Prevalence of foramen arcuale and its clinical significance: a meta-analysis of 55,985 subjects

Author:

Pękala Przemysław A.12,Henry Brandon M.12,Pękala Jakub R.2,Hsieh Wan Chin13,Vikse Jens12,Sanna Beatrice4,Walocha Jerzy A.12,Tubbs R. Shane5,Tomaszewski Krzysztof A.12

Affiliation:

1. International Evidence-Based Anatomy Working Group;

2. The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland;

3. First Faculty of Medicine, Charles University, Prague, Czech Republic;

4. Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy; and

5. Seattle Science Foundation, Seattle, Washington

Abstract

OBJECTIVEThe foramen arcuale (FA) is a bony bridge located over the vertebral artery on the posterior arch of the atlas. The presence of an FA can pose a risk during neurosurgery by providing a false impression of a broader posterior arch. The aim of this study was to provide the most comprehensive investigation on the prevalence of the FA and its clinically important anatomical features.METHODSMajor electronic databases were searched to identify all studies that reported relevant data on the FA and the data were pooled into a meta-analysis.RESULTSA total of 127 studies (involving 55,985 subjects) were included. The overall pooled prevalence of a complete FA was 9.1% (95% CI 8.2%–10.1%) versus an incomplete FA, which was 13.6% (95% CI 11.2%–16.2%). The complete FA was found to be most prevalent in North Americans (11.3%) and Europeans (11.2%), and least prevalent among Asians (7.5%). In males (10.4%) the complete FA was more common than in females (7.3%) but an incomplete FA was more commonly seen in females (18.5%) than in males (16.7%). In the presence of a complete FA, a contralateral FA (complete or incomplete) was found in 53.1% of cases.CONCLUSIONSSurgeons should consider the risk for the presence of an FA prior to procedures on the atlas in each patient according to sex and ethnic group. We suggest preoperative screening with computerized tomography as the gold standard for detecting the presence of an FA.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

Reference264 articles.

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3. Posterior bridging of the atlas vertebra in south Indians;Manjunath;Indian J Med Sci,2001

4. Radiographic anomalies that may alter chiropractic intervention strategies found in a New Zealand population;Beck;J Manipulative Physiol Ther,2004

5. Radiological analysis of ponticulus posticus in Koreans;Cho;Yonsei Med J,2009

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