Neurosurgery craniovertebral junction this is an uncommon site for tumors, including rare tumors of the lower cranial nerves or upper cervical nerve roots. Craniovertebral junction cvj abnormalities involve the osseous structures and the contained nervous system. The craniovertebral junction cvj comprises the occiput, atlas, and axis and is visible in most magnetic resonance mr imaging studies of the brain. Motor endplateanatomical, functional, and molecular. Richard mendel md, spinal neurosurgeon, speaks of the craniovertebral junction, its anatomy, pathology, and treatments. The craniovertebral junction is an intricate structure with unique anatomy and complex biomechanical characteristics.
Neurosurgery the original and definitive reference on surgery of the craniovertebral junction, now in an updated second edition. Pathology of the craniovertebral junction includes stenosis of the foramen magnum from downward discplacement of the cerebellar tonsils, so called arnoldchiari malformation, treated with. The neuromuscular junction is composed of three parts. A neuromuscular junction is a synapse between a motor neuron and skeletal muscle. The importance of craniovertebral and cervicomedullary. These anomalies can lead to cranial nerve compression, vertebral artery compression and obstructive hydrocephalus. Anterior angulation or wedging of the vertebral bodies at the thoracolumbar junction is a recognized normal anatomic feature. Increased field strengths permit higher signaltonoise ratio snr as well as spatial resolution and thus better delineation of.
Relevant anatomy of the craniovertebral junction request pdf. The radiologist has a significant part to play in the appropriate management of patients who have suffered injury to this vital junction between the cranium and the spine. The image shows an elevated left shoulder due to a sprengel anomaly. The venous structures contributing to craniocervical junction venous drainage, including the inferior petrosal sinus ips, transversesigmoid sinus, jugular vein, condylar vein, marginal sinus and suboccipital cavernous sinus were well depicted in all cases. Furthermore, individual chapters cover endovascular surgery, endoscopic skull base techniques, navigation and robotics, ensuring that surgeons stay uptodate. To resume the most common developmental and acquired cvj abnormalities that are often encountered during cranial or spine plain film, ct or mr evaluation. Imaging of the blunt traumatic injuries to the craniocervical junction can be challenging but central to improving morbidity and mortality related to such injury. Anatomy and biomechanics of normal craniovertebral.
Craniovertebral junction abnormalities thieme connect. Anteroposterior radiograph of a patient with klippelfeil syndrome showing multiple congenital anomalies and cervical scoliosis. The cvj consists of the occiput, atlas, axis, and associated ligaments. A knowledge of the bony configuration, ligamentous attachments, joint articulations, vascular supply, muscle function, and lymphatic drainage as well as the kinetic anatomy of the craniocervical junction is necessary to understand the etiology of abnormalities in this area and their treatment.
Craniovertebral junction anomalies knowledge for medical. All these joints function as 1 unit to generate the movement of rotation of atlas with head around the vertical axis. In addition to housing vital neural and vascular structures, the majority of cranial flexion, extension, and axial rotation is accomplished at the cvj. The junction between the base of the skull and brainstem and the cervical spine and spinal cord. Spinal cord compression if the anteroposterior diameter of the foramen magnum behind the odontoid process is pdf file. Posterior photo of a patient with klippelfeil syndrome and an anomaly of the occipitocervical junction. Surgery of the craniovertebral junction springerlink. Neurosurgery craniovertebral junction house clinic. Anatomy, pathology, surgery richard mendel md, spinal neurosurgeon, speaks of the craniovertebral junction, its anatomy, pathology, and treatments. Signs and symptoms are variable in cvj abnormalities, although most signs and symptoms may lead the patient to consult a neurologist or neurosurgeon.
Anatomy and biomechanics of the craniovertebral junction. These characteristics allow for significant flexion, extension, and axial rotation with remarkable stability under normal circumstances. Neuromuscular junction at the neuromuscular junction, the motor neuron forms a flat branching plate called a motor end plate see picture. The anatomy of the craniovertebral junction, although complex, may be well visualized by routine mr imaging. As the axon of the motor neuron enters the skeletal muscle, it forms many branches called axon terminals. Control voluntary control by conscious nervous system. In the modern surgical approach to the craniovertebral junction cvj, past and. The craniovertebral junction, with a significant range of pathologies and anatomical complexities, continues to be a challenging area for surgeons. Craniovertebral junction deformities clinical gate. Each row of three thumbnails correspond to a given level and the green cross indicates the reference planes for each image of this level. Medical anatomy and physiology unit five muscular system page 2 draft copy 4. Page 2 of 64 learning objectives to outline normal anatomy of the craniovertebral junction cvj.
