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Anatomic and radiologic characteristics of the craniocervical junction and their significance for the choice of neurosurgical approach

dc.contributor.advisorSamardžić, Miroslav
dc.contributor.otherMarinković, Slobodan
dc.contributor.otherGrujičić, Danica
dc.contributor.otherAntunović, Vaso
dc.contributor.otherRakić, Miodrag
dc.creatorMilić, Ivan
dc.date.accessioned2016-12-30T16:13:51Z
dc.date.available2016-12-30T16:13:51Z
dc.date.available2020-07-03T08:47:49Z
dc.date.issued2016-09-17
dc.identifier.urihttp://nardus.mpn.gov.rs/handle/123456789/7354
dc.identifier.urihttp://eteze.bg.ac.rs/application/showtheses?thesesId=4386
dc.identifier.urihttps://fedorabg.bg.ac.rs/fedora/get/o:14281/bdef:Content/download
dc.identifier.urihttp://vbs.rs/scripts/cobiss?command=DISPLAY&base=70036&RID=48496655
dc.description.abstractUvod: Interesovanje za kraniocervikalni prelaz (engl. „the craniocervical junction“ – CCJ) započelo je disekcijama i izvanrednim crtežima Leonarda da Vinčija, a nastavljeno je ispitivanjima Andreasa Vezalijusa u 16. veku, kao i italijanskih anatoma i umetnika u 17. i 18. stoleću (Saunders, 1973; Persaud, 1984; Düring and Poggesi, 2006; Nathan, 2007). Veliki doprinos dali su Buržer u 19. veku i Pernkopf u 20. stoleću (Pernkopf, 1963; Bourgery i Jacob, 2005). Ipak, najdetaljnija istraživanja ovog područja obavljena su u poslednjih nekoliko decenija (Martin i sar., 2010; Steinmetz i sar., 2010; Lopez i sar., 2015). Kraniocervikalni prelaz obuhvata, u najužem smislu, donji deo okcipitalne kosti, atlas i aksis. Spomenuti autori proučili su ove osteološke komponente i izvršili odgovarajuća merenja, ali ne u potpunosti. Zato smo odlučili da CCJ ispitamo mnogo detaljnije u anatomskom i radiološkom domenu, kako bismo dali doprinos neurohirurškim intervencijama u ovom području. Ciljevi: 1) precizno utvrđivanje anatomskih odnosa osteoloških komponenti CCJa, uključujući i morfometrijska ispitivanja, kao i proučavanja obližnjih neuralnih struktura, naročito odnosa kičmene moždine, moždanog stabla i tonzila cerebeluma; 2) utvrđivanje odnosa spomenutih elemenata nakon maksimalne fleksije i ekstenzije, u poređenju sa neutralnim položaj glave i vrata; 3) utvrđivanje patoloških poremećaja i urođenih malformacija komponenti CCJa; 4) poboljšanje neurohirurških intervencija u predelu CCJ u svetlosti dobijenih podataka tokom naših istraživanja. Materijal i metode: Korišćene su, najpre, standardne anatomske metode na 22 uzorka okcipitalne kosti, 7 atlasa i 7 aksisa, uključujući precizna morfometrijska proučavanja. Druga grupa uzoraka obuhvatala je tri glave s mozgom prethodno fiksiranih u 10% formalinu. Nakon zamrzavanja na minus 250 C, svaka glava je serijski sečena u predelu CCJ u jednoj od tri glavne ravni: aksijalnoj, koronalnoj i sagitalnoj. Na ovim presecima ispitani su odnosi pojedinih elemenata CCJa, kako koštanih, tako i mišićnih, vaskularnih i neuralnih. Radiološke metode obuhvatale su multislajsnu kompjuterizovanu tomographiju (MSCT) i magnetnorezonantni „imadžing“ (MRI). Prva grupa sastojala se od 22 volontera koji su snimani na MSCT skeneru u neutralnom položaju, a zatim u maksimalnoj fleksiji i ekstenziji...sr
