Atlanto-occipital fusion: Case report

Authors

DOI:

https://doi.org/10.33448/rsd-v12i14.44513

Keywords:

Atlanto-occipital function; Assimilation of the atlas; Vertebral artery variation.

Abstract

The article discusses cranio-cervical joints, specifically the atlanto-occipital and atlantoaxial joints. The atlanto-occipital joints include the occipital condyle and the superior articular surfaces of the first cervical vertebra (C1 or Atlas), allowing flexion, extension and lateral tilt of the head. The atlantoaxial joints include C1 and C2 (Axis) vertebrae, enabling rotation. Atlanto-occipital fusion is a rare congenital condition in which C1 fuses with the occipital bone of the skull. This can lead to narrowing of the Foramen Magnum, with or without compression of central structures (spinal cord or brain stem). Although this condition can be asymptomatic, when associated with other cranio-cervical anomalies, such as Basilar Invagination and Platybasia, it can bring instability to the neck, in addition to tonsillar herniation, neural compression and cerebral ischemia. This condition is related to an embryonic malformation of the Pro Atlas, which can occur in different regions of the joint. Furthermore, the type of fusion can vary, eventually resulting in stress at the C1-C2 junction, leading to subluxations and neurovascular complications. Despite its rarity, preoperative diagnosis using computed tomography or magnetic resonance imaging is essential to identify these changes and avoid injuries during surgery. In conclusion, atlanto-occipital fusion is a rare condition that, when associated with other anomalies, can cause damage to the central nervous system, highlighting the importance of adequate diagnosis and treatment. The objective of the study is to illustrate, discuss and investigate the prevalence of atlanto-occipital fusion in human skulls, which the authors found one case among the 117 skulls analyzed.

References

Abumi, K., Avadhani, A., Manu, A., & Rajasekaran, S. (2010). Occipitocervical fusion. European Spine Journal, 19(2), 355–356. https://doi.org/10.1007/s00586-010-1303-3

Al-Motabagani, M. A., & Surendra, M. (2006). Total occipitalization of the atlas. Anatomical science international, 81, 173-180.

Canelas, H. M., Zaclis, J., & Tenuto, R. A. (1952). Contribuição ao estudo das malformações occipito-cervical, particularmente da impressão basilar. Arquivos de Neuro-Psiquiatria, 10(4), 407–476. https://doi.org/10.1590/S0004-282X1952000400001

Chi, Y.-Y., Zhuang, J., Jin, G., Hack, G. D., Song, T.-W., Sun, S.-Z., Chen, C., Yu, S.-B., & Sui, H.-J. (2022). Congenital Atlanto-Occipital Fusion and its Effect on the Myodural Bridge: A Case Report Utilizing the P45 Plastination Technique. International Journal of Morphology, 40(3), 796–800. https://doi.org/10.4067/S0717-95022022000300796

Cirpan, S., Yonguc, G. N., Mas, N. G., Aksu, F., & Magden, A. O. (2016). Morphological and morphometric analysis of foramen magnum: an anatomical aspect. Journal of Craniofacial Surgery, 27(6), 1576-1578.

Debernardi, A., D’Aliberti, G., Talamonti, G., Villa, F., Piparo, M., & Collice, M. (2011). The Craniovertebral Junction Area and the Role of the Ligaments and Membranes. Neurosurgery, 68(2), 291–301. 10.1227/NEU.0b013e3182011262

Iwanaga, J., Singh, V., Takeda, S., Ogeng’o, J., Kim, H., Moryś, J., Ravi, K. S., Ribatti, D., Trainor, P. A., Sañudo, J. R., Apaydin, N., Sharma, A., Smith, H. F., Walocha, J. A., Hegazy, A. M. S., Duparc, F., Paulsen, F., Del Sol, M., Adds, P., & Tubbs, R. S. (2022). Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: Recommendations from Anatomical Journal Editors‐in‐Chief. Clinical Anatomy, 35(4), 526–528. 10.1002/ca.23849

Joaquim, A. F., Barcelos, A. C. E. S., & Daniel, J. W. (2021). Role of Atlas Assimilation in the Context of Craniocervical Junction Anomalies. World Neurosurgery, 151, 201–208. 10.1016/j.wneu.2021.05.033

