Thierry A.G.M. Huisman
We chose to retrospectively review the neuroimaging findings in pediatric tectorial membrane injuries/retroclival hemorrhages (REH) to better understand the incidence and mechanisms of injury that may lead to these findings. In addition, and maybe foremost, we aimed to alert the readership about the importance of actively reviewing this area carefully in the pediatric population. The cranio-cervical junction is at increased risk for ligamentous injury in young children due to the unique biomechanical characteristics of the pediatric cranio-cervical junction. These hemorrhages and possible associated ligamentous injuries may be easily overlooked on acute head CT or cervical spine CT. Often, the CT imaging protocols of the cervical spine do not include sagittal soft tissue algorithm reconstructions, limiting recognition of this potentially life-threatening complication.
In our institution, the pediatric head and cervical spine CT protocols always include a soft tissue sagittal reconstruction, which facilitates recognition of REH on acute CT studies. In addition, if there is a clinical or radiologic suspicion for a cranio-cervical injury, MR imaging of the cranio-cervical junction will complete the diagnostic work-up to evaluate the degree and extent of ligamentous injury.
Since the publication of our report we have been contacted by multiple radiologic groups to share our imaging protocols/algorithms.
Injury to the cranio-cervical junction is actively studied in very young children who have experienced acute acceleration-deceleration injuries of the head and neck region. Furthermore, we are actively studying children who have been exposed to nonaccidental injury, including possible