Anatomske i radiološke karakteristike kraniocervikalnog prelaza i njihov značaj za izbor neurohirurškog pristupa
Anatomic and radiologic characteristics of the craniocervical junction and their significance for the choice of neurosurgical approach
Докторанд
Milić, IvanМентор
Samardžić, MiroslavЧланови комисије
Marinković, SlobodanGrujičić, Danica
Antunović, Vaso
Rakić, Miodrag
Метаподаци
Приказ свих података о дисертацијиСажетак
Uvod: 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) preci...zno 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...
Objective: 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 neurosurgic...al
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...