological exams and polysomnography results. Results 51 children were included and severe FMS (AFMS3-4) was present in 35%. Sixty-five percent of the children underwent foramen magnum decompression (FMD). Neurological examination had a high specificity (94%), but a low sensitivity (28%) for severe FMS. Signs of central apnea on polysomnography did not correlate to severity of FMS (p=0.735). Surgery improved FMS (p<0.001) and decreased central apnea (p=0.070), but carried a risk of 9% for severe complications. Conclusions This study suggests that severe FMS is common in children with achondroplasia, that neurological symptoms may be absent even in severe FMS, and that FMD improves both FMS and central apnea. In order to limit morbidity and mortality by identifying children with severe FMS in need of FMD, we recommend routine MRI on all children with achondroplasia.

No description available.

Biometrische und funktionsanalytische Röntgenuntersuchungen des Kopf-Hals-Überganges von in dieser Region nicht erkrankten Hunden der Rasse Deutscher Schäferhund sowie verschiedener Zwergrassen werden verglichen. Für die Morphologischen Untersuchungen werden standardisiert gelagerte Röntgenaufnahmen von 129 anästhesierten Hunden angefertigt und die Parameter Atlaslänge, Axislänge (ohne Dens), Denslänge, Länge von C3 sowie Breite und Höhe des Foramen magnum vermessen. Die zur Länge von C3 ins Verhältnis gesetzten Längenparameter ergeben für Deutsche Schäferhunde eine signifikant größere relative Länge des dorsalen Atlasbogen (0,72 ± 0,07) als für Yorkshire Terrier (0,64 ± 0,08) und eine größere relative Länge des Dens axis beim Deutschen Schäferhund (0,40 ± 0,04) als bei Yorkshire Terriern (0,33 ± 0,05) und Zwergrassen allgemein (0,34 ± 0,06). Die relative Länge des Axiskörpers differierte dagegen unwesentlich. Der radiologisch ermittelte Foramen-magnum-Index ist bei den untersuchten Zwergrassen (0,57 ± 0,11) deutlich geringer als er bei kleinen Rassen mit dorsaler Kerbe des Foramen magnum (Mazerationspräparate) in der Literatur beschrieben wird. Für die Funktionsanalyse wird ein in der Humanmedizin etabliertes Verfahren nach ARLEN (1979) auf den Kopf-Hals-Übergang des Hundes angewandt und die Differenz der Intervertebralwinkel zwischen maximaler Beugung und Streckung im Bereich des Kopf-Hals-Überganges gemessen. Für Deutsche Schäferhunde wird eine signifikant höhere Beweglichkeit im Atlantookzipitalgelenk (89,26° ± 9,12°) als bei Zwergrassen (77,43° ± 11,91°) gemessen. Die Beweglichkeit im Bereich des Atlantoaxialgelenkes ist bei Zwergrassen (26,37° ± 6,32°) signifikant größer als bei Deutschen Schäferhunden (20,69° ± 5,29°). Bei der Beurteilung der funktionsanalytischen Parameter in Zusammenhang mit den morphologischen Parametern ergibt sich für die Rasse Yorkshire Terrier ein geringerer Bewegungsausschlag im Atlantookzipitalgelenk bei kurzem Dens (72,91° ± 11,82°) im Vergleich zum langen Dens (83,78° ± 10,34°). Eine positive Korrelation zwischen Denslänge und Bewegungsausschlag im Atlantookzipitalgelenk (r = 0,25) und eine negative Korrelation zwischen Atlaslänge und Bewegungsausschlag im Atlantoaxialgelenk (r = - 0,19) werden statistisch gesichert. Die Arbeit ist Grundlagenforschung, deren Ergebnisse verglichen mit Messwerten von im Kopf-Hals-Übergang funktionell erkrankten Hunden zu Aussagen mit klinischer Relevanz führen kann.

