Orhan BEĞER, Ahmet Hakan ÖZTÜRK, Celal BAĞDATOĞLU, Derya Ümit TALAŞ, Hakan ÖZALP, Engin KARA, Yusuf VAYİSOĞLU, Osman ERDOĞAN, Ahmet DAĞTEKİN, Vural HAMZAOĞLU

İnsan Kuru Kafalarında Klivus’un Morfometrik Analizi: Radyoanatomik Çalışma

Amaç: Bu çalışma, klivus’un uzunluk, genişlik ve kafa tabanı ile açılanması gibi morfometrik özelliklerini, kafa tabanı cerrahisi açısından açığaçıkarmayı amaçlamaktadır.Gereç ve Yöntem: Çalışmaya, Mersin Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı envanterinde bulunan 24 insan kuru kafatası dahil edildi.Direkt anatomik ölçümler (DAÖ) dijital kumpas ve dijital görüntü analiz programı ile yapıldı. Bilgisayarlı tomografi (BT) kullanılarak radyolojikanalizler gerçekleştirildi.Bulgular: DAÖ ve BT için klivus’un uzunluk ve iç yüzey alanı sırasıyla 25,17±3,98/24,83±3,91 mm ve 546,51±66,44/523,37±87,48 mm2 olarakbulundu. DAÖ ve BT için klival açının (Welcher açısı) 126,12±9,51°/124,37±10,86° olduğu görüldü. DAÖ ve BT ile elde edilen sayısal veriler arasındaistatistiksel olarak farklılık olmadığı belirlendi (p>0,05).Sonuç: Klivus anomalilerinin platibazi, basilar invajinasyon, Charge sendromu veya Chiari tip I gibi hastalıklar ile ilişkilendirildiği dikkatealındığında, verilerimizin klivus bağlamında kafa tabanı malformasyonlarının tespiti ve bu bölgeye cerrahi yaklaşımların seçiminde kullanılabileceğidüşüncesindeyiz.

Morphometric Analysis of the Clivus in Human Dry Skulls: A Radioanatomical Study

Objectives: This study aims to reveal morphometric properties of the clivus including length, width and angle to the base of the skull from the perspective of skull base procedures. Materials and Methods: Twenty-four human dry skulls were included in the inventory of Mersin University Medical Faculty Anatomy Department. Direct anatomic measurements (DAM) were performed using digital caliper and digital image analysis software. Radiological analysis was performed using computed tomography (CT). Results: The length and inner surface area of the clivus for DAM and CT were 25.17±3.98/24.83±3.91 mm and 546.51±66.44/523.37±87.48 mm2, respectively. Clival angle (Welcher angle) for DAM and CT was 126.12±9.51°/124.37±10.86°. No statistically significant difference was found between the numerical data obtained by DAM and CT (p>0.05). Conclusion: Considering that clivus anomalies are associated with diseases such as platybasia, basilar invagination, CHARGE syndrome or Chiari type I, the data of the present study can be used for the detection of clivus anomalies as well as choosing the type of approach to the skull base.

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1. Nemzek WR, Brodie HA, Hecht ST, et al. MR, CT, and plain film imaging of the developing skull base in fetal specimens. Am J Neuroradiol. 2000;21:1699- 1706.
2. Di Leva A, Bruner E, Haider T, et al. Skull base embryology: a multidisciplinary review. Childs Nerv Syst. 2014;30:991-1000.
3. Richtsmeier JT, Flaherty K. Hand in glove: brain and skull in development and dysmorphogenesis. Acta Neuropathol. 2013;125:469-489.
4. Som PM, Naidich TP. Development of the skull base and calvarium: an overview of the progression from mesenchyme to chondrification to ossification. Neurographics. 2013;3:169-184.
5. Jeffery N, Spoor F. Ossification and midline shape changes of the human fetal cranial base. Am J Phys Anthropol. 2004;123:78-90.
6. Hamzaoglu V, Aktekin M, Ismi O, et al. The Measurement of Various Anatomical Structures and Assessment of Morphometric Development of Fetal Skull Base. J Craniofac Surg. 2018;29:e232-e238.
7. D. L. McRae (1953) Bony Abnormalities in the Region of the Foramen Magnum: Correlation of the Anatomic and Neurologic Findings, Acta Radiologica. 1953;40:2-3:335-354.
8. de Geus CM, Bergman JEH, van Ravenswaaij-Arts CMA, et al. Imaging of Clival Hypoplasia in CHARGE Syndrome and Hypothesis for Development: A Case-Control Study. AJNR Am J Neuroradiol. 2018;39:1938-1942.
9. Fernandes YB, Ramina R, Campos-Herrera CR, et al. Evolutionary hypothesis for Chiari type I malformation. Med Hypotheses. 2013;81:715-719.
10. Papadias A, Miller C, Martin WL, et al. Comparison of prenatal and postnatal MRI findings in the evaluation of intrauterine CNS anomalies requiring postnatal neurosurgical treatment. Childs Nerv Syst. 2008;24:185-192.
11. Smoker WR. Craniovertebral junction: normal anatomy, craniometry, and congenital anomalies. Radiographics. 1994;14:255-277.
12. Karagöz F, Izgi N, Kapíjcíjoğlu Sencer S. Morphometric measurements of the cranium in patients with Chiari type I malformation and comparison with the normal population. Acta Neurochir (Wien). 2002;144:165-171.
13. Kazancı A, Şimşek S. Kraniyovertebral Bileşke: Radyolojik Değerlendirme ve Ölçümler. Türk Nöroşir Derg. 2015;25:116-121.
14. Aras Y, Ünal TC. Kraniyovertebral Kavşak Anomalilerinin Radyolojik Değerlendirilmesi. Türk Nöroşir Derg. 2015;25:122-132.
15. Shkarubo AN, Koval’ KV, Dobrovol’skiy GF, et al. Extended endoscopic endonasal posterior (transclival) approach to tumors of the clival region and ventral posterior cranial fossa. Part 1. Topographic and anatomical features of the clivus and adjacent structures. Burdenko’s Journal of Neurosurgery. 2017;81:5-16.
16. Dagtekin A, Avci E, Kara E, et al. Posterior cranial fossa morphometry in symptomatic adult Chiari I malformation patients: comparative clinical and anatomical study. Clin Neurol Neurosurg. 2011;113:399-403.
17. Lieberman DE, Ross CF, Ravosa MJ. The primate cranial base: ontogeny, function, and integration. Am J Phys Anthropol. 2000;Suppl 31:117-69.