Basilar impression and Arnold-Chiari malformation. A study of 66 cases.
Basilar impression and Arnold-Chiari malformation. A study of 66 cases.
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基底印模和 Arnold-Chiari 畸形。
DOI：
10.1136/jnnp.31.6.596
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发表时间：
1968
期刊：
影响因子：
--
通讯作者：
Bregeat David
中科院分区：
文献类型：
--
作者：
M. Caetano de Barros;W. Farias;L. Ataide;S. Lins;Fischgold;Bregeat David
我们一直感兴趣的颅底变形的问题，称为基底压迹和描述的解剖学家自1790年以来（阿克曼），虽然最近才认识到从临床的角度来看，很长一段时间。这种情况引起了我们的注意，特别是因为它在巴西东北部的发病率很高，并引起了我们中的一位撰写的其他论文（de Barros，1957年，1959年）。Chamberlain的论文（1939）已经建立了精确的术前诊断的可能性。作者描述了一条线，在平片的头骨，允许承认的畸形正在讨论。张伯伦线在头颅侧面观中是从枕骨大孔的背侧唇到硬腭的背侧缘，在正常人中是从寰椎和齿突尖上方经过。当有基底压迹时，这些结构在这条线之上。菲利普斯（1955）认为任何基于张伯伦线的基底压迹定义都是武断的，尽管他承认当齿突尖端高于张伯伦线超过5 mm时，基底压迹存在。对于麦克雷（1953）来说，这一界限仅为3 mm。由于在头颅平片上绘制张伯伦线并不总是那么容易，因此可以借助断层摄影或其他参考线。McGregor的线（1948）连接硬腭的背缘和枕骨的最低点。在正常人中，这条线几乎与张伯伦的线重合，而在有基底印象的人中，这条线往往与张伯伦的线分开，布尔（1946）、布尔、尼克松和普拉特（1955）指出，经过硬腭和寰椎的平面是平行的，或者它们稍微相交，当有基底印象时，这种关系就改变了（图1）。
We have been interested for a long time in the problem of the deformation of the base of the skull known as basilar impression and described by the anatomists since 1790 (Ackermann), although only recently recognized from the clinical point of view. This condition has attracted our attention particularly because of its high incidence in the Northeast of Brazil and has given rise to other papers written by one of us (de Barros, 1957, 1959). The possibility of precise pre-operative diagnosis has been established by Chamberlain's paper (1939). This author described a line in plain radiograph of the skull which permits recognition of the malformation under discussion. Chamberlain's line is that which in a lateral view of the skull goes from the dorsal lip of the foramen magnum to the dorsal margin of the hard palate and in normal individuals passes above the atlas and the tip of the odontoid process. When a basilar impression is present, these structures are above this line. Phillips (1955) considers as arbitrary any definition of basilar impression based on Chamberlain's line, although admitting that it exists when the tip of the odontoid process is found more than 5 mm above this line. To McRae (1953) the limit would be only 3 mm. As it is not always easy to draw Chamberlain's line in a plain radiograph of the skull, one can resort to the tomograph or to other referencial lines. McGregor's line (1948) connects the dorsal rim of the hard palate to the lowest point of the occipital bone. In normal individuals this line almost superimposes that of Chamberlain, whereas in people having basilar impression it tends to be separate from it. Bull (1946) and Bull, Nixon, and Pratt (1955) point out that the planes passing by the hard palate and by the atlas are parallel or they slightly intersect, this relation being altered when there is basilar impression (Fig. 1).