dc.description.abstractObjective: The interest in the craniocervical junction (the CCJ) started with dissections and brilliant drawings of Leonardo da Vinci, and it was continued by the examinations of Andreas Vesalius in the 16th century, and the Italian anatomists and artists in the 17th and 18th century (Saunders, 1973; Persaud, 1984; Düring and Poggesi, 2006; Nathan, 2007). A great contribution was given by Bourgery in the 19th century and Pernkopf in the 20th century (Pernkopf, 1963; Bourgery and Jacob, 2005). However, the most detailed study of this region was performed in the recent few decades (Martin et al., 2010; Steinmetz et al., 2010; Lopez et al., 2015). The craniocervical junction, in the narrower sense, comprises the lower part of the occipital bone, the atlas and the axis. The mentioned authors examined these osteological components and made certain measurements, although not fully. Therefore we decided to examine the CCJ in much more details and thus to give a contribution to the neurosurgical interventions in this region. Aims: 1) a precise determination of the anatomic relationships of the CCJ osteological components, including the morphometric examination, as well as a study of the adjacent neural structures, especially the relationships of the spinal cord, the brain stem and the cerebellar tonsils; 2) a determination of the relationships of the mentioned elements following a maximum flextion and extension, compared to the neutral position of the head and neck; 3) a determination of the pathological disorders and the congenital malformations of the CCJ components; 4) an improvement of the neurosurgical interventions in the CCJ region in the light of the data obtained in our study. Material and methods: First of all, some standard anatomic methods were applied in 22 occipital bones, 7 atlas and 7 axis specimens, including a precise morphometric examination. The second group of the specimens comprised three heads with a brain previously fixed in a 10% formaldehyde solution. Following their freezing at minus 250 C, each head was serially sectioned in the CCJ region in one of the three planes: the axial, coronal and sagittal. In these sections, the relationships among the individual CCJ elements were examined, both the osseous and the muscular, vascular and neural ones. Radiologic methods comprised the multislice computerized tomography (MSCT) and magnetic resonance imaging (MRI). The first group consisted of the 22 volunteers examined in an MSCT scanner in the neutral position, and thereafter in a maximum flexion and extension...en
dc.formatapplication/pdf
dc.languagesr
dc.publisherУниверзитет у Београду, Медицински факултетsr
dc.rightsopenAccessen
dc.sourceУниверзитет у Београдуsr
dc.subjectkraniocervikalni prelazsr
dc.subjectcraniocervical junctionen
dc.subjectcraniovertebral junctionen
dc.subjectcerebrospinal junctionen
dc.subjectanatomyen
dc.subjectmalformationsen
dc.subjectmultislice CTen
dc.subjectMRIen
dc.subjectneurosurgical operationsen
dc.subjectkraniovertebralni spojsr
dc.subjectcerebrospinalni spojsr
dc.subjectanatomijasr
dc.subjectmorfometrijasr
dc.subjectmultislajsni CTsr
dc.subjectMRIsr
dc.subjectneurohirurške operacijesr
dc.titleAnatomske i radiološke karakteristike kraniocervikalnog prelaza i njihov značaj za izbor neurohirurškog pristupasr
dc.title.alternativeAnatomic and radiologic characteristics of the craniocervical junction and their significance for the choice of neurosurgical approachen
dc.typedoctoralThesis
dc.rights.licenseBY-NC-ND
dcterms.abstractСамарджић, Мирослав; Грујичић, Даница; Ракић, Миодраг; Маринковић, Слободан; Aнтуновић, Васо; Милић, Иван; Aнатомске и радиолошке карактеристике краниоцервикалног прелаза и њихов значај за избор неурохируршког приступа; Aнатомске и радиолошке карактеристике краниоцервикалног прелаза и њихов значај за избор неурохируршког приступа;
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/8857/Disertacija.pdf
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/8858/Disertacija7160.pdf


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