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Wang Z, Li Z, Han S, Hu X, Pang S, Li Y, Gao J. Magnetic Resonance Imaging-Related Anatomic and Functional Parameters for the Diagnