Prevalence and Surgical Implications of the Arcuate Foramen: A 3D CT-Based Observational Study

NCT07130461 | Completed

• 1 other identifier: E-53593568-771-250207806
• Study Type: observational
• Target: 200
• Locations: 1 country
• Sites: 1

Brief Summary

This study aims to determine the prevalence and types of the arcuate foramen (AF), an anatomical variation of the first cervical vertebra (atlas), using three-dimensional computed tomography (3D CT). The arcuate foramen is formed when a bony bridge develops over the groove for the vertebral artery. Although often asymptomatic, it may increase the risk of vascular or nerve injury during surgery in the craniovertebral junction region. In this retrospective observational study, 3D CT scans of 200 adult patients obtained between January 2023 and July 2025 at Giresun University Faculty of Medicine were reviewed. The presence of AF was classified as complete or incomplete, and also categorized according to its location (right, left, or bilateral). Associations with demographic variables (age, sex) were analyzed. The results will help improve awareness of AF in preoperative planning for neurosurgical and spinal procedures, potentially reducing the risk of complications involving the vertebral artery and surrounding neurovascular structures.

Conditions

Arcuate Foramen; Anatomical Variations; Spine Surgery Complications

Keywords

Arcuate Foramen; 3D Computed Tomography; Vertebral Artery; Volume Rendering; OsiriX

Outcome Measures

Primary Outcomes (1)

• Prevalence of Arcuate Foramen Variants

  Proportion of participants with complete arcuate foramen identified on 3D computed tomography (CT). Unit of Measure: Percentage (%) of participants. Measurement Tool: High-resolution 3D reconstructed craniovertebral junction CT images, evaluated independently by two neuroradiologists. Analysis: Proportion calculated with 95% confidence intervals (CI).

  Baseline (single review of existing imaging data)

Secondary Outcomes (1)

• Association between Arcuate Foramen Type and Demographic Characteristics (Age and Sex)

  Baseline.

Study Arms (1)

All Adults Undergoing Head CT/CTA (2023-2025)

Consecutive adult patients (≥18 years) whose high-quality 3D CT or CTA images included the atlas (C1) vertebra. Images were evaluated retrospectively for the presence, type (complete/incomplete), and laterality (right/left/bilateral) of the arcuate foramen.

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adult patients (≥18 years) who underwent head computed tomography (CT) or computed tomography angiography (CTA) at Giresun University Faculty of Medicine between January 2023 and July 2025, whose images included the atlas (C1) vertebra and met quality criteria for three-dimensional reconstruction.

You may qualify if:

• Age ≥ 18 years at the time of imaging
• High-quality CT or CTA images including the atlas (C1) vertebra and posterior arch
• Imaging obtained between January 2023 and July 2025 at Giresun University Faculty of Medicine
• Images suitable for 3D volume rendering analysis without significant artifacts

You may not qualify if:

• Motion or metallic artifact preventing adequate evaluation of atlas anatomy
• Prior cervical spine surgery or trauma affecting the atlas
• Congenital anomalies or severe deformity of the atlas obscuring posterior arch assessment
• Incomplete demographic or imaging data

Sponsors & Collaborators

• Ondokuz Mayıs University: lead

Study Sites (1)

Giresun University Faculty of Medicine

Giresun, (506) 291 66 78, Turkey (Türkiye)

Location

Related Publications (3)

• Arslan D, Ozer MA, Govsa F, Kitis O. The Ponticulus Posticus as Risk Factor for Screw Insertion into the First Cervical Lateral Mass. World Neurosurg. 2018 May;113:e579-e585. doi: 10.1016/j.wneu.2018.02.100. Epub 2018 Feb 25.

  PMID: 29486308 RESULT

• Pekala PA, Henry BM, Pekala JR, Hsieh WC, Vikse J, Sanna B, Walocha JA, Tubbs RS, Tomaszewski KA. Prevalence of foramen arcuale and its clinical significance: a meta-analysis of 55,985 subjects. J Neurosurg Spine. 2017 Sep;27(3):276-290. doi: 10.3171/2017.1.SPINE161092. Epub 2017 Jun 16.

  PMID: 28621616 RESULT

• Elliott RE, Tanweer O. The prevalence of the ponticulus posticus (arcuate foramen) and its importance in the Goel-Harms procedure: meta-analysis and review of the literature. World Neurosurg. 2014 Jul-Aug;82(1-2):e335-43. doi: 10.1016/j.wneu.2013.09.014. Epub 2013 Sep 18.

  PMID: 24055572 RESULT

Study Officials

• Tamer Tamdogan, MD

  Giresun University Faculty of Medicine

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: August 11, 2025
• First Posted: August 19, 2025
• Study Start: July 1, 2025
• Primary Completion: July 31, 2025
• Study Completion: July 31, 2025
• Last Updated: August 19, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)