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Isolated atlas-duplication as a manifestation of persistent proatlas: a case report

  • Anatomic Variations
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Abstract

Purpose

Atlas-duplication is an exceedingly rare dysplasia of the craniocervical junction. To the best of our knowledge, only two cases of atlas-duplication have been reported and these were associated with complete anterior rachischisis and os odontoideum. We aimed to report a case of isolated atlas-duplication of incidental finding and without attributable symptoms which makes it unique.

Methods

Following a normal coronarography for a suspected myocardial infarction, a 60-year-old-man with no significant medical history developed a transient ischemic attack that justified brain computed-tomography angiography.

Results

There was no evidence for cerebral ischemic lesion, intracranial occlusion or significant artery disease. Bone analysis revealed eight cervical vertebral segments with an additional vertebral level located between the occiput and the atlas. This vertebra presented all the morphological characteristics of an atlas vertebra except for hypoplasia of the left transverse process. An incomplete anterior rachischisis was associated, and there was no other abnormality of craniocervical junction. The clinical examination revealed no neck pain, no limitation of joint amplitude and no neurological deficit. Apart from preventive treatment of ischemic stroke, no orthopedic or surgical treatment was undertaken. After 1.5 years of radiological monitoring, the patient remains symptom-free.

Conclusions

Atlas-duplication is an exceedingly rare dysplasia of the craniocervical junction that may be found isolated and incidentally. If this variation does not necessarily warrant specific treatment, brain CT angiography is recommended to detect anatomical variations of the vertebral arteries.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Kessel M, Balling R, Gruss P (1990) Variations of cervical vertebrate after expression of Hox-1.1 transgene in mice. Cell 61:301–308

    Article  CAS  Google Scholar 

  2. Klimo P, Coon V, Brockmeyer D (2011). Incidental os odontoideum: current management and strategies. FOC 31-E10

  3. Menezes AH (2008) Craniocervical developmental anatomy and its implications. Childs Nerv Syst 24:1109–1122

    Article  Google Scholar 

  4. Le Double AF (192). Traité des variations de la colonne vertébrale de l’Homme et leur signification au point de vue de l’anthropologie zoologique. Paris : Vigot frères.

  5. Offiah CE, Day E (2017) The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Insights Imaging 8:29–47

    Article  Google Scholar 

  6. Pang D, Thompson DNP (2011) Embryology and bony malformations of the craniovertebral junction. Childs Nerv Syst 27:525–564

    Google Scholar 

  7. Shapiro R, Robinson F (1976). Anomalies of craniovertebral border. American Journal of Roentgenelogy.

  8. Shoja MM, Rhamdhan R, Jeansen CJ et al (2018) Embyology of the craniovertebral junction and posterior fossa, part I: developpement of the upper vertebrae and skull. Clin Anat 31:466–487

    Article  Google Scholar 

  9. Spittank H, Goehmann U, Hage H, Sacher R (2016) Persistent proatlas with additional segmentation of the craniovertebral junction—The Tsuang-Goehmann Malformation. Radiology Case 10:15–23

    Article  Google Scholar 

  10. Tsuang F-Y, Chen J-Y, Wang Y-H, Lai D-M (2011) Occipitocervical malformations with atlas duplication. J Neurol Neurosurg Psychiatry 82:1101–1102

    Article  Google Scholar 

Download references

Funding

No funds, grants or other support was received.

Author information

Authors and Affiliations

  1. Department of Neuroradiology, Neurological and Neurosurgical Hospital P. Wertheimer, East Group Hospital, 69500, Hospices Civils de Lyon. 59 Bd PinelBron, France

    Lea Zumbihl, Yves Berthezene, Marc Hermier & Alexandre Bani-Sadr

  2. CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 7 avenue Jean Capelle O, 69100, Villeurbanne, France

    Yves Berthezene & Alexandre Bani-Sadr

  3. Department of Neurosurgery and Spine Surgery, Neurological and Neurosurgical Hospital P. Wertheimer, Hospices Civils de Lyon, Claude Bernard University of Lyon, 1, 59 Bd Pinel, 69500, Bron, France

    Lea Zumbihl & Cédric Barrey

Authors
  1. Lea Zumbihl
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  2. Yves Berthezene
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  3. Marc Hermier
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  4. Cédric Barrey
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  5. Alexandre Bani-Sadr
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Contributions

LM, CB and ABS analyzed the patient data regarding imaging. CB analyzed the patient data regarding clinical aspects. LM and ABS wrote the first draft of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alexandre Bani-Sadr.

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Conflict of interests

The authors declare no competing interests.

Ethics approval and consent to participate:

The included participant gave informed consent for participation. The local institutional review board (number: 00009118) approved this study. The participant has consented to the submission of the case report to the journal.

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Zumbihl, L., Berthezene, Y., Hermier, M. et al. Isolated atlas-duplication as a manifestation of persistent proatlas: a case report. Surg Radiol Anat 44, 595–598 (2022). https://doi.org/10.1007/s00276-022-02918-7

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  • DOI: https://doi.org/10.1007/s00276-022-02918-7

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