ICCBH2019 Late Breaking Abstracts (1) (10 abstracts)
Foramen magnum stenosis (FMS): neuroradiological aspects before and after cervical decompression in paediatric patients with achondroplasia (ACH)
Anna Elsa Maria Allegri 1 , Natascia Di Iorgi 1 , Mariasavina Severino 2 , Giuseppa Patti 1 , Giulia Siri 1 , Gianluca Piatelli 3 , Daniela Fava 1 , Flavia Napoli 1 , Beatrice Michelis 4 & Mohamad Maghnie 1
1Paediatric Clinic, Gaslini Children’s Hospital, Genova, Italy; 2Neuroradiology Gaslini Children’s Hospital, Genova, Italy; 3Neurosurgery Gaslini Children’s Hospital, Genova, Italy; 4Paediatric Orthopedics Unit Gaslini Children’s Hospital, Genova, Italy.
The identification of markers indicative of pathological FMS plays a pivotal role in the prevention of ACH complications.
Objective: Identify key cranio-cervical junction neuroradiological features for the surgical choice and for the decompression outcome.
Methods: Out of 191 ACH patients, we selected 24 patients before 4 years of age, who performed a first brain MRI and/or CT. Patients were divided into 2 groups: surgically treated (STP=15/24) and no-surgically treated (NSTP=9/24). Data were compared with a control group (CG) of 24 children of the same age and with a group of ACH patients surgically treated at an age above 4 years (ACHPST>4 years 5/191). Antero-posterior cervical osteo-ligamentous diameter (APCOL-D), anteroposterior cervical bone diameter (APCB-D), degree of cervical stenosis (grade:0 to 3, defined on the basis of the increase in stenosis and grade 4A and 4 B according to the degree of stenosis plus myelopathy1), prominence of posterior margin foramen magnum (PFMPM), prominence first cervical vertebra posterior arc (PFCVPA), hypertrophy of soft tissues, occipital bone spur, orientation of the posterior edge of the foramen magnum, odontoideum bone were evaluated by MRI.
Results: 12/24 subjects performed the first MRI in the first 6 months of life and 4/12 have myelopathy (stenosis 4A and 4B). All STP have cervical stenosis of grade >2, while the NSTP have degrees <2. Grade 1 is equally represented in STP and NSTP. The APCB-D is decreased in the STPvsCG (P≤0.0001) and in the NSTPvsCG (P≤0.001); there is no significant difference between STPvsNSTP. APCOL-D is decreased in the STPvsNSTP, STPvsCG (P=0.0001) and NSTPvsCG (P=0.001), with an OR=3.95 (P=0.02, values <7.6 mm determine a risk of surgical therapy 4 times higher). PFMPM is associated with surgery (P=0.003), while no other qualitative parameters are significantly associated. In STP there is an increase of APCOL-D and APCB-D (P=0.0001).
Conclusions: MRI screening role was confirmed, and highlighted its role in the first 6 months of life. The most important parameters for surgical choice are: PFMPM, APCOL-D, the degrees of stenosis >2. STP have a good radiologic decompression outcome. The data of this pilot study will be correlated with multidisciplinary approach, useful particularly for evaluation of grade1 stenosis (gray area regarding surgery)
Disclosure: The authors declared no competing interests.
Volume 7
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