Impressão basilar e malformação de Arnold-Chiari: considerações técnico-cirúrgicas a propósito de 13 casos

Silva, José A. Gonçalves da; Silva, Cláudio E. Gonçalves da; Brito, Jussara; Sousa, Maricélia B. Rodrigues; Silva, João B. Gonçalves da

doi:10.1590/s0004-282x1978000100003

Cited by 5 publications

(6 citation statements)

References 11 publications

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“…Quanto ao tratamento cirúrgico da siringomielia, empregamos nos 20 casos iniciais a descompressão da fossa posterior proposta por Gardner e Angel 16 , em 1958, acrescida, em alguns casos, de mielotomia mediana ou lateral 22 . Em virtude dos resultados não satisfatórios, praticamos nos 10 casos seguintes a ressecção das amígdalas cerebelares herniadas.…”

Section: Comentáriosunclassified

Achados cirúrgicos em 260 casos de impressão basilar e/ou malformação de Arnold-Chiari

Silva¹,

Brito²,

Nóbrega³

et al. 1994

Arq. Neuro-Psiquiatr.

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RESUMO -A impressão basilar ocupa lugar de destaque entre as malformações occipitocervicais. A forma primária decorre de erro embriogênico, enquanto a forma secundária é causada por afecções ósseas diversas, como doença de Paget, displasia fibrosa, osteoporose e osteomalacia. A descrição original da impressão basilar foi feita por Ackermann 1 , em 1790, em estudos sobre o cretinismo. Virchow 32 , em 1857, denominou-a de platibasia e rejeitou a relação entre impressão basilar e cretinismo, como fora admitida por Ackermann 1 . Virchow 33 , em 1876, denominou a malformação de impressão basilar, tendo descrito detalhadamente as modificações ósseas e sendo o primeiro autor a admitir a origem congênita em muitos de seus casos. Homén 23 , em 1901, foi o primeiro autor a correlacionar os dados clínicos com os achados anátomo-patológicos. A necropsia de seu paciente evidenciou achatamento do bulbo e cerebelo, bem como presença de cavidade cística na medula espinhal. Explicou a patogenia dos sintomas clínicos através da compressão das estruturas comprometidas na invaginação da apófise odontóide. Quanto à clínica, a impressão basilar sintomática pode apresentar síndromes clínicas diversas, isoladas ou combinadas, tais como síndrome dos nervos intracranianos, síndromes sensitivas superficial e profunda, cerebelar, de hipertensão intracraniana, bulbar, medular, de insuficiência vertebrobasi 1 ar 2 , 6 , 2 4 ' 2 5 .

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Section: Comentáriosunclassified

Achados cirúrgicos em 260 casos de impressão basilar e/ou malformação de Arnold-Chiari

Silva¹,

Brito²,

Nóbrega³

et al. 1994

Arq. Neuro-Psiquiatr.

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“…In the following years, patients were treated for craniovertebral abnormalities with decompression of the posterior fossa by enlargement of the opening of the foramen magnum and C1 arch removal. Since then, the optimal treatment for symptomatic cases of BI and/or CM-I is considered surgery with opening of the dura mater (3, 45).…”

Section: Resultsmentioning

confidence: 99%

“…Tenuto et al (47) published a study describing posterior fossa decompression with opening and postsurgical preservation of the pachymeninges. However, the morbidity and mortality in the patients were high due to the possibility that scars had formed in the leptomeninges or tonsillar herniation had occurred (45,48).…”

Section: Resultsmentioning

confidence: 99%

Basilar invagination associated with chiari malformation type I: A literature review

