Craniovertebral joints definition of craniovertebral. 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. The plasma membranes of adjacent cells are usually separated by extracellular fluids that allow transport of nutrients and wastes to and from the bloodstream. Normal anatomy with mr correlation article pdf available in american journal of roentgenology 1585.
Craniocervical junction disorders can put pressure on the lower parts of the brain, the top part of the spinal cord, or nearby nerves. These characteristics allow for significant flexion, extension, and axial rotation with remarkable stability under normal circumstances. Popularized by crockard, the microsurgical ventral approach to the cvj has been widely described for decompression of irreducible extradural pathology 6. Learn about human anatomy and physiology online by downloading openstaxs free anatomy and physiology book and using our accompanying study guide. In classical anatomy the human stomach is divided into four sections. The craniocervical junction ccj is a collective term used to describe the articulation of the skull and the cervical spine. Knowledge of the anatomy of this system facilitates. As shown in figure 1, three kinds of cell junctions are recognized. Page 2 of 64 learning objectives to outline normal anatomy of the craniovertebral junction cvj. These anomalies can lead to cranial nerve compression, vertebral artery compression and obstructive hydrocephalus.
Anatomy and physiology a thorough understanding of dental and oral anatomy and physiology is essential for all members of the veterinary dental team. 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 abnormalities neurologic disorders. Craniovertebral junction the craniovertebral or craniocervical junctioncvj is a collective term that refers to the occiputp. For example, misalignment of the first and second spinal bones atlantoaxial subluxation. 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 transverse ligament of the atlas is the key component of the cruciform ligament and is one of the most important ligaments in the body. The images below are reconstructions obtained from a scan of the craniocervical junction. Mr imaging of the craniovertebral junction, cranium, and. The superior mediastinum extends from the thoracic inlet to the plane between the manubriosternal joint and the t45 disk space. Craniovertebral junction cvj anomalies can be congenital, developmental or due to malformation secondary to any acquired disease process. The craniovertebral junction, with a significant range of pathologies and anatomical complexities, continues to be a challenging area for surgeons. Embryology in relation to the biomechanics of the craniocervical junction and the impact of trauma on this structure, it is useful to visualise the craniocervical junction as composed of two components. To evaluate the prevalence of anatomical variations of the vertebral artery at the craniovertebral junction and the posterior arch of the atlas in the us population. Jul 28, 2015 craniovertebral junction surgery involves an appropriate philosophical, biomechanical and anatomical understanding apart from high degree of technical skill and ability of controlling venous and arterial bleeding. 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. Congenital, developmental, and acquired bony abnormalities, result in compression and distortion of the neural structures, the vertebrobasllar vascular system and the cerebrospinal fluid channels.
Cervical approaches are used on an almost daily basis to access the cervical trachea, upper esophagus, and superior mediastinum. Diagnosis, pathology, surgical techniques provides indepth coverage of uptodate management principles for this delicate anatomic region. This is a complex region where the skull and upper cervical spine connect. Craniovertebral joints definition of craniovertebral joints. Anatomy and biomechanics of normal craniovertebral junction. Learn neuromuscular junction anatomy with free interactive flashcards. The atlas, first cervical vertebra, has its origins in the fourth occipital and first cervical sclerotomes. Anomalies of the cvj may be congenital or acquired. Craniocervical junction abnormalities can cause or contribute to cervical spinal cord or brain stem compression. It is the largest, strongest and thickest craniocervical ligament mean heightthickness 67 mm.
The craniovertebral junction cvj is the most mobile of the upper cervical spine especially in children. Human anatomy terminology is well documented in both english and french. 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. Anatomy and biomechanics of the craniovertebral junction. The bony anatomy and the normal biomechanics of the cvj in children are presented and subsequently the biomechanics of complex stabilization. The sternocleidomastoid muscle, which runs superiorly and laterally from the manubrium sternal head and the medial half of the clavicle clavicular head to the mastoid process of the temporal bone, divides the side of the neck into anterior and posterior triangles, which are important descriptive landmarks. Spinal cord compression if the anteroposterior diameter of the foramen magnum behind the odontoid process is pdf file. Neurosurgery craniovertebral junction this is an uncommon site for tumors, including rare tumors of the lower cranial nerves or upper cervical nerve roots. Pathology of the cervicothoracic junction clinical gate. Imaging of the blunt traumatic injuries to the craniocervical junction can be challenging but central to improving morbidity and mortality related to such injury. Whilst successful surgery may produce remarkable clinical results and may be compatible with good and new life, any complication can be devastating for the patient and for the family. Choose from 500 different sets of neuromuscular junction anatomy flashcards on quizlet. In relation to the biomechanics of the craniocervical junction and the impact of trauma on this structure, it is useful to visualise the craniocervical junction as composed of two components. The discs contain adherans to hold the cells together, and there are gap junctions.
