Les espaces intervertébraux postérieurs de la jointure crânio-rachidienne

Kahn, J.L.; Sick, H.; Koritké, J.G.

doi:10.1159/000147287

Cited by 20 publications

(17 citation statements)

References 3 publications

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“…Instead of the classical membranes, thin expansions of some muscular fascia descend directly to the dura mater. These findings are in agreement with the first description of the atlanto-occipital level by Kahn et al 3 and further corroborated by Hack et al 7 and Scali et al 2,5 . At the C1-C2 level, our observations differed from the reports of Mitchell et al 8 and Dean and Mitchell 9 that described an attachment of the ligamentum nuchae to the cervical posterior dura mater.…”

Section: Discussionsupporting

confidence: 92%

“…Surprisingly, we did not find the classical membranes in the deep posterior occipito-cervical region. These observations are in agreement with more recent anatomical studies, which demonstrate that these classical membranes are not part of the closing tissues of this region 2,3,4,5 . Our study provides a better understanding of the anatomical aspects of this region's closing structures, as well as their implication in surgical approaches to the occipito-cervical region.…”

supporting

confidence: 93%

“…In 1992, Khan et al 3 conducted a study on the posterior intervertebral spaces of the craniovertebral junction and observed the absence of the atlanto-axial membrane. Pimenta and cols.…”

Section: Discussionmentioning

confidence: 99%

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Posterior atlanto-occipital and atlanto-axial area and its surgical interest

Pimenta

Gusmão

Kehrli

2014

Arq. Neuro-Psiquiatr.

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Classic anatomical studies describe two membranes -atlanto-occipital and atlanto-axial in the posterior aspect of the craniocervical region. During many surgical procedures in this area, however, we have not found such membranes. Objective: To clarify the anatomical aspects and structures taking part of the posterior atlanto-occipital and atlanto-axial area. Method: Analysis of histological cuts of three human fetuses and anatomical studies of 8 adult human cadavers. Results: In both atlanto-occipital and atlanto-axial areas, we have observed attachment between suboccipital deep muscles and the spinal cervical dura. However, anatomical description of such attachments could not be found in textbooks of anatomy. Conclusion: Our study shows the absence of the classical atlanto-occipital and atlanto-axial membranes; the occipito-C1 and C1-C2 posterior intervals are an open area, allowing aponeurotic attachment among cervical dura mater and posterior cervical muscles.Keywords: posterior atlanto-occipital membrane, atlanto-axial area, neurosurgery. RESUMOEm livros clássicos de anatomia é referida a existência de duas membranas, atlanto-occipital e atlanto-axial, participando do fechamento da região cranio-cervical. Entretanto, em frequentes procedimentos cirúrgicos que envolvem esta região, jamais detectamos a presença de tais membranas. Objetivo: Estudar os aspectos anatômicos e as estruturas que participam do fechamento posterior dos espaços atlanto-occipital e atlanto-axial. Método: Estudo de cortes histológicos de três fetos humanos e estudos anatômicos em 8 cadáveres humanos adultos. Resultados: Em ambos os espaços, atlanto-occipital e atlanto-axial, encontramos uma aderência entre as estruturas musculares profundas e a dura-mater, sem as membranas atlanto-occipital e atlanto-axial descritas nos livros clássicos de anatomia. Conclusão: Não foram encontradas as membranas atlanto-occipital e atlanto-axial no material estudado; os espaços atlanto-occipital e atlanto-axial são abertos permitindo expansões aponeuróticas entre os músculos profundos e a dura-mater.Palavras-chave: membrana atlanto-axial posterior, área atlanto-axial, neurocirurgia.The posterior craniocervical junction is composed of bony and ligamentous structures that together are responsible for biomechanical stability. The atlanto-axial and atlanto-occipital membranes have been described, but their detailed anatomy, histology and biomechanics have not been clarified. This region may be affected by several pathologies, particularly by trauma, tumors and congenital malformations. Thus, a better understanding of its anatomy is essential for surgeons involved in spine care.The atlanto-occipital and atlanto-axial membranes have been described by many authors 1,2 . Pernkopf and Fick initially questioned this anatomical description, in 1952 and 1904, respectively. They noted that the atlanto-occipital membrane differs from the ligamentum flavum, and that it may be absent in some cases in which the dura mater itself constitutes the sole closing of the...

