E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Morphometric Analysis of Craniocervical Junction in Patients with Myelomeningocele: Relationship with Hydrocephalus and Chiari-Related Tonsillar Herniation
Mustafa Ozkan✉ ,
Harun Demirci
Neurosurgery, Gaziantep Deva Hospital
Accepted: 28/07/2026
Article in Press
Corresponding Author:
Mustafa Ozkan (mustafaozkan06@gmail.com)
Abstract
Aim
Myelomeningocele (MMC), the most common life-compatible central nervous system congenital anomaly, is frequently associated with intracranial malformations, including hydrocephalus and Chiari-related hindbrain herniation. This study aimed to examine magnetic resonance imaging (MRI)-based craniocervical junction (CCJ) morphometry in MMC and its relationship with hydrocephalus and Chiari-related tonsillar herniation.
Material and Methods
Seventy-seven patients with MMC treated between 2019 and 2023 were retrospectively evaluated using preoperative MRI. CCJ morphometric parameters (McRae line length, supraocciput length, clivus length, odontoid height, basion-dens interval (BDI), basion-posterior axial interval, pB-C2 distance, clivus-supraocciput angle, Wackenheim angle, Boogard angle, and tonsillar herniation) were compared according to the presence of hydrocephalus and the severity of tonsillar herniation. All measurements were performed twice on separate occasions, and the mean value was used for analysis.
Results
Hydrocephalus was present in 68.8% of patients. Greater tonsillar herniation, increased supraocciput length (SOL), and a smaller Boogard angle (BA) were independently associated with hydrocephalus. Each 1-mm increase in tonsillar herniation increased the odds of hydrocephalus by 1.075 (95% confidence intervals: 1.018–1.135; p = 0.009). Patients with hydrocephalus had larger SOL and Wackenheim angle (WA), but smaller BA and pB-C2 distance than those without hydrocephalus. Increasing tonsillar herniation was associated with decreased BDI and increased SOL.
Conclusion
CCJ morphometric parameters were significantly related to hydrocephalus and Chiari-related tonsillar herniation in MMC patients. These findings further clarify the etiopathogenesis of MMC-related anomalies and may aid in risk stratification during clinical follow-up.
Myelomeningocele (MMC), the most common life-compatible central nervous system congenital anomaly, is frequently associated with intracranial malformations, including hydrocephalus and Chiari-related hindbrain herniation. This study aimed to examine magnetic resonance imaging (MRI)-based craniocervical junction (CCJ) morphometry in MMC and its relationship with hydrocephalus and Chiari-related tonsillar herniation.
Material and Methods
Seventy-seven patients with MMC treated between 2019 and 2023 were retrospectively evaluated using preoperative MRI. CCJ morphometric parameters (McRae line length, supraocciput length, clivus length, odontoid height, basion-dens interval (BDI), basion-posterior axial interval, pB-C2 distance, clivus-supraocciput angle, Wackenheim angle, Boogard angle, and tonsillar herniation) were compared according to the presence of hydrocephalus and the severity of tonsillar herniation. All measurements were performed twice on separate occasions, and the mean value was used for analysis.
Results
Hydrocephalus was present in 68.8% of patients. Greater tonsillar herniation, increased supraocciput length (SOL), and a smaller Boogard angle (BA) were independently associated with hydrocephalus. Each 1-mm increase in tonsillar herniation increased the odds of hydrocephalus by 1.075 (95% confidence intervals: 1.018–1.135; p = 0.009). Patients with hydrocephalus had larger SOL and Wackenheim angle (WA), but smaller BA and pB-C2 distance than those without hydrocephalus. Increasing tonsillar herniation was associated with decreased BDI and increased SOL.
Conclusion
CCJ morphometric parameters were significantly related to hydrocephalus and Chiari-related tonsillar herniation in MMC patients. These findings further clarify the etiopathogenesis of MMC-related anomalies and may aid in risk stratification during clinical follow-up.
Keywords
Myelomeningocele
Craniocervical junction
Morphometry
Hydrocephalus
Tonsillar Herniation