Foramen Magnum Syndrome Research Articles

OCCIPITALISATION OF ATLAS VERTEBRA AND ITS CLINICAL FRAMES OF REFERENCE- AN ANALYSIS

Vertebral column is made of 33 vertebrae named as cervical, thoracic, lumbar, sacral and coccygeal vertebrae. Axial skeleton comprises of skull and vertebral column. 12 pairs of cranial nerves and 31 pairs of spinal nerves exit from the central nervous system which control the entire body. Malformations or fusion of vertebrae could be one of the etiologies of nerve compression syndromes. Vital structures emerge out through intervertebral foramina extending from cervical to coccygeal vertebrae. Occipitalisation of atlas, the first cervical vertebra is one of the emergencies leading to wide spectrum of presentations like chronic neck pain or foramen magnum syndrome or unconscious state due to compression of medulla oblongata. During routine examination of skull bones while teaching, one skull was found to exhibit assimilation of atlas. Photographs were captured and compared with normal skull. Thorough examination revealed incomplete occipitalisation of atlas. The anterior arch was completely fused but the posterior arch was bifid showing a split. The styloid process on right side seemed to be long and very close leading to compression of structures of styloid apparatus in addition. On observation, it was found to be a male skull. Fusion of vertebrae may be a congenital anomaly due to maldevelopment of somites in forming vertebrae. Skeletal element of caudal 4th occipital somite forms the occipital bone and when it is fused with the proximal 1st cervical somite leads to occipitalisation of atlas. Acquired conditions like atlantoaxial subluxation, chiari malformations or cervical vertebral fusion or foramen magnum abnormalities have been associated with assimilation of atlas. The present study reports occipitalisation of atlas which is incomplete with a bifid posterior arch. Prevalence of such anomalies may form the differential diagnosis of chronic headache or myelopathies.

Two cases of calcium pyrophosphate deposition disease (CPPD) presented with spondylodiscitis.

Calcium pyrophosphate deposition disease (CPPD) is a crystal arthropathy, and may present with various clinical manifestations such as asymptomatic CPPD, osteoarthritis with CPPD, acute CPPD crystal arthritis (formerly pseudogout), and chronic CPPD crystal inflammatory arthritis. It is known that aging, trauma and osteoarthritis are major risk factors for CPPD. Acute CPP arthritis may occur as monoarticular or oligoarticular and usually involves large peripheral joints such as the knees, wrists and ankles. CPPD is characterized by sudden onset of severe pain, swelling and periarticular erythema, and systemic symptoms such as fever, chills, and weakness may occur. On the other hand, axial CPPD has been reported rarely and most cases appear with symptoms related to a mass effect such as foramen magnum syndrome, spinal stenosis, radiculopathy, myelopathy, synovial cyst or cauda equina syndrome. In addition, there are fewer reported cases of spinal CPPD that cause neck and back pain. This clinical condition should be considered in the differential diagnosis of acute neck and back pain.

Foramen magnum syndrome after iatrogenic cerebrospinal fluid leak during lumbar spine surgery: A series of two cases

Foramen magnum syndrome (FMS) is a rare complication from lumbar spine surgery. Cerebrospinal fluid (CSF) leaks can be difficult to treat. FMS is a dangerous complication due to excessive distal CSF drainage from a dural tear or secondary to a “controlled” lumbar drainage. We present two cases of FMS after iatrogenic CSF leaks. Both patients underwent decompressive laminectomy as a part of the index surgery. Intraoperative dural tear was not identified in either case. A postoperative computed tomography (CT) myelogram ordered in view of the positional headaches indicated a CSF leak. A lumbar drain was placed, but both the patients worsened symptomatically. CT head in Case 1 indicated tonsillar ectopia within the foramen magnum, while that in Case 2 revealed a posterior fossa hemorrhage with fullness of the foramen magnum and profound hydrocephalus. Both patients were treated surgically. Additional corrective measures were also initiated to reverse the pathology. Both patients made a good recovery with resolution of symptoms. Development of neurological changes in a patient with CSF leak may indicate an acute intracranial process. Treatment of foramen magnum syndrome requires prompt realization of the underlying pathology and measures to cease or modulate the CSF drainage. The dangers of excessive distal CSF drainage, whether it is from a dural tear or from “controlled” lumbar drainage, should be considered.

Foramen magnum syndrome from a tumor in a neurofibromatosis type 1 patient

Foramen magnum tumors are rare in neurofibromatosis type 1. They may present with bizarre symptoms and may mimic many neurological conditions. We report a case of foramen magnum syndrome secondary to tumor misdiagnosed as cervical spine tuberculosis.

