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The role of clivus length and cranial base flexion angle in basilar invagination and Chiari malformation pathophysiology

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Abstract

Background

The craniovertebral junction is an anatomically well-defined transitional zone located between the skull and the cervical spine. Multiple malformations can affect this region with the most prominent being basilar invagination (BI) and Chiari malformation (CM). Despite numerous studies, the origin, pathophysiology, and classification of these pathologies remain controversial. The objective of this study was to evaluate the implication of cranial base flexion angle and clivus length in the development of these conditions.

Methods

Midline tomography and magnetic resonance imaging of normal subjects and patients diagnosed with BI (types I and II) and Chiari malformation were evaluated. A craniometric study of the skull base was performed. Linear and angular measurements were used for comparisons between groups.

Results

109 images from patients with craniovertebral junction malformation and controls were evaluated. Seventeen had BI-I, 26 had BI-II, 36 had CM, and 30 were normal subjects. Demographic data for the two groups were not significantly different. Craniometric analysis of images revealed a gradation in linear and angular variables from controls to CM, BI-I, and BI-II patients. Clivus length was significantly smaller in BI-II patients compared with other groups, while basal angle was greater. Moderate or strong correlations were noted among all variables analyzed.

Conclusion

Data suggest that clivus length and basal angle may play a role in pathophysiology of BI and CM.

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Abbreviations

BI:

Basilar invagination

CL:

Clivus length

CM:

Chiari malformation

CVJ:

Craniovertebral junction

CVJM:

Craniovertebral junction malformation

HNFA:

Head-neck flexion angle

CL:

Violation of the chamberlain’s line

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Authors and Affiliations

  1. Department of Neurosurgery, Hospital do Servidor Público Estadual – IAMSPE, São Paulo, Brazil

    Juliete M. Diniz & Ricardo V. Botelho

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  1. Juliete M. Diniz
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  2. Ricardo V. Botelho
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Correspondence to Ricardo V. Botelho.

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This work was conducted in accordance with Brazilian ethical standards (Resolution No. 510, dated April 7, 2016).

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The authors declare that they have no conflict of interest.

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Diniz, J.M., Botelho, R.V. The role of clivus length and cranial base flexion angle in basilar invagination and Chiari malformation pathophysiology. Neurol Sci 41, 1751–1757 (2020). https://doi.org/10.1007/s10072-020-04248-1

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  • DOI: https://doi.org/10.1007/s10072-020-04248-1

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