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Cranial Bones: Superior and Posterior View01:14

Cranial Bones: Superior and Posterior View

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The superior view of the cranium shows the frontal and paired parietal bones.
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...
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Related Experiment Video

Updated: Sep 20, 2025

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
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Investigating Type B Basilar Invagination Through Cephalic Indices.

José J C Nascimento1, Leandro M Silva1, Elayne C O Ribeiro2

  • 1Postgraduate Program in Neuropsychiatry, Federal University of Pernambuco, Recife, Brazil.

World Neurosurgery
|June 10, 2022
PubMed
Summary

The height/width index (HWI) is a more accurate diagnostic tool for type B basilar invagination (BI) than the width/length index (WLI). HWI offers robust sensitivity and specificity for identifying this condition.

Keywords:
CephalometryOdontoid processSensitivity and specificitySkull

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Area of Science:

  • Neurosurgery
  • Radiology
  • Medical Imaging

Background:

  • Basilar invagination (BI) is a complex condition affecting the craniocervical junction.
  • Accurate diagnosis of type B basilar invagination is crucial for effective management.

Purpose of the Study:

  • To compare the diagnostic accuracy of cephalic indices, specifically the width/length index (WLI) and height/width index (HWI), for type B basilar invagination (BI).

Main Methods:

  • Retrospective analysis of head and neck MRI scans from 31 type B BI cases and 96 controls.
  • Two blinded examiners measured cephalic indices (WLI and HWI), odontoid process to Chamberlain line distance, and clivus canal angle.
  • Reproducibility assessed by intraclass correlation coefficient; diagnostic accuracy determined by receiver operating characteristic (ROC) curve analysis.

Main Results:

  • Cephalic indices demonstrated high inter- and intra-examiner reproducibility (≥94%).
  • The HWI showed a significantly larger area under the ROC curve (0.874) compared to WLI (0.639).
  • HWI achieved a sensitivity of 74.7% and specificity of 85.5% for type B BI detection.

Conclusions:

  • The height/width index (HWI) exhibits superior diagnostic performance for type B basilar invagination compared to the width/length index (WLI).
  • Cranial height and width proportions, as measured by HWI, are valuable for clinicians investigating type B BI.