Orientador: Paulo Henrique Ferreira Caria / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-13T11:52:52Z (GMT). No. of bitstreams: 1 Manoel_Cristiano_M.pdf: 2133778 bytes, checksum: 24f1ce494393f39e56ad26c09d34e4bb (MD5) Previous issue date: 2009 / Resumo: Metodos Craniometricos, tem sido regularmente aplicado na determinacao do genero em diversas regioes mundiais. Avaliar morfometricamnte o indice de confiabilidade de tre metodologias distintas para determinacao do genero na populacao brasileira. Foram avaliados 215 cranios humanos brasileiros com genero, idade e etnia identificados, pertencentes a Universidade Federal de Sao Paulo. Foram utilizadas as metodologias, do cranio, area do triangulo mastoideo e do forame magno, de acordo com os criterios, estabelecidos por Yscan & Steyn (1999), Kemkes & Gobel (2006) e Gunay & Altinkok (2000). Os valores obtidos foram submetidos a analise estatistica, calculo do coeficiente de correlacao Intra-classe, test t student, com nivel de significancia de 5%, regressao logistica multipla, odss Ratio, Mann-Whitney e ANOVA multivariada. A analise por meio do metodo craniometrico revelou que o genero influenciou (p<0,05) em todas as mensuracoes. Nao houve diferenca significante da posicao do processo mastoide entre os grupos etnicos e os generos (p>0,05), porem houve prevalencia do genero masculino sobre o feminino nas mensuracoes Po-Ms e As - Po (p<0,05). A analise estatistica (ANOVA e Tukey test) revelou que o genero influenciou na largura do forame magno, sendo os masculinos (30,3±0,20) maiores que os femininos (29,4±0,23), mas nao o comprimento (p<0,05). As tres diferentes metodologias empregadas apresentaram diferencas morfometricas entre os generos para as caracteristica craniofaciais do brasileiro. Portanto, em conjunto com outras tecnicas antropologicas pode contribuir para a determinacao do genero de individuos desconhecidos. / Abstract: Craniometryc methods, has been regularly applied, for providing assistance in the gender determination in various regions in the worldwide. To evaluate morphometrically the reliability of three differents methodologies for gender determination in Brazilian population. Were evaluated 215 Brazilians human skulls with gender, age and ethnicity previously identified, belong to the Federal University of Sao Paulo. The following methodology, the skull craniometry, triangle mastoid area and foramen magnum, according to the criteria established by Yscan & Steyn (1999), Gobel & Kemkes (2006) and Gunay & Altinkok (2000). The datas were submitted to statistical analysis, Intra-class correlation coefficient, student t test, with level significance 5%, multiple logistic regression, odss Ratio, Mann-Whitney and multivariate ANOVA. The analysis by the craniometric method showed that gender influenced (p <0.05) in all measurements, more in men than women. There was no significant difference in the mastoid process position between the ethnic groups and genders (p> 0.05), but there was prevalence of male over female in the measurements and the Po-Ms - Po (p <0.05). ANOVA and Tukey test showed that gender influenced the width of the foramen magnum, and the male (30.3 ± 0.20) higher than the female (29.4 ± 0.23) but not the length (p <0.05). The three differents methods show mophometric difference between sexes for the craniofacial characteristics of the Brazilian. Therefore, together with other anthropological techniques can help to determine the gender of unknown individuals and be used in assotiation with medical expertise and odontolegais. / Mestrado / Anatomia / Mestre em Biologia Buco-Dental

Submitted by Natalia de Souza Gonçalves (natalia.goncalves@ufpe.br) on 2016-10-10T12:57:26Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) CLAUDIO VIDAL - COLACAO.pdf: 6023190 bytes, checksum: d165c8659f0d2b209cb4a7a228a33bd7 (MD5) / Made available in DSpace on 2016-10-10T12:57:26Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) CLAUDIO VIDAL - COLACAO.pdf: 6023190 bytes, checksum: d165c8659f0d2b209cb4a7a228a33bd7 (MD5) Previous issue date: 2014-06-13 / A alta prevalência de malformação da junção crânio-vertebral (JCV) no Nordeste do Brasil é historicamente associada ao biótipo braquicefálico também comum nessa região. A ectopia tonsilar, marco anatomopatológico da Malformação de Chiari tipo I (MC I), pode ser entendida no contexto de uma desproporção vigente entre o continente (crânio) e seu conteúdo (tecido nervoso) resultante de uma fossa posterior de pequenas dimensões. A forma mais adequada de se tratar a MC I é um dos tópicos mais controversos da neurocirurgia. O presente estudo se propôs a avaliar duas técnicas cirúrgicas comumente empregadas no tratamento da MC I. Métodos: Foram avaliados 32 indivíduos, distribuídos em dois grupos. No Grupo 1, 16 pacientes foram submetidos apenas à descompressão ósteodural da JCV, sem manipulação da membrana aracnoide. No Grupo 2, 16 pacientes foram submetidos à: descompressão ósteodural associada à abertura e dissecção da membrana aracnoide, e redução das tonsilas por termocoagulação e/ou aspiração. A comparação entre os grupos se fundamentou na avaliação de parâmetros clínicos e de Cine Ressonância Magnética do fluxo liquórico, nos períodos que antecederam e sucederam o ato cirúrgico. Resultados: Ambas as técnicas foram equivalentes (p>0,05) em proporcionar melhoria neurológica dos pacientes no período pós-operatório, porém o Grupo 2 cursou com mais complicações pós-operatórias, sendo o risco relativo de 2,45 (I.C.-1,55 a 3,86) para eventos adversos. No que tange à restauração do fluxo liquórico pela JCV no período pósoperatório, a quantidade de LCR que passa pela JCV do Grupo 1 foi maior que no Grupo 2 (p<0,05). Conclusão: A descompressão ósteodural da JCV sem manipulação da aracnoide é a forma mais adequada de tratamento da MC I entre as duas técnicas analisadas / Abnormalities of the craniovertebral junction (CVJ) are highly prevalent in Northeast of Brazil, where it is linked to braquicefalic biotype, also common in this region. The ectopic tonsils are the main anatomopathological feature of the type 1 Chiari Malformation (CM 1) and derived from a small posterior fossa. The best way to treat the CM 1 is one of the most controversial topics in the neurosurgical field. The present study evaluated the two most applied techniques to treat CM 1, by means of clinical and radiological parameters. Methods: A total of 32 patients were evaluated. They were divided in two groups: Group 1 had 16 patients that were submitted to cranio-dural decompression of the CVJ; Group 2 also had 16 patients and in addition to cranio-dural decompression of the CVJ, they also had intra-arachnoid manipulation, including tonsils reductions. These groups were analyzed and compared in terms of neurological exam and cerebrospinal fluid flow imaging by using phase-contrast magnetic resonance technique, in two different times: pre and postoperative periods. Results: Both techniques were equivalents in terms of neurological improvement of the patients (p>0,05), but the Group 2 had more surgical complications, with relative risk for this kind of event, of 2,5. Whatever the cerebrospinal fluid flow at CVJ, the patients of the Group 1 achieved greater amount of flow than the Group 2 (p<0,05) in the postoperative period. Conclusion: The exclusive cranio-dural decompression of the CVJ for treatment of CM 1 had better general results when compared to the addition of intra-arachnoid manipulation to the procedure.