Shunt malfunction causing acute neurological deterioration in 2 patients with previously asymptomatic Chiari malformation Type I

Patients with symptomatic Chiari malformation Type I (CM-I) typically exhibit a chronic, slowly progressive disease course with evolution of symptoms. However, some authors have reported acute neurological deterioration in the setting of CM-I and acquired Chiari malformations. Although brainstem dysfunction has been documented in patients with CM-II and hydrocephalus or shunt malfunction, to the authors' knowledge only 1 report describing ventriculoperitoneal (VP) shunt malfunction causing neurological deterioration in a patient with CM-I exists. The authors report on their experience with the treatment of previously asymptomatic CM-I in 2 children who experienced quite different manifestations of acute neurological deterioration secondary to VP shunt malfunction. Presumably, VP shunt malfunction created a positive rostral pressure gradient across a stenotic foramen magnum, resulting in tetraparesis from foramen magnum syndrome in 1 patient and acute ataxia and cranial nerve deficits from syringobulbia in the other. Although urgent shunt revisions yielded partial recovery of neurological function in both patients, marked improvement occurred only after posterior fossa decompression.

A case of foramen magnum syndrome caused by atlanto-occipital assimilation with intracanal fibrosis

We describe a case of foramen magnum syndrome secondary to atlanto-occipital assimilation with spinal-cord compression caused by retro-odontoid fibrous pannus. Association of atlanto-occipital assimilation with the occurrence of severe neurological symptoms resulting from upper spinal cord compression remains rare in the literature. The embryonic process leading to this malformation is discussed. The anatomy and pathogenesis of this syndrome are described.

Intradural C-1 Ventral Root Schwannomas Treated by Surgical Resection Via the Lateral Suboccipital Transcondylar Approach-Three Case Reports-

Three female patients aged 50-79 years (mean 61.0 years) presented with extremely rare intradural C-1 root schwannoma manifesting as foramen magnum syndrome. Magnetic resonance imaging revealed the intradural extra-axial tumors extending from the anterior aspect of the medullospinal junction, with a mean major diameter of 2.7 cm. Total resection of the tumors was performed via the lateral suboccipital transcondylar approach after a mean period of 11.7 months from the symptom onset. The final diagnosis of schwannoma of the C-1 ventral root was based on the intraoperative and histological findings. All three patients were successfully rehabilitated, with symptomatic improvement and no evidence of tumor recurrence. All three patients were successfully treated by surgical resection via the lateral suboccipital transcondylar approach. This approach is effective and safe provided individual anatomy, drilling of the occipital condyle, and patient position are considered carefully.

Schwannoma of the spinal accessory nerve in the cisterna magna

Background Intracranial schwannoma of the accessory nerve can be divided into two types. One is a jugular foramen type arising from the accessory nerve of the jugular foramen, while the other is an intracisternal type, which arises from the spinal root of the accessory nerve and is separate from the jugular foramen. The latter type is rare, and only 9 cases have been reported previously. Case description A 46-year-old female presented with a large, midline mass lesion in the posterior fossa manifesting as foramen magnum syndrome. Magnetic resonance imaging (MRI) revealed a huge tumor with cystic lesion located in the cisterna magna with extension to the C1 spinal level. The tumor was totally removed by a suboccipital craniectomy and C1 laminectomy. It originated from the spinal root of the right accessory nerve. Temporary slight atrophy of the right sternocleidomastoid muscle was observed, but the patient was free of disease 2 years after treatment. Conclusions We report a schwannoma of the spinal accessory nerve in the cisterna magna. The clinical and neuroradiological findings are discussed with a review of the literature. The initial symptoms were variable without loss of function of the cranial nerve, and the tumor tended to grow in the cisterna magna without laterality. Because of the absence of typical neurologic symptoms, early neuroradiological investigation by MRI is recommended for accurate diagnosis of these tumors.

Acute Foramen Magnum Syndrome Caused by an Acquired Chiari Malformation after Lumbar Drainage of Cerebrospinal Fluid: Report of Three Cases

The perioperative use of lumbar drainage of cerebrospinal fluid (CSF) is relatively common in neurosurgery, and the development of "acquired" Chiari malformations (tonsillar herniation) with lumbar CSF diversion procedures has been reported. We describe the history of three patients who developed a foramen magnum syndrome, attributable to acquired Chiari I malformations, after perioperative lumbar drainage of CSF. We propose that the mechanism responsible for Chiari I malformations involves a negative pressure gradient between the cranial and spinal regions, created by CSF drainage. Theories regarding the formation of acquired Chiari I malformations, the possible synergistic roles of intracranial pathological conditions and CSF drainage in the development of this entity, and the implications for the use of perioperative lumbar drainage are discussed.

