Historical and modern perspectives in management of basilar invagination

Winner of the Vesalius Award Award, Abhidha Harshad Shah, MS, MD, presented her research, Management of Basilar Invagination: A Historical Perspective, during the 2016 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.

For a long time, basilar invagination remained an anatomic and radiological curiosity. It is only recently that this entity has entered the realm of clinical neurosurgery.

Historically, the terms basilar invagination and platybasia were used interchangeably, causing confusion in diagnosis and management. Basilar invagination has been defined as a prolapse of the vertebral column into the spinal cord. Platybasia is defined as an abnormal obtuse angle between the anterior skull base and the clivus. The author reviewed existing literature and summarized the historical and modern perspectives in the management of basilar invagination.

From radiological curiosities, the subject of basilar invagination is now viewed as eminently treatable. A more pronounced understanding of the subject has taken place in the last three decades when, on the basis of understanding of the biomechanical subtleties, the treatment paradigm has altered remarkably. Surgery that involves decompression of the region, stabilization and realignment now form the basis of treatment. As the understanding of basilar invagination has evolved, it appears that mechanical instability is the cause. Craniovertebral re-alignment and atlantoaxial fixation as pioneered by Goel et al. is the current management of this anomaly.