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    Congenital Atlanto-Occipital Fusion and its Effect on the Myodural Bridge: A Case Report Utilizing the P45 Plastination Technique

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    Author
    Chi, Yan Yan
    Zhuang, Jing
    Jin, Gong
    Hack, Gary D.
    Song, Ting Wei
    Sun, Shi Zhu
    Chen, Cheng
    Yu, Sheng Bo
    Sui, Hong Jin
    Date
    2022-06-01
    Journal
    International Journal of Morphology
    Publisher
    Universidad de la Frontera
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.4067/S0717-95022022000300796
    Abstract
    The atlanto-occipital joint is composed of the superior fossa of the lateral masses of the atlas (C1) and the occipital condyles. Congenital Atlanto-occipital fusion (AOF) involves the osseous union of the base of the occiput (C0) and the atlas (C1). AOF or atlas occipitalization/assimilation represents a craniovertebral junction malformation (CVJM) which can be accompanied by other cranial or spinal malformations. AOF may be asymptomatic or patients may experience symptoms from neural compression as well as limited neck movement. The myodural bridge (MDB) complex is a dense fibrous structure that connects the suboccipital muscular and its related facia to the cervical spinal dura mater, passing through both the posterior atlanto-occipital and atlanto-axial interspaces. It is not known if atlas occipitilization can induce structural changes in the MDB complex and its associated suboccipital musculature. The suboccipital region of a cadaveric head and neck specimen from an 87-year-old Chinese male having a congenital AOF malformation with resultant changes to the MDB complex was observed. After being treated with the P45 plastination method, multiple slices obtained from the cadaveric head and neck specimen were examined with special attention paid to the suboccipital region and the CVJM. Congenital atlanto-occipital fusion malformations are defined as partial or complete fusion of the base of the occiput (C0) with the atlas (C1). In the present case of CVJM, unilateral fusion of the left occipital condyle with the left lateral mass of C1 was observed, as well as posterior central fusion of the posterior margin of the foramen magnum with the posterior arch of C1. Also noted was a unilateral variation of the course of the vertebral artery due to the narrowed posterior atlanto-occipital interspace. Surprisingly, complete agenesis of the rectus capitis posterior minor (RCPmi) and the obliques capitis superior (OCS) muscles was also observed in the plastinated slices. Interestingly, the MDB, which normally originates in part from the RCPmi muscle, was observed to originate from a superior bifurcation within an aspect of the nuchal ligament. Therefore, the observed changes involving the MDB complex appear to be an effective compensation to the suboccipital malformations. © 2022, Universidad de la Frontera. All rights reserved.
    Sponsors
    National Natural Science Foundation of China
    Keyword
    Congenital atlanto-occipital fusion
    Craniovertebral junction malformations
    Myodural bridge
    P45 plastination
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/19479
    ae974a485f413a2113503eed53cd6c53
    10.4067/S0717-95022022000300796
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