Acute Foramen Magnum Syndrome Caused by an Acquired Chiari Malformation after Lumbar Drainage of Cerebrospinal Fluid: Report of Three Cases

The perioperative use of lumbar drainage of cerebrospinal fluid (CSF) is relatively common in neurosurgery, and the development of "acquired" Chiari malformations (tonsillar herniation) with lumbar CSF diversion procedures has been reported.We describe the history of three patients who developed a foramen magnum syndrome, attributable to acquired Chiari I malformations, after perioperative lumbar drainage of CSF.We propose that the mechanism responsible for Chiari I malformations involves a negative pressure gradient between the cranial and spinal regions, created by CSF drainage. Theories regarding the formation of acquired Chiari I malformations, the possible synergistic roles of intracranial pathological conditions and CSF drainage in the development of this entity, and the implications for the use of perioperative lumbar drainage are discussed.

Surgical experience with skull base approaches for foramen magnum meningioma.

The surgical treatment of patients with foramen magnum meningioma remains challenging. This study evaluated the outcome of this tumor according to the evolution of surgical approaches during the last 29 years. A retrospective analysis of medical records, operative notes, and neuroimages of 492 meningioma cases from 1972 to 2001 identified seven cases of foramen magnum meningioma (1.4%). All patients showed various neurological symptoms corresponding with foramen magnum syndrome. The tumor locations were anterior in five cases and posterior in two. Surgical removal was performed through a transoral approach in one patient, the suboccipital approach in three, and the transcondylar approach in two. Total removal was achieved in all patients, except for one who refused any surgical treatment. The major complications were tetraparesis and lower cranial nerve paresis for tumors in anterior locations, and minor complications for posterior locations. One patient died of atelectasis and pneumonia after a long hospitalization. The transcondylar approach is recommended for anterior locations, and the standard suboccipital approach for posterior locations.

Foramen magnum syndrome caused by atlanto-occipital assimilation

Atlanto-occipital assimilation is one of the most common congenital anomalies of the craniovertebral junction, and it usually is asymptomatic. We report a case of this malformation with unusual neurological symptoms which correlate with radiological findings. The anomaly caused the so-called foramen magnum syndrome, which was difficult to localize with neurological examination. The patient also had atlanto-axial dislocation, which was thought to enhance the symptoms with change of head/neck position.

P-5-651 - The hypoglossal canal: An anatomical study

Intracranial schwannoma of the accessory nerve can be divided into two types. One is a jugular foramen type arising from the accessory nerve of the jugular foramen, while the other is an intracisternal type, which arises from the spinal root of the accessory nerve and is separate from the jugular foramen. The latter type is rare, and only 9 cases have been reported previously.A 46-year-old female presented with a large, midline mass lesion in the posterior fossa manifesting as foramen magnum syndrome. Magnetic resonance imaging (MRI) revealed a huge tumor with cystic lesion located in the cisterna magna with extension to the C1 spinal level. The tumor was totally removed by a suboccipital craniectomy and C1 laminectomy. It originated from the spinal root of the right accessory nerve. Temporary slight atrophy of the right sternocleidomastoid muscle was observed, but the patient was free of disease 2 years after treatment.We report a schwannoma of the spinal accessory nerve in the cisterna magna. The clinical and neuroradiological findings are discussed with a review of the literature. The initial symptoms were variable without loss of function of the cranial nerve, and the tumor tended to grow in the cisterna magna without laterality. Because of the absence of typical neurologic symptoms, early neuroradiological investigation by MRI is recommended for accurate diagnosis of these tumors.

Foramen magnum syndrome caused by a dolichoodontoid process

A 21-year-old Japanese man with basilar impression with an anomalous configuration of the odontoid process and many other vertebral anomalies is reported. We thought that posterior decompression alone would be hazardous; therefore, in one session, the odontoid tip and anterior arch of the atlas were removed transorally, and posterior fixation between the occipital squama and the lamina of C-3 using acrylic plastic was performed. This treatment resulted in marked clinical improvement and required only a short hospital stay.

Iodide transport from the spinal subarachnoid fluid in the cat.

ARTICLESIodide transport from the spinal subarachnoid fluid in the catJP Hammerstad, AV Lorenzo, and RW CutlerJP Hammerstad, AV Lorenzo, and RW CutlerPublished Online:01 Feb 1969https://doi.org/10.1152/ajplegacy.1969.216.2.353MoreSectionsPDF (1 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited By“Stealth Cranioplasty” for Adult Chiari Malformation Type 1: A Philosophical Journey of Innovation, Adaptation, and Evolution22 April 2020Fluid and ion transfer across the blood–brain and blood–cerebrospinal fluid barriers; a comparative account of mechanisms and roles31 October 2016 | Fluids and Barriers of the CNS, Vol. 13, No. 1Choroid plexus coagulation for hydrocephalus not due to CSF overproduction: a review15 November 2012 | Child's Nervous System, Vol. 29, No. 1The Pressure Distribution of Cerebrospinal Fluid Responds to Residual Compression and Decompression in an Animal Model of Acute Spinal Cord InjurySpine, Vol. 37, No. 23Acute Foramen Magnum Syndrome Caused by an Acquired Chiari Malformation after Lumbar Drainage of Cerebrospinal Fluid: Report of Three CasesNeurosurgery, Vol. 51, No. 3“Acquired” Chiari I malformationJournal of Neurosurgery, Vol. 80, No. 6Acquired Chiari MalformationsNeurosurgery, Vol. 34, No. 3Acquired Chiari MalformationsNeurosurgery, Vol. 34, No. 3The Distribution of Medication along the Spinal Canal after Chronic Intrathecal AdministrationNeurosurgery, Vol. 33, No. 2The Pharmacokinetics of L-DOPA in Plasma and CSF of the MonkeyL-Dopa pharmacokinetics in plasma and cisternal and lumbar cerebrospinal fluid of monkeysAnnals of Neurology, Vol. 27, No. 5Experimental hydrocephalus and hydrosyringomyelia in the catActa Neurochirurgica, Vol. 74, No. 1-2Pharmacokinetic aspects of spinal morphine analgesiaActa Anaesthesiologica Scandinavica, Vol. 28Chiari I “malformation”—an acquired disorder?Journal of Neurosurgery, Vol. 55, No. 4On the transmission of external pressure fluctuations to the cerebrospinal fluidJournal of Theoretical Biology, Vol. 88, No. 2The response of brain to transient elevations in intraventricular pressureJournal of the Neurological Sciences, Vol. 48, No. 3Ultrastructural observations in experimental hydrocephalus in the rabbitJournal of the Neurological Sciences, Vol. 43, No. 3Production and removal of 5-hydroxyindole acetic acid in the spinal region of the rabbitExperimental Neurology, Vol. 54, No. 2Selected topics relating to hydrocephalusExperimental Eye Research, Vol. 25Cerebrospinal fluid formation in ventricles and spinal subarachnoid space of the rhesus monkeyJournal of Neurosurgery, Vol. 42, No. 6Further studies on the difference between ventricular and subarachnoid perfusionBrain Research, Vol. 89, No. 1Comparison of radio-iodinated serum albumin and blue dextran as indicators to measure rate of formation of cerebrospinal fluidExperimental Neurology, Vol. 47, No. 2Clearance of Some Quaternary Amines from the Spinal Subarachnoid Space*Acta Physiologica Scandinavica, Vol. 93, No. 3Physiology of the Choroid PlexusBULK FLOW IN THE CEREBROSPINAL FLUID SYSTEM OF THE DOG29 January 2009 | Acta Neurologica Scandinavica, Vol. 51, No. 1Ventricular perfusion in cats with kaolin-induced hydrocephalusJournal of Neurosurgery, Vol. 41, No. 1SPINAL SUBARACHNOID PERFUSION IN THE RAT: GLYCINE TRANSPORT FROM SPINAL FLUIDJournal of Neurochemistry, Vol. 22, No. 3Subarachnoid versus ventricular perfusion in the rabbitBrain Research, Vol. 58, No. 1LEUCINE TRANSPORT FROM THE VENTRICLES AND THE CRANIAL SUBARACHNOID SPACE IN THE CATJournal of Neurochemistry, Vol. 19, No. 5Extraventricular origin of the cerebrospinal fluid: formation rate quantitatively measured in the spinal subarachnoid space of dogsJournal of Neurosurgery, Vol. 36, No. 3The Blood–Brain BarrierThe Extracellular Space in the Vertebrate Central Nervous SystemFormation of Cerebrospinal Fluid in Spinal Subarachnoid SpaceNature, Vol. 233, No. 5315Removal of acetylcholine during perfusion of liquor-spaces and its influence on outflow volumeExperientia, Vol. 27, No. 3Variations in protein permeability in different regions of the cerebrospinal fluidExperimental Neurology, Vol. 28, No. 2Cerebrospinal fluid formation and absorption and transport of iodide and sulfate from the spinal subarachnoid spaceJournal of the Neurological Sciences, Vol. 10, No. 3 More from this issue > Volume 216Issue 2February 1969Pages 353-358 Copyright & PermissionsCopyright © 1969 by American Physiological Societyhttps://doi.org/10.1152/ajplegacy.1969.216.2.353PubMed5766989History Published online 1 February 1969 Published in print 1 February 1969 Metrics