Congenital Basilar Invagination Refinement Genotyping And Clinical Analysis

Objectives To investigate the modified classification and clinical features of basilar invagination.Methods The clinical data of 139 patients from June 2005 to December 2013 who accepted treatment in our hospital were retrospectively analyzed. Based on Atul Goel classification, the basilar invagination were diagnosed and divided into four categories according to the pathogenesis of syringomelia.The information of age, sex, weight, clinical manifestation, cervical vertebra MRI, MRI-C ine and three-dimensional CT Reconstruction of cranio-cervical junction were analyzed associated with clinical manifestation.Results In 139 patients, BIa+0 type, BIa+S type, BIb+0 type and BIb+S type were respectively found in 31 out of 139 patients(22.3%), 45 out of 139 patients(32.4%), 21 out of 139 patients(15.1%), 42 out of 139 patients(30.2%).Among them, BIa+0 type and BIb+0 type are dominated by brain stem compressed, pyramid sign and cerebellar injury. The BIa+S type and BIb+S type contain both brainstem compression symptoms and syringomyeliasymptoms.There was no significant difference(P>0.05) in age, sex and weight between the patients in these four classifications. In the research, patients were assessed according to the JOA scoring system and neurological scoring system before and after the treatment, respectively. The results suggested that, treatment guided by these clinical classification cloud widely improve the recovery of patients. In the JOA scoring analysis, the mean value of BIa+0 type patient before surgery was 10.97 and could increase to 12.45 after surgery, with a improvement rate of 30.78%. The mean value of BIa+S type patient before surgery was 10.78 and could increase to 12.76 after surgery, with aimprovement rate of 35.09%. The mean value of BIb+S type patient before surgery was 11.71 and could increase to 13.57 after surgery, with a improvement rate of 36.57%.The mean value of BIb+S type patient before surgery was 10.95 and could increase to 12.71 after surgery, with a improvement rate of 31.92%. In the evaluation of related neurological disorders, after the d iagnosis and refined classification guided treatment, the improvement rates among each type were: BIa+0, 86.5%; BIa+S, 88.4%; BIb+0, 83.7%; BIb+S, 79.1%.Conclusions Successful management of congenital craniocervical anomalies requires a thoroughly understanding of the neural and bonyanatomy of the craniovertebral junction. Lesions and anatomical structure of craniovertibral junction areadissected was evidently present with the cervical vertebra MRI, MRI-Cine and three-dimensional CT reconstruction of cranio-cervical junction. Refinement of congenital basilar invagination classification based on the presence or absence of syringomyelia and atlantoaxial dislocation could chould accurately reflect the pathological features of complicated basilar invagination, promote the patients outcomes and reduce surgical strategies’ rate of morbidity and morbidity.