Ulus Travma Acil Cerrahi Derg. 2022; 28(7): 997-1007 | DOI: 10.14744/tjtes.2022.45610

Measuring the shape and dimensions of normal the bony structures in the craniovertebral junction from computed tomography images of the pediatric age group

Mustafa Kaya¹, Davut Ceylan², Tibet Kaçýra², Emrah Keskin², Yýldýray Çelenk³, Ezel Yaltýrýk Bilgin⁴, Özlem Kýtýki Kaçýra^5
1Department of Neurosurgery, Sakarya University Training and Research Hospital, Sakarya-Türkiye
²Department of Neurosurgery, Zonguldak Bülent Ecevit University Faculty of Medicine, Zonguldak-Türkiye
³Department of Emergency, Ereðli State Hospital, Zonguldak-Türkiye
⁴Department of Radiology, Ereðli State Hospital, Zonguldak-Türkiye
⁵Department of Radiology, Sakarya University Training and Research Hospital, Sakarya-Türkiye

BACKGROUND: The aim of this study is to contribute to the literature by determining the morphometric reference values of the bony structures in the craniovertebral junction (CVJ) from computer tomography (CT) images of the pediatric age group.
METHODS: In this study, CT’s of 151 simple trauma patients aged between 3 and 15 years between 2016 and 2020 were evaluated. All CT examinations were performed using a 32-slice CT and included images of the skull base and C1-C2 junction. A total of 10 measurements were obtained from these images, including Wachenheim clivus canal angle (WCA), Welcher basal angle (WBA), Cran-iocervical tilt angle (CCT), power ratio (PR), Atlantodens interval, McRae Line (MRL), McRae - Dens distance, basion-dens interval (BDI), basion-axis interval (BAI), and atlantooccipital measurement (AOM).
RESULTS: In comparison between gender groups, MRL (p=0.011) and AOM (p<0.001) measurements were found to be significantly higher in males. McRae-Dens distance, BDI, and AOM were significantly higher in patients aged 3–9 years (respectively, p=0005, p=0.003, p<0.001), and BAI (p=0.001) was significantly higher in patients aged 10–15 years. The McRae - Dens distance (p=0.119) was similar between patients with and without terminal ossicle in odontoid apex. But BDI of patients without terminal ossicle was significantly higher (p=0.048). All parameters, except the WCA, WBA, CCT, and PR, were statistically significantly correlated with the patient age (respectively, p=0.21, p=0.13, p=0.70, p=0.99).
CONCLUSION: In this study, the morphometric reference values of the bone structures at the CVJ were determined from the CT images of the pediatric age group.

Keywords: Bony structures, computer tomography images, craniovertebral junction; pediatric age.

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Pediatrik yaþ grubunun bilgisayarlý tomografi görüntülerinden kraniyovertebral bileþkedeki normal kemik yapýlarýn þekil ve boyutlarýnýn ölçülmesi

Mustafa Kaya¹, Davut Ceylan², Tibet Kaçýra², Emrah Keskin², Yýldýray Çelenk³, Ezel Yaltýrýk Bilgin⁴, Özlem Kýtýki Kaçýra^5
1Sakarya Eðitim ve Araþtýrma Hastanesi, Beyin ve Sinir Cerrahisi Kliniði, Sakarya
²Zonguldak Bülent Ecevit Üniversitesi Týp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalý, Zonguldak
³Ereðli Devlet Hastanesi, Acil Servis Kliniði, Zonguldak
⁴Ereðli Devlet Hastanesi, Radyoloji Kliniði, Zonguldak
⁵Sakarya Eðitim ve Araþtýrma Hastanesi, Radyoloji Kliniði, Sakarya

AMAÇ: Bu çalýþma, pediatrik yaþ grubunun bilgisayarlý tomografi (BT) görüntülerinden kraniyovertebral bileþkedeki kemikli yapýlarýn morfometrik referans deðerlerini belirleyerek literatüre katkýda bulunmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Bu çalýþmada, 2016–2020 yýllarý arasýnda yaþlarý 3–15 arasýnda deðiþen, 151 basit travmalý çocuk hastanýn servikal BT’leri deðerlendirildi. Tüm BT incelemelerinde 32-kesitli bir BT kullanýlarak, kafa tabaný ve C1-C2 bileþkesinin görüntüleri deðerlendirildi. Bu görüntülerden Wachenheim clivus kanal açýsý (WKA), Welcher bazal açýsý (WBA), kraniyoservikal tilt açýsý (KST), Power oraný (PO), Atlantodens intervali (ADI), McRae Line (MRL), McRae - Dens mesafesi, Bazion-Dens aralýðý (BDA), Bazion-aksis aralýðý (BAA), Atlantooksipital mesafe (AOM) olmak üzere toplam 10 ölçüm elde edildi.
BULGULAR: Cinsiyet gruplarý karþýlaþtýrýldýðýnda MRL (p=0.011) ve AOM (p<0.001) ölçümleri erkeklerde anlamlý olarak yüksek bulundu. McRae-Dens mesafesi, BDA ve AOM 3–9 yaþ arasý hastalarda anlamlý olarak daha yüksekti (sýrasýyla, p=0005, p=0.003, p<0.001) ve BAA (p=0.001) anlamlý olarak 10–15 yaþýndaki hastalarda daha yüksekti. McRae - Dens mesafesi (p=0.119) odontoid apeksinde terminal kemikçik olan ve olmayan hastalar arasýnda benzerdi. Ancak terminal kemiði olmayan hastalarda BDA anlamlý olarak daha yüksekti (p=0.048). WKA, WBA, KST ve PO dýþýn-daki tüm parametreler, hasta yaþý ile istatistiksel olarak anlamlý þekilde iliþkiliydi (sýrasýyla, p=0.21, p=0.13, p=0.70, p=0.99).
TARTIÞMA: Bu çalýþmada, pediatrik yaþ grubunun BT görüntülerinden kraniyovertebral bileþkedeki kemik yapýlarýnýn morfometrik referans deðer-leri belirlendi.

Anahtar Kelimeler: Bilgisayarlý tomografi, kraniovertebral bileþke, kemik yapýlar; pediatrik yaþ.

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