Biometrische und funktionsanalytische Röntgenuntersuchungen des Kopf-Hals-Überganges von in dieser Region nicht erkrankten Hunden der Rasse Deutscher Schäferhund sowie verschiedener Zwergrassen werden verglichen. Für die Morphologischen Untersuchungen werden standardisiert gelagerte Röntgenaufnahmen von 129 anästhesierten Hunden angefertigt und die Parameter Atlaslänge, Axislänge (ohne Dens), Denslänge, Länge von C3 sowie Breite und Höhe des Foramen magnum vermessen. Die zur Länge von C3 ins Verhältnis gesetzten Längenparameter ergeben für Deutsche Schäferhunde eine signifikant größere relative Länge des dorsalen Atlasbogen (0,72 ± 0,07) als für Yorkshire Terrier (0,64 ± 0,08) und eine größere relative Länge des Dens axis beim Deutschen Schäferhund (0,40 ± 0,04) als bei Yorkshire Terriern (0,33 ± 0,05) und Zwergrassen allgemein (0,34 ± 0,06). Die relative Länge des Axiskörpers differierte dagegen unwesentlich. Der radiologisch ermittelte Foramen-magnum-Index ist bei den untersuchten Zwergrassen (0,57 ± 0,11) deutlich geringer als er bei kleinen Rassen mit dorsaler Kerbe des Foramen magnum (Mazerationspräparate) in der Literatur beschrieben wird. Für die Funktionsanalyse wird ein in der Humanmedizin etabliertes Verfahren nach ARLEN (1979) auf den Kopf-Hals-Übergang des Hundes angewandt und die Differenz der Intervertebralwinkel zwischen maximaler Beugung und Streckung im Bereich des Kopf-Hals-Überganges gemessen. Für Deutsche Schäferhunde wird eine signifikant höhere Beweglichkeit im Atlantookzipitalgelenk (89,26° ± 9,12°) als bei Zwergrassen (77,43° ± 11,91°) gemessen. Die Beweglichkeit im Bereich des Atlantoaxialgelenkes ist bei Zwergrassen (26,37° ± 6,32°) signifikant größer als bei Deutschen Schäferhunden (20,69° ± 5,29°). Bei der Beurteilung der funktionsanalytischen Parameter in Zusammenhang mit den morphologischen Parametern ergibt sich für die Rasse Yorkshire Terrier ein geringerer Bewegungsausschlag im Atlantookzipitalgelenk bei kurzem Dens (72,91° ± 11,82°) im Vergleich zum langen Dens (83,78° ± 10,34°). Eine positive Korrelation zwischen Denslänge und Bewegungsausschlag im Atlantookzipitalgelenk (r = 0,25) und eine negative Korrelation zwischen Atlaslänge und Bewegungsausschlag im Atlantoaxialgelenk (r = - 0,19) werden statistisch gesichert. Die Arbeit ist Grundlagenforschung, deren Ergebnisse verglichen mit Messwerten von im Kopf-Hals-Übergang funktionell erkrankten Hunden zu Aussagen mit klinischer Relevanz führen kann.