title: Radiologic Evaluation of Basilar Invagination Without Obvious Atlantoaxial Instability (Group B Basilar Invagination): Analysis Based on a Study of 75 Patients.
abstract: BACKGROUND
  We evaluated the radiologic features of 75 patients with group B basilar invagination who exhibited no evidence of atlantoaxial instability based on the conventional parameter of an abnormal increase in the atlantodental interval. We specifically studied the variability and possible significance of the presence of cerebrospinal fluid (CSF) within and outside the confines of neural tissues.
  
  
  METHODS
  During the period January 2008-May 2015, we encountered 75 cases with group B basilar invagination. These patients were divided into 4 groups depending on cervical spinal imaging that showed the presence of syringomyelia (group B1), increased CSF volume in the extramedullary space or external syrinx (group B2), the presence of both syringomyelia and external syrinx (group B3), and no abnormality of CSF cavitation in the spinal canal (group B4).
  
  
  RESULTS
  Our cohort comprised 39 group B1 cases, 10 group B2 cases, 20 group B3 cases, and 6 group B4 cases. The neck size and posterior fossa height were simultaneously reduced, by 15.89% and 15%, respectively, but the length of the neural structures remained within the normal range. Excessive amounts of CSF were present within or outside the confines of neural structures, including the spinal cord, brainstem, and cerebellum.
  
  
  CONCLUSIONS
  In cases of basilar invagination, various musculoskeletal and neural alterations seem to have a common functional role in protecting the craniocervical cord and delaying or stalling neurologic dysfunction.
authors.affiliation: Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India; Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, India. Electronic address: atulgoel62@hotmail.com.
authors.forename: Atul
authors.initials: A
authors.lastname: Goel
authors.affiliation: Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.
authors.forename: Trimurti
authors.initials: T
authors.lastname: Nadkarni
authors.affiliation: Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.
authors.forename: Abhidha
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Sathe
authors.affiliation: Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Patil
mesh_terms: D000293:Adolescent; D000328:Adult; D001139:Arnold-Chiari Malformation / Q000000981:diagnostic imaging*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000592:standards; D008297:Male; D008875:Middle Aged; D013595:Syringomyelia / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000592:standards; D055815:Young Adult
keywords: Atlantoaxial instability; Basilar invagination; Chiari 1 malformation; Syringomyelia