The myelin sheath stops just short of the branching presynaptic terminal synaptic vesicles containing neurotransmitter acetylcholine are present in the presynaptic terminal. Congenital, developmental, and acquired bony abnormalities, result in compression and distortion of the neural structures, the vertebrobasllar vascular. Review of neuromuscular junction anatomy and function oxford. Clinical and radiographic anatomy of the craniovertebral junction. As the standard of care for the evaluation of the cervical spine shifts from plain radiographs to multidetector row ct mdct, a reexamination of the normal anatomic relationships of the occipitovertebral articulations is needed. This is a complex region where the skull and upper cervical spine connect. General location located in the walls of hollow internal organs such as the blood vessels, stomach, intestines, urinary bladder, and the ureters. After a brief introduction to anatomy, biomedical considerations, and embryology, the multidisciplinary team of authors, led by professor goel, discusses in detail the most innovative fixation. The craniovertebral junction cvj is composed of the occiput, the foramen magnum, and the first two cervical vertebrae, encompassing the medulla oblongata and the upper cervical spinal cord. Defining normal vertebral angulation at the thoracolumbar. The neuromuscular junction nmj is a synapse that develops between a motor neuron and a muscle fiber, and is made up of several components. Anatomy of the junction of the inferior petrosal sinus and the jugular vein. The craniovertebral junction is the most complex of the axial skeleton, residing between the skull and the upper cervical spine.
This lesson describes the events of synaptic transmission leading to contraction of skeletal muscle. This new edition of surgery of the craniovertebral junction focuses on surgical decision making and technological advances in the treatment modalities for this region. The bones and ligaments provide structural support for the head and. Anatomy of the craniovertebral junction cvj includes the foramen magnum located in the occipital bone, atlas c1, and axis c2 united by ligaments and muscles, the lower cranial. Craniovertebral junction the craniovertebral or craniocervical junction cvj is a collective term that refers to the occiput posterior skull base, atlas, axis, and supporting ligaments. Craniovertebral junction anomalies radiology reference. It also performs its role of protection of most critical neural and vascular structures whilst permitting a wide range of movements to great perfection. Craniovertebral junction cvj anomalies can be congenital, developmental or due to malformation secondary to any acquired disease process. Cvj anomalies that decrease the volume of the posterior cranial fossa e. At the end of each axon terminal, there is a bulbous swelling called synaptic end bulb.
Neurosurgery surgery of the craniovertebral junction. The thoracolumbar junction is also the most common location for osteoporotic and traumatic vertebral fractures. The cvj refers to the occiput, atlas, axis, and supporting ligaments. The occipitocervical junction, also known as the craniocervical or craniovertebral junction cvj, consists of the two joints the atlantooccipital and atlantoaxial, the spinal cord, and several. The venous circulation at the craniocervical junction in 14 patients was evaluated on all mr images obtained at 1. Craniocervical junction abnormalities can cause or contribute to cervical spinal cord or brain stem compression. The cvj is a compromise between strength and flexibility. Surgery of the craniovertebral junction, second edition is the surgical resource every spine and skull base surgeon should have on their bookshelf. Craniometric measurements used in radiologic assessment of cvj anomalies include the chamberlain line, wackenheim clivus baseline, welcher basal angle, and atlantooccipital joint axis angle. Craniocervical junction venous anatomy on enhanced mr. Choose from 500 different sets of neuromuscular junction anatomy flashcards on quizlet. Craniovertebral junction anomalies linkedin slideshare.
Following a brief introduction to the relevant anatomy and biomechanics of cvj, it explores the field of craniovertebral junction lesions and their management. Anomalies of the cvj may be congenital or acquired. Advances in multidetector computed tomography and magnetic resonance imaging mri have provided better insight into the normal anatomy and pathology of this complex area. Craniovertebral junction the craniovertebral or craniocervical junctioncvj is a collective term that refers to the occiput posterior skull base, atlas, axis, and supporting ligaments. Normal anatomy with mr correlation article pdf available in american journal of roentgenology 1585.
Craniovertebral joints definition of craniovertebral. Biomechanics of the craniovertebral junction intechopen. It also includes the cervicomedullary junction medulla, spinal cord, and lower cranial nerves. Knowledge of the embryology and normal anatomy as well as. Stimulation of the nerve, causes release of acetylcholine into the. Massimiliano visocchi institute of neurosurgery, catholic university, largo gemelli, 8 00168 rome, italy introduction in the modern surgical approach to the craniovertebral junction cvj, past and. The imaging characteristics and differential diagnoses of these lesions are provided.
More than 50% of traumatic fractures occur between t12 and l2 1, 2. The images below are reconstructions obtained from a scan of the craniocervical junction. This essay discusses the anatomy of the complex articulations of the craniovertebral junction. Transoral approaches provide the fundamental anatomy and technique upon. Learn neuromuscular junction anatomy with free interactive flashcards. Craniovertebral junction is supremely designed and immaculately structured to perform its unique role of providing stability and mobility to the most stable and most mobile regions of the body. Written by masters in the field, the craniovertebral junction. Imaging of the craniovertebral junction sciencedirect.
Diagnosis, pathology, surgical techniques provides indepth coverage of uptodate management principles for this delicate anatomic region. The connection between the brain and the spinal cord is at the base of the brainstem in the region of the craniocervical junction. We aimed to define the normal anatomic relationships of craniocervical articulations on mdct and address any discrepancies with. Terms in this set 7 definition of cell junctions contact points between the plasma membranes of tissue cells how cells are held together to form. There are three main issues in dealing with congenital craniovertebral junction cvj anomalies, namely, arnold chiari malformation. Magnetic resonance imaging of the ligaments of the. The lower thoracic spine is also the most common site of scheuermanns disease. Representative mr images and gross anatomic photographs are presented to illustrate the intricate ligamentous and articular anatomy.
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