Occipitocervical synostosis: case report

Occipitocervical synostosis: case report

Fusion of atlas with the occipital bone is a rare congenital anomaly known as occipitocervical synostosis, occipitalization of atlas,assimilation of atlas or atlanto-occipital fusion. We describe two cases of occipitocervical synostosis identified amongst one-hundred dry adult human occipital bones from the collection of Ege University, School of Medicine, Department of Anatomy (incidence 0.5%). The synostosis was complete type for both cases. Occipitocervical synostosis is clinically important as it may causenarrowing of foramen magnum which may compress the brainstem, vertebral artery and cranial nerves, and during surgicalapproaches to the craniovertebral region.

___

  • Mudaliar RP, Shetty S, Nanjundaiah K, Kumar JP, Kc J. An osteo- logical study of occipitocervical synostosis: its embryological and clinical significance. J Clin Diagn Res 2013;7:1835-37.
  • Campos D, Silva TH, Ellwanger JH, Goerck ML, Kipper JF, Piazza JL, Kraether NL. Atlanto-occipital fusion and its neurological com- plications: a case report. Journal of Morphological Sciences 2012;29: 111-3.
  • Guebert GM, Yochum TR, Rowe LJ. Congenital anomalies and normal skeletal variants. In: Yochum TR, Rowe LJ, editors. Essentials of skeletal radiology. Baltimore: Williams and Wilkins; 1987. p. 197-306.
  • Saini V, Singh R, Bandopadhyay M, Tripathi SK, Shamal SN. Occipitalization of the atlas: Its occurrence and embryological basis. International Journal of Anatomical Variations 2009;2:85-8.
  • Jadhav SD, Ambali MP, Patil RJ, Doshi MA, Roy PP. Assimillation of atlas in Indian dry skulls. Journal of Krishna Institute of Medical Sciences University 2012;1:102-6.
  • Al-Motabagani MA, Surendra M. Total occipitalization of the atlas. Anat Sci Int 2006;81:173-80.
  • Taitz C. Bony observation of some morphological variation and anomalies of the cranio-vertebral region. Clin Anat 2000;13:354-60.
  • Lang J. Craniocervical region, osteology and articulation. Neuroorthopedics 1986;1:67-92.
  • Goel A, Sharma P, Dange N, Kulkami AG. Techniques in the treat- ment of craniovertebral instability. Neurol India 2005;53:525-33.
  • Bergman P. On varieties of atlas in man. Folio Morphologica (Warsaw) 1967;26:129-39.
  • Smith CA, Tuan RS. Human PAX gene expression and development of vertebral column. Clin Orthop Relat Res 1994;(302):241-50.
  • Jayanthi V, Kulkarni R, Kulkarni RN. Atlanto-occipital fusion - report of two cases. J Anat Soc India 2003;52:71-3.
  • Mayhew IG, Watson AG, Heissan JA. Congenital occipitoatlantoax- ial malformations in the horse. Equine Vet J 1978;10:103-13.
  • Van Nie CJ, Folkerts JF. Occipitalization of the atlas in a sheep [pro- ceedings]. Acta Morphol Neerl Scand 1977;15:325.
  • Pang D, Thompson DN. Embryology and bony malformations of the craniovertebral junction. Review. Childs Nerv Syst 2011;27:523-64.
  • Tubbs RS, Salter EG, Oakes WJ. The intracranial entrance of the atlantal segment of the vertebral artery in crania with occipitalization of the atlas. J Neurosurg Spine 2006;4:319-22.
  • Nimje DA, Wankhede HA. Atlanto-occipital fusion: a rare anomaly of the craniocervical junction. Edorium Journal of Anatomy and Embryology 2014;1:1-4.
  • Kassim NM, Latiff AA, Das S, Ghafar NA, Suhaimi FH, Othman F, Hussan F, Sulaiman IM. Atlanto-occipital fusion: an osteological study with clinical implications. Bratisl Lek Listy 2010;111:562-5.
  • Gopal K, Choudhary AK, Agarwal J, Ali S. Morphological status of assimilated atlas vertebra with occipital bone and its clinical signifi- cance. International Journal of Research in Medical Sciences 2015;3: 420-42.
  • Nayak S, Vollala VR, Raghunathan D. Total fusion of atlas with occipital bone: a case report. Neuroanatomy 2005;4:39-40.
  • Caspersen LM, Kjaer I, Sonnesen L. How does occipitalization influence the dimensions of the cranium? Orthod Craniofac Res 2010;13:162-8.
  • Bose A, Shrivastava S. Partial occipitalization of atlas. International Journal of Anatomical Variations 2013;6:81-4.
  • Lopez ZA, Limousin LA, Mantz JR. Contribution to the classifica- tion of malformations of the atlas in the light of a new unstable mal- formation (3 cases). [Article in Spanish] Revista Clínica Española 1964;94:208-15.
  • Budin E, Sondheimer F. Lateral spread of the atlas without fracture. Radiology 1966;87:1095-8.
  • Albrecht HJ, Castrischer E. Fission formation in the anterior and posterior atlas arch. [Article in German] Fortschr Geb Rontgenstr Nuklearmed 1968;108:543-5.
  • Childers JC, Wilson FC. Bipartite atlas. J Bone Joint Surg Am 1971; 53:578-582.
  • Keller HL. Variations in form and abnormalities of the atlas and its surrounding area. [Article in German] Fortschr Geb Rontgenstr Nuklearmed 1961;95:361-70.
  • Vakili ST, Aguilar JC, Muller J. Sudden unexpected death associat- ed with atlanto-occipital fusion. Am J Forensic Med Pathol 1985;6:39-43.
  • McRae DL, Barnum AS. Occipitalization of the atlas. Am J Roentgenol Radium Ther Nucl Med 1953;70:23-46.
  • Iwata A, Murata M, Nukina N, Kanazawa I. Foramen magnum syn- drome caused by atlanto-occipital assimilation. J Neurol Sci 1998; 154:229-31.