title: The importance of platybasia and the palatine line in patient selection for endonasal surgery of the craniocervical junction: a radiographic study of 12 patients.
abstract: OBJECTIVE
  Ventral decompressive surgery of the craniocervical junction is performed to manage a variety of conditions, including basilar invagination, which can be associated with platybasia. We have noted that the anatomic changes of platybasia could affect the height of the odontoid over a line drawn along the nasal cavity floor, the palatine line (PL). This anatomic change may influence the use of nasal endoscopic surgery for patients with platybasia who also have basilar invagination. We investigated whether the height of the craniocervical junction is elevated over the PL in patients with and without platybasia.
  
  
  METHODS
  We conducted a retrospective review of consecutive craniovertebral junction surgical cases during a 14-month period. During that time we treated 12 patients, including 4 with platybasia and 8 without. The average age was 50 years (range, 18-64 years). Preoperative and postoperative radiographic images were evaluated and charts reviewed.
  
  
  RESULTS
  The mean height of the odontoid over the PL without platybasia was 3.5 mm (range, 0-19.0 mm). In those with platybasia, it was 15.5 mm (range, 7-26.0 mm; P=.021). There was a statistically significant increase in the height of the clival tip and C1 ring in patient with platybasia as well.
  
  
  CONCLUSIONS
  Platybasia is associated with an increase in the odontoid and craniocervical junction over the PL. This increase in height has implications for endoscopic approach selection in patients with platybasia. Platybasia patients with basilar invagination may be better suited to a transnasal approach.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Ivan H
authors.initials: IH
authors.lastname: El-Sayed
authors.forename: Jau-Ching
authors.initials: JC
authors.lastname: Wu
authors.forename: Nripendra
authors.initials: N
authors.lastname: Dhillon
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.forename: Praveen
authors.initials: P
authors.lastname: Mummaneni
mesh_terms: D000293:Adolescent; D000328:Adult; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging* / Q000601:surgery*; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging* / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D009809:Odontoid Process / Q000000981:diagnostic imaging; D021362:Palate, Hard / Q000000981:diagnostic imaging*; D010985:Platybasia / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult