Sardhara Jayesh, Behari Sanjay, Singh Suyash, Srivastava Arun K, Chauhan Gaurav, Lal Hira, Das Kuntal K, Bhaisora Kamlesh Singh, Mehrotra Anant, Mishra Prabhakar, Jaiswal Awadhesh K
Department of Neurosurgery, Sanjay Gandi Post Graduate Institute of Medical Science, Lucknow, India.
Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Neurospine. 2021 Mar;18(1):206-216. doi: 10.14245/ns.2040608.304. Epub 2021 Jan 25.
The conventional criteria for defining the basilar invagination (BI) focus on the relationship of odontoid tip to basion and opisthion, landmarks that are intrinsically variable especially in presence of occipitalised atlas. A universal single reference line is proposed that helps in unequivocally establishing the diagnosis of BI, may be relevant in establishing both Goel types A and B BI, as well as in differentiating a 'very high' from 'regular' BI.
Study design - case-control study. In 268 patients (group I with BI [n = 89] including Goel type A BI [n = 66], Goel type B BI [n = 23], and group II controls [n = 179]), the perpendicular distance between odontoid tip and line subtended between posterior tip of hard palate-internal occipital protuberance (P-IOP line) was measured. Logistic regression analysis determined factors influencing the proposed parameter (p < 0.05).
In patients with a 'very high' BI (n = 5), the odontoid tip intersected/or was above the P-IOP line. In patients with a 'regular' BI (n = 84), the odontoid tip was 6.56 ± 3.9mm below the P-IOP line; while in controls, this distance was 12.53 ± 4.28 mm (p < 0.01). In Goel type A BI, the distance was 7.01 ± 3.78 mm and in type B BI, it was 5.07 ± 4.19 mm (p = 0.004). Receiver-operating characteristic curve analysis identified 9.0 mm (8.92-9.15 mm) as the cut-point for diagnosing BI using the odontoid tip-P-IOP line distance as reference.
The odontoid tip either intersecting the P-IOP line (very high BI) or being < 9 mm below the P-IOP line (Goel types A and B BI) is recommended as highly applicable criteria to establish the diagnosis of BI. This parameter may be useful in establishing the diagnosis in all varieties of BI.
传统的颅底陷入（BI）定义标准侧重于齿突尖与颅底点和枕骨大孔后缘的关系，这些标志本质上是可变的，尤其是在存在枕化寰椎的情况下。提出了一条通用的单一参考线，有助于明确诊断BI，可能与确定Goel A型和B型BI相关，也有助于区分“极高”型与“普通”型BI。
研究设计——病例对照研究。在268例患者中（I组为BI患者[n = 89]，包括Goel A型BI患者[n = 66]、Goel B型BI患者[n = 23]，II组为对照组[n = 179]），测量齿突尖与硬腭后缘-枕内隆突连线（P-IOP线）之间的垂直距离。逻辑回归分析确定影响该参数的因素（p < 0.05）。
在“极高”型BI患者（n = 5）中，齿突尖与P-IOP线相交或位于其上方。在“普通”型BI患者（n = 84）中，齿突尖位于P-IOP线下方6.56±3.9mm处；而在对照组中，该距离为12.53±4.28mm（p < 0.01）。在Goel A型BI中，该距离为7.01±3.78mm，在B型BI中为5.07±4.19mm（p = 0.004）。受试者工作特征曲线分析确定以齿突尖-P-IOP线距离作为参考诊断BI的切点为9.0mm（8.92 - 9.15mm）。
推荐将齿突尖与P-IOP线相交（极高型BI）或位于P-IOP线下方< 9mm（Goel A型和B型BI）作为诊断BI的高度适用标准。该参数可能有助于诊断所有类型的BI。
