Traumatic atlanto-occipital dissociation: No longer a death sentence

Filiberto, Dina M.; Sharpe, John P.; Croce, Martin A.; Fabian, Timothy C.; Magnotti, Louis J.

doi:10.1016/j.surg.2018.05.011

“…The adipose tissues compartmented by thin fibrous septa were widely distributed between the occiput and dens as a fat pad and posteriorly supported by the TM. The typical presence of the fat pad in the supradental space directly visualized on CT and MRI exams allows improvement of the sensitivity for diagnosing major CVJ injuries and further expedite follow-up cervical www.nature.com/scientificreports/ MRI to evaluate the remaining major CVJ ligaments for injury 20 . Although the venous plexus in this space has been thought to communicate with the extradural venous plexus and drained into the intraspinal plexus [21][22][23][24] , studies on their exact origins are insufficient.…”

Section: Discussionmentioning

confidence: 99%

An anatomical and radiological study of the tectorial membrane and its clinical implications

Lee

¹

,

Cho

²

,

Kwon

³

et al. 2022

Sci Rep

0

1

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The radiological image of an intact tectorial membrane (TM) became an important favorable prognostic factor for craniovertebral instability. This study visualized the fascial layers of the TM and adjacent connective tissues with clinical significance by micro-CT and histological analysis. The TM firmly attached to the bony surface of the clivus, traversed the atlantoaxial joint posteriorly, and was inserted to the body of the axis showing wide distribution on the craniovertebral junction. The supradental space between the clivus, dens of the axis, anterior atlantooccipital membrane, and the TM contained profound venous networks within the adipose tissues. At the body of the axis, the compact TM layer is gradually divided into multiple layers and the deeper TM layers reached the axis while the superficial layer continued to the posterior longitudinal ligament of the lower vertebrae. The consistent presence of the fat pad and venous plexus in the supradental space and firm stabilization of the TM on the craniovertebral junction was demonstrated by high-resolution radiologic images and histological analysis. The evaluation of the TM integrity is a promising diagnostic factor for traumatic craniovertebral dislocation.

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“…In the setting of signi cant cervical hyper exion-hyperextension injury in adult patients, the TM may tear with a resultant shearing injury of the adjacent venous plexus in the supradental space causing the "supradental sign" -the hematoma formation and effacement of the fat pad in the supradental space 19 . The typical presence of the fat pad directly visualized on CT and MRI exams allows improvement of the sensitivity for diagnosing major CVJ injuries and further expedite follow-up cervical MRI to evaluate the remaining major CVJ ligaments for injury 20 . Although the venous plexus in this space has been thought to communicate with the extradural venous plexus and drained into the intraspinal plexus [21][22][23][24] , studies on their exact origins are insu cient.…”

Section: Discussionmentioning

confidence: 99%

An anatomical and radiological study of the tectorial membrane and supradental venous plexus: its clinical significance in traumatic craniovertebral dislocation

Lee

¹

,

Cho

²

,

Kwon

³

et al. 2022

Preprint

0

View full text Add to dashboard Cite

The radiological image of an intact tectorial membrane (TM) became an important favorable prognostic factor for craniovertebral instability. This study visualized the fascial layers of the TM and adjacent connective tissues with clinical significance by micro-CT and histological analysis. The TM firmly attached to the bony surface of the clivus, traversed the atlantoaxial joint posteriorly, and was inserted to the body of the axis showing wide distribution on the craniovertebral junction. The supradental space between the clivus, dens of the axis, anterior atlantooccipital membrane, and the TM contained profound venous networks within the adipose tissues. At the body of the axis, the compact TM layer is gradually divided into multiple layers and the deeper TM layers reached the axis while the superficial layer continued to the posterior longitudinal ligament of the lower vertebrae. The consistent presence of the fat pad and venous plexus in the supradental space and firm stabilization of the TM on the craniovertebral junction was demonstrated by high-resolution radiologic images and histological analysis. The evaluation of the TM integrity is a promising diagnostic factor for traumatic craniovertebral dislocation.

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“…2 However, recent studies and case reports have demonstrated increased numbers of survivors with improved neurologic outcomes, which is attributed to advancements in prehospital care, field resuscitation, cervical immobilization, and rapid transport to a trauma center. 3 Missed or delayed diagnosis of traumatic AOD is relatively common and is associated with worsening neurologic function and outcome. 4 Emergency physicians should have a high suspicion of the diagnosis of AOD in patients presenting with shock, mental change, and motor weakness after a blunt, high-energy injury.…”

Section: Discussionmentioning

confidence: 99%

“…Traumatic AOD is associated with a high mortality rate and devastating neurologic morbidity, so it was once thought to be uniformly fatal 2 . However, recent studies and case reports have demonstrated increased numbers of survivors with improved neurologic outcomes, which is attributed to advancements in prehospital care, field resuscitation, cervical immobilization, and rapid transport to a trauma center 3 . Missed or delayed diagnosis of traumatic AOD is relatively common and is associated with worsening neurologic function and outcome 4 .…”

Section: Discussionmentioning

confidence: 99%