Lawrence1 1department of orthopaedics, university of utah, salt lake city, utah, united states evid based spine care j 2014. The imaging characteristics and differential diagnoses of these lesions are provided. Cellular and molecular anatomy of the human neuromuscular junction. Craniocervical junction abnormalities are congenital or acquired abnormalities of the occipital bone, foramen magnum, or first two cervical vertebrae that decrease the space for the lower brain stem and cervical cord. Knowledge of the embryology and normal anatomy as well as. The author presents his 30year experience with treating complex craniovertebral junction instability related surgical issues. Cellular and molecular anatomy of the human neuromuscular. These anomalies can lead to cranial nerve compression, vertebral artery compression and obstructive hydroc. Written by masters in the field, the craniovertebral junction.
Scribd is the worlds largest social reading and publishing site. Anatomy, pathology, surgery richard mendel md, spinal neurosurgeon, speaks of the craniovertebral junction, its anatomy, pathology, and treatments. The craniovertebral or craniocervical junction cvj is a collective term that refers to the occiput posterior skull base, atlas, axis, and supporting ligaments. In addition to basic and scholarly knowledge of anatomy, thoracic surgeons must understand the anatomic relationship between the neck, the mediastinum, and both pleural spaces. Biomechanics of the craniovertebral junction intechopen. The surgical approach to pathology of the cervicothoracic junction is dependent on numerous factors, including local anatomy, the pathologic entity, the goal of surgery, medical comorbid conditions, and the familiarity of the individual surgeon with the procedure and anatomic region. All these joints are superbly adapted for eye and head coordination and serve as a universal joint and together allow horizontal and vertical scanning movements of the head. Epub, pdf, and html and on every physical printed page the following. 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. These are a pair of ellipsoid type of synovial joints. The evolutionary changes and structural alterations that have occurred due to the functional variations are clearly seen in the comparison. Cv junction anomalies free download as powerpoint presentation. 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. Comparative quantitative analysis of osseous anatomy of the. Cvj anomalies that decrease the volume of the posterior cranial fossa e. All these joints function as 1 unit to generate the movement of rotation of atlas with head around the vertical axis. The craniovertebral junction cvj is a collective term that refers to the occiput posterior skull base, atlas, axis, and supporting ligaments. The shortest and most physiological route to the ventral aspect of the cvj is represented by an anterior approach through the pharynx. Mr imaging of the craniovertebral junction, cranium, and brain was performed in 10 patients aged 3 months to 16 years with achondroplasia. The human anatomy glossary canwill be used by those with body ailments. The craniovertebral joints virtually include the atlantooccipital joints, atlantoaxial joints, the ligaments connecting the axis with the occipital bones, and the ligamentum nuchae figs. Somitethe building block of vertebrae, skeletal muscle and dermis.
Recent studies from asia have reported a 5% to 10% pre. Magnetic resonance imaging of the ligaments of the. The cervical vertebrae are seven in number, and all have one characteristic feature. Ct anatomy of the craniovertebral junction in infants and. The suboccipital cavernous sinus, a vertebral venous plexus surrounding the horizontal portion of the vertebral artery at the skull base, provides an alternative pathway of cranial venous drainage by virtue of its connections to the cranial dural sinuses, the vertebral venous plexus, and the jugular venous system. The craniovertebral junction is an intricate structure with unique anatomy and complex biomechanical characteristics.
Anatomy, embryology, and normal and abnormal development. Craniovertebral junction surgery is complex, is anatomical, is biomechanical, is philosophical and needs highest degree of technical expertise and experience. The anatomy of craniovertebral junction bones of the tiger, horse, and deer was analyzed and compared with human bones. Hemivertebra is a type of vertebral anomaly and results from a lack of formation of one half of a vertebral body. Craniovertebral junction anomalies knowledge for medical. 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. Craniocervical junction venous anatomy on enhanced mr images. 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 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. Often, an unsedated animal will allow you only a brief look in the. Free anatomy and physiology textbook for download openstax. Craniocervical junction venous anatomy on enhanced mr. The supraclavicular fossa is a depression located above the clavicle lateral to. 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 and upper spinal nerves, the caudal brainstem and rostral spinal cord, the vertebral arteries and their branches, the venous drainages through the jugular vein, and the vertebral plexus.
Vertebral artery anomalies at the craniovertebral junction. It encloses the soft tissue structures of the cervicomedullary junction medulla, spinal cord, and. To resume the most common developmental and acquired cvj abnormalities that are often encountered during cranial or spine plain film, ct or mr evaluation. All patients had narrowing of the subarachnoid space at the level of the foramen magnum and five had compressive deformities of the cervicomedullary junction. The craniovertebral junction cvj is composed of the occiput, the foramen magnum, and the first two cervical vertebrae, encompassing the medulla oblongata and craniovertebral junction anomalies knowledge for medical students and physicians. You must know what is normal and be able to quickly recognize the abnormal. Anatomy of the neck and cervicothoracic junction sciencedirect.
It encloses the soft tissue structures of the cervicomedullary junction medulla, spinal cord, and lower cranial nerves. Anatomy and biomechanics of normal craniovertebral. Pdf the anatomy of the craniovertebral junction, although complex, may be well visualized by routine mr imaging. The rectum is the final straight portion of the large intestine in humans and some other mammals, and the gut in others.
The junction completely encircles each cell, preventing the movement of material between the cell. The craniovertebral junction cvj is the most mobile of the upper cervical spine especially. In certain tissues, however, the membranes of adjacent cells may join and form a junction. The craniovertebral junction cvj and cervical spine are among the most complex areas of the spine, both anatomically and embryologically. Tight junctions are characteristic of cells lining the digestive tract, where materials are required to pass through cells rather than intercellular spaces to penetrate the bloodstream. Anatomy, embryology, and normal and abnormal development of the craniovertebral junction and cervical spine. Cv junction anomalies human anatomy human head and neck. Enamel hypoplasia is a different condition in which the enamel produced is properly mineralized and is shiny and hard like normal enamel, but it is thinner. At one end of the spectrum is the tight junction, which separates the cells into. Jul 22, 2017 craniovertebral junction anatomy, craniometry, anamolies and radiology slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Comparative quantitative analysis of osseous anatomy of. The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other.
The vertebral artery in relation to the c1c2 complex. The craniovertebral junction cvj has unique anatomical structures that separate it from the subaxial cervical spine. With the widespread availability of mr imaging, which is well suited for evaluating the cvj because of its direct sagittal imaging capabilities, renewed understanding of cvj anatomy and anomalies is important for all radiologists. The superior mediastinum and associated vasculature. Microsoft powerpoint cvjembryology, anatomy, radiology 2011. 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 latest management strategies for complex lesions of the craniovertebral junction. Junction definition of junction by medical dictionary. The connection between the brain and the spinal cord is at the base of the brainstem in the region of the craniocervical junction. The third to sixth cervical vertebrae are typical because they bear common features.
The craniovertebral junction cvj comprises the occiput, atlas, and axis and is visible in most magnetic resonance mr imaging studies of the brain. Cardiac muscle cells are joined by complex junctions called intercalated discs. The superior and inferior limbs of the cruciform ligament are extremely thin and offer no known craniocervical stability, whilst the transverse ligament. The cervical spine consists of seven vertebrae and is located at the base of the skull. Neurosurgery craniovertebral junction house clinic. S o m i t e outer dermatome inner myotome medial sclerotome vertebra. Anatomy of craniocervical junction musculoskeletal key. The synchondroses may appear solid at softtissue window settings, while, with appropriate bonewindow settings, a lucent line will be seen. The craniovertebral junction is the most complex of the axial skeleton, residing between the skull and the upper cervical spine. Craniocervical junction disorders brain, spinal cord. Each row of three thumbnails correspond to a given level and the green cross indicates the reference planes for each image of this level. After a brief introduction to anatomy, biomedical considerations, and embryology, the multidisciplinary.
The discoid expansion of the terminal branch of the axon forms the motor end plate, the neurotransmitter that diffuses across the synapse is acetylcholine. Proximally, the thoracic inlet is bounded by the superior aspect of the manubrium, the superior border of the first rib, and the t1 vertebral body. Increased field strengths permit higher signaltonoise ratio snr as well as spatial resolution and thus better delineation of. These anomalies include persistent ossiculum terminale, odontoid aplasia, and os odontoideum. It is unique among vertebrae in not having a body and is formed from three ossification sites.
Relevant anatomy of the craniovertebral junction request pdf. Genetic abnormalities such as dentinogenesis imperfecta also result in abnormal root structure development. Congenital, developmental, and acquired bony abnormalities, result in compression and distortion of the neural structures, the vertebrobasllar vascular. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Craniovertebral junction the craniovertebral or craniocervical junctioncvj is a collective term that refers to the occiput posterior skull base, atlas, axis, and supporting ligaments. In addition to housing vital neural and vascular structures, the majority of cranial flexion, extension, and axial rotation is accomplished at the cvj. If you continue browsing the site, you agree to the use of cookies on this website.