Kagawa, M., Jinnai, T., Matsumoto, Y., Kawai, N., Kunishio, K., Tamiya, T., & Nagao, S. (2006). Chiari I malformation accompanied by assimilation of the atlas, Klippel-Feil syndrome, and syringomyelia: case report. Surgical Neurology, 65(5), 497–502. 10.1016/j.surneu.2005.06.034

Kassim, N. M., Latiff, A. A., Das, S., Ghafar, N. A., Suhaimi, F. H., Othman, F., Hussan, F., & Sulaiman, I. M. (2010). Atlanto-occipital fusion: an osteological study with clinical implications. Bratislavske Lekarske Listy, 111(10), 562–565.

Kim, M. S. (2015). Anatomical Variant of Atlas: Arcuate Foramen, Occpitalization of Atlas, and Defect of Posterior Arch of Atlas. Journal of Korean Neurosurgical Society, 58(6), 528. 10.3340/jkns.2015.58.6.528

Menezes, A. H., & Dlouhy, B. J. (2020). Atlas assimilation: spectrum of associated radiographic abnormalities, clinical presentation, and management in children below 10 years. Child’s Nervous System, 36(5), 975–985. 10.1007/s00381-019-04488-3

Moore, K. L., & Dalley, A. F. (2019). Anatomia Orientada para a Clínica (8th ed.). Guanabara Koogan.

Natsis, K., Lyrtzis, C., Totlis, T., Anastasopoulos, N., & Piagkou, M. (2017). A morphometric study of the atlas occipitalization and coexisted congenital anomalies of the vertebrae and posterior cranial fossa with neurological importance. Surgical and Radiologic Anatomy, 39(1), 39–49. 10.1007/s00276-016-1687-9

Netter, F. H. (2013). The Netter Collection of Medical Illustrations: Musculoskeletal System Part II—Spine and Lower Limb (2nd ed.). Elsevier.

Piplani, S., & Kullar, J. (2017). Occipitalization of Atlas: A Case Report with its Ontogenic Basis and Review of Literature. AMEI’s Current Trends in Diagnosis & Treatment, 1(1), 34–37. 10.5005/jp-journals-10055-0007

Pires, L. A., Teixeira, Á. R., Leite, T. F., Babinski, M. A., & Chagas, C. A. (2016). Morphometric aspects of the foramen magnum and the orbit in Brazilian dry skulls. International Journal of Medical Research & Health Sciences, 5(4), 34-42.

Radinsky, L. (1967) Relative brain size: a new measure. Science. 155(3764):836-8. 10.1126/science.155.3764.836.

Sharma, D. K., Sharma, D., & Sharma, V. (2017). Atlantooccipital fusion: Prevalence and its developmental and clinical correlation. Journal of Clinical and Diagnostic Research, 11(6), AC01–AC03. 10.7860/JCDR/2017/26183.9999

Skrzat, J., Walocha, J., & Goncerz, G. (2011). Possible compression of the atlantal segment of the vertebral artery in occipitalisation. Folia Morphologica, 70(4), 287–290.

Tubbs, R. S., Lancaster, J. R., Mortazavi, M. M., Shoja, M. M., Chern, J. J., Loukas, M., & Cohen-Gadol, A. A. (2011). Morphometry of the outlet of the foramen magnum in crania with atlantooccipital fusion. Journal of Neurosurgery: Spine, 15(1), 55–59. https://doi.org/10.3171/2011.3.SPINE10828

Wang, S., Wang, C., Liu, Y., Yan, M., & Zhou, H. (2009). Anomalous Vertebral Artery in Craniovertebral Junction With Occipitalization of the Atlas. Spine, 34(26), 2838–2842. 10.1097/BRS.0b013e3181b4fb8b

Downloads

Published

21/12/2023

How to Cite

CRUZ, L. B. V. da .; FALEIROS , M. C. .; GUIMARÃES, H. M. .; SUGINO, R. L. .; CARVALHO, C. A. M. de .; BARBOSA, M. M. .; VERRI, E. D. . Atlanto-occipital fusion: Case report. Research, Society and Development, [S. l.], v. 12, n. 14, p. e83121444513, 2023. DOI: 10.33448/rsd-v12i14.44513. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/44513. Acesso em: 5 nov. 2024.

Issue

Section

Health Sciences