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Section: Discussionsupporting

confidence: 92%

supporting

confidence: 93%

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Posterior atlanto-occipital and atlanto-axial area and its surgical interest

Pimenta

Gusmão

Kehrli

2014

Arq. Neuro-Psiquiatr.

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“…This bridge travels through the posterior atlantoaxial interspace and links these muscles to the cervical dura mater [1], [5], [8], [11]–[15].…”

Section: Introductionmentioning

confidence: 99%

Definition of the To Be Named Ligament and Vertebrodural Ligament and Their Possible Effects on the Circulation of CSF

Zheng

Yuan

et al. 2014

PLoS ONE

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Few studies have been conducted specifically on the dense connective tissue located in the posterior medial part of the cervical epidural space. This study was undertaken to examine the presence of this connection between the cervical dura mater and the posterior wall of spinal canal at the level of C1–C2. 30 head-neck specimens of Chinese adults were used. Gross dissection was performed on the suboccipital regions of the 20 specimens. Having been treated with the P45 plastination method, 10 specimens were sliced (9 sagittal and 1 horizontal sections). As a result, a dense fibrous band was identified in the nuchal ligament of 29 specimens (except for one horizontal section case). This fascial structure arose from the tissue of the posterior border of the nuchal ligament and then projected anteriorly and superiorly to enter the atlantoaxial interspace. It was termed as to be named ligament (TBNL). In all 30 specimens the existence of a fibrous connection was found between the posterior aspect of the cervical dura mater and the posterior wall of the spinal canal at the level of the atlas to the axis. This fibrous connection was identified as vertebrodural ligament (VDL). The VDL was mainly subdivided into three parts, and five variations of VDL were identified. These two structures, TBNL and VDL, firmly link the posterior aspect of cervical dura mater to the rear of the atlas-axis and the nuchal region. According to these findings, the authors speculated that the movements of the head and neck are likely to affect the shape of the cervical dural sleeve via the TBNL and VDL. It is hypothesized that the muscles directly associated with the cervical dural sleeve, in the suboccipital region, may work as a pump providing an important force required to move the CSF in the spinal canal.

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“…Soft tissue connections extending from the suboccipital muscles and the nuchal ligament to the spinal dura mater and their role have been studied recently. In 1992, these fascial communications were briefly described by Khan and Kortiké () in a report of the posterior intervertebral spaces of the craniovertebral joint. Hack et al (), who proposed the concept of a myodural bridge in 1995, believed that the myodural bridge is a connective tissue bridge that connected the rectus capitis posterior minor muscle to the spinal dura mater via the posterior atlanto‐occipital interspace.…”

mentioning

confidence: 99%

Connection of the Posterior Occipital Muscle and Dura Mater of the Siamese Crocodile

Zhang

Tang

Zhang

et al. 2016

The Anatomical Record

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The myodural bridge was proposed initially in 1995. The myodural bridge is a connective tissue bridge that connects a pair of deep muscles at the suboccipital region to the dura mater. There have been numerous studies concerning the morphology and function of the myodural bridge. To determine whether a myodural bridge exists in reptiles, six Siamese crocodiles were investigated using gross anatomy dissection and P45 sheet plastination technologies. As a result, we demonstrated that the posterior occipital muscles of the Siamese crocodile are directly or indirectly connected to the proatlas, atlas, and intermembrane between them. Multiple trabeculae existing in the posterior epidural space extended from the ventral surface of the proatlas, atlas, and intermembrane between them to the dorsal surface of the spinal dura mater. This study showed that the posterior occipital muscle in the suboccipital region of the Siamese crocodile is connected to the spinal dura mater through the proatlas, atlas, and the trabeculae. In conclusion, a myodural bridge-like structure exists in reptiles. This connection may act as a pump to provide cerebrospinal fluid (CSF) circulation at the occipitocervical junction. We hypothesize that a physiologic role of the Siamese crocodile's myodural bridge may be analogous to the human myodural bridge. Anat Rec, 299:1402-1408, 2016. © 2016 Wiley Periodicals, Inc.

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Les espaces intervertébraux postérieurs de la jointure crânio-rachidienne

Cited by 20 publications

References 3 publications

Posterior atlanto-occipital and atlanto-axial area and its surgical interest

Posterior atlanto-occipital and atlanto-axial area and its surgical interest

Definition of the To Be Named Ligament and Vertebrodural Ligament and Their Possible Effects on the Circulation of CSF

Connection of the Posterior Occipital Muscle and Dura Mater of the Siamese Crocodile

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