Brito¹,

Santos²,

Nascimento³

et al. 2019

Clinics

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Basilar invagination (BI) and Chiari malformation type I (CM-I) are very important anomalies that introduce instability and compression in the occipitocervical transition region and have complex clinical characteristics. These anomalies vary according to the affected structures. The present study revises current knowledge regarding the anatomy, anatomo-physiology, clinical manifestations, and radiological findings of these entities and the associated surgical treatment approaches. A bibliographic survey was performed through a search in the Medline, PubMed, SciELO, Science and LILACS databases. When associated, these craniovertebral malformations result in neurological deficits due to neural parenchyma compression; however, the presence of microtraumas due to repetitive lesions caused by the bulb and cervical marrow instability has been highlighted as a determinant dysfunction. Surgical treatment is controversial and has many technical variations. Surgery is also challenging due to the complex anatomical characteristics and biomechanics of this region. Nevertheless, advances have been achieved in our understanding of related mechanisms, and compression and atlantoaxial instability are considered key elements when selecting the surgical approach.

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“…For example, brachycephaly is much more prevalent in certain regions, such as northeastern Brazil and Southeast Asia (7,9,13) . Since the 1970s, surgeons in Brazil have reported cases in which CVJ abnormalities and brachycephaly occurred in conjunction (12,29) . It is possible that the morphology of the cranial vault and the shape of the skull base are influenced by the same constitutional factors, being flatter in Brazil than in Europe, for example.…”

Section: Médiamentioning

confidence: 99%

“…Anomalies of the CVJ are particularly common in India and in the northeastern region of Brazil ( 7 - 9 ) ; it is notable that nearly all cases in northeastern Brazil are of type B, whereas nearly half of those in India are of type A. In both of those countries, the reported number of surgical cases is among the largest in the world ( 10 - 12 ) . Studies indicate that type B basilar invagination may be related to the flattened conformation of the calvaria, or brachycephaly, a phenotype found in approximately 80% of the population in northeastern Brazil, a prevalence much higher than that found in samples from western Europe and the North America ( 10 , 13 ) .…”

Section: Introductionmentioning

confidence: 99%

Craniometric parameters for the evaluation of platybasia and basilar invagination on magnetic resonance imaging: a reproducibility study

Silva

Vieira

et al. 2020

Radiol Bras

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Objective: The present study aims to perform a reproducibility study of the clivus-canal angle (CCA), Welcker’s basal angle (WBA), and the distance from the odontoid process to Chamberlain’s line (DOCL) on magnetic resonance imaging (MRI). Materials and Methods: Two medical students and two radiologists respectively evaluated 100 and 50 consecutive MRI scans of adult skulls, selected randomly. Each examiner, working independently and blinded to the previous results, performed readings for each patient on two different occasions. Measurements were performed in T1-weighted sequences acquired in the midsagittal plane. The levels of intraobserver reproducibility and interobserver agreement were evaluated by calculating the intraclass correlation coefficients (ICCs) and the corresponding 95% confidence intervals. Results: The mean values obtained by the examiners were 150° for the CCA, 130° for the WBA, and 2.5 mm for the DOCL. The ICC for interobserver agreement was 0.980, 0.935, and 0.967, for the CCA, WBA, and DOCL, respectively, for the students, compared with 0.977, 0.941, and 0.982, respectively, for the radiologists, and 0.980, 0.992, and 0.990, respectively, for all of the examiners together. In the analysis of intraobserver agreement, the ICC ranged from 0.929 to 0.959 for the CCA, from 0.918 to 0.964 for the WBA, and from 0.918 to 0.981 for the DOCL. Conclusion: The measurement of the CCA, WBA, and DOCL appears to show excellent intraobserver reproducibility and interobserver agreement on MRI.

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Impressão basilar e malformação de Arnold-Chiari: considerações técnico-cirúrgicas a propósito de 13 casos

Cited by 5 publications

References 11 publications

Achados cirúrgicos em 260 casos de impressão basilar e/ou malformação de Arnold-Chiari

Achados cirúrgicos em 260 casos de impressão basilar e/ou malformação de Arnold-Chiari

Basilar invagination associated with chiari malformation type I: A literature review

Craniometric parameters for the evaluation of platybasia and basilar invagination on magnetic resonance imaging: a reproducibility study

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