Tectorial membrane injury in adult and pediatric trauma patients: a retrospective review and proposed classification scheme

Background and purpose

Traumatic tectorial membrane injuries have different radiologic presentations in adult versus pediatric patients. The purpose of this study was to identify and classify the different types of tectorial membrane injuries that occur in the adult and pediatric populations.

Materials and methods

Patients who suffered tectorial membrane injury were identified retrospectively using the keywords 'tectorial membrane," "craniocervical ligament tear/injury," and "atlanto-occipital dissociation" included in radiology reports between 2012 and 2018 using Nuance mPower software. All relevant imaging studies were reviewed by two certificates of additional qualification-certified neuroradiologists. Detailed descriptions of injuries were recorded along with any relevant additional findings, including clinical history.

Results

Ten adults and six pediatric patients were identified with acute traumatic injuries of the tectorial membrane. Ninety percent of the adult patients sustained complete disruptions inferior to the clivus, or subclival, with 22% of tears at the level of the basion and 78% at the level of the odontoid tip. In contrast, 83% of pediatric patients suffered a stripping injury of the tectorial membrane located posterior to the clivus, or retroclival. Stretch injuries of the tectorial membrane were identified in 10% of adults and 17% of pediatric patients. The juvenile-type injury, which causes retroclival epidural hematoma, was determined to preferentially occur in patients less than or equal to 14 years of age with a high level of statistical significance (p value = 0.0014).

Conclusions

A classification system for tectorial membrane injuries is proposed based on this data: type 1—retroclival stripping injury (more common in pediatric patients); type 2a—subclival disruption at the basion and type 2b—subclival disruption at the odontoid (both more common in adult patients); and type 3—thinning of the tectorial membrane.