Anatomical location of the vertebrobasilar junction: computed tomography morphometrics for planning endoscopic transsphenoidal transclival approaches
Abstract
Background: The aim of this study was to determine the anatomical localisation and morphometry of vertebrobasilar junction (VBJ) by computed tomography (CT) images which may be helpful in planning the correct procedure before surgery such as endoscopic transsphenoidal transclival approach to the retroclival space.
Materials and methods: Vertebrobasilar junction level was determined on axial, coronal reformat and sagittal reformat images. Clivus length, the distances of the VBJ to the upper and lower end of the clivus and to the bottom of the sphenoid sinus were measured. In addition, the position and distance of the VBJ relative to the midline were measured. The vertebral artery dominance was determined and the position of VBJ relative to the midline was evaluated.
Results: When compared by gender, 1, a, b and c values were significantly longer in males than in females (p < 0.05). The location of the bottom of the sphenoid sinus was higher than the VBJ level in 263 (98.1%) cases, equal to the VBJ level in 1 (0.4%) case, and lower than the VBJ level in 4 (1.5%) cases. There was no statistically significant difference between the distances to the midline when the VBJs with right and left localisation were compared (p > 0.05). A statistically significant relationship was found between vertebral artery predominance and localisation of VBJ relative to the midline (p < 0.001).
Conclusions: Careful perusal of CT images and the described VBJ morphometrics can help in accurate procedure planning to avoid basilar artery injury.
Keywords: vertebro-basilar junctionclivusendoscopic transsphenoidal transclival approachcomputed tomography
References
- Akkasoglu S, Aldur M, Sargon M, et al. Morphometry and geometry of the formation of basilar artery. Med-Science. 2019; 8(4): 980–985.
- Cloud GC, Markus HS. Diagnosis and management of vertebral artery stenosis. Ojm-Int J Med (OJM). 2013; 96: 27–34.
- de Notaris M, Cavallo LM, Prats-Galino A, et al. Endoscopic endonasal transclival approach and retrosigmoid approach to the clival and petroclival regions. Neurosurgery. 2009; 65(6 Suppl): 42–50; discussion 50.
- Dzierżanowski J, Szarmach A, Baścik B, et al. Intracranial region of the vertebral artery: morphometric study in the context of clinical usefulness. Folia Morphol. 2017; 76(3): 379–387.
- Cossu G, Daniel RT, George M, et al. New frontiers in managing clival tumors — the extended endoscopic endonasal approach. Endoscopy - Innovative Uses and Emerging Technologies. 2015.
- Gupta T. Quantitative anatomy of vertebral artery groove on the posterior arch of atlas in relation to spinal surgical procedures. Surg Radiol Anat. 2008; 30(3): 239–242.
- Sanmillan JL, Lawton MT, Rincon-Torroella J, et al. Assessment of the endoscopic endonasal transclival approach for surgical clipping of anterior pontine anterior-inferior cerebellar artery aneurysms. World Neurosurg. 2016; 89: 368–375.
- Shkarubo A, Koval K, Chernov I, et al. Endoscopic endonasal transclival removal of tumors of the clivus and anterior region of the posterior cranial fossa (results of surgical treatment of 140 patients). Chinese Neurosurg J. 2018; 4(1).
- Singh H, Greenfield JP, Anand VK, Schwartz TH. Pediatric Endonasal Endoscopic Skull Base Surgery: A case-Based Manuel. Endo Press, Tuttlingen 2016.
- Songur A, Gonul Y, Ozen OA, et al. Variations in the intracranial vertebrobasilar system. Surg Radiol Anat. 2008; 30(3): 257–264.
- Ting E, Ting F, Chia G, et al. Imaging in endoscopic endonasal skull base surgery. In: Chong V(ed.). Skull Base Imaging. Elsevier. Skull Base Imaging. 2018: 65–82.
- Zhu W, Wang YF, Dong XF, et al. Study on the correlation of vertebral artery dominance, basilar artery curvature and posterior circulation infarction. Acta Neurol Belg. 2016; 116(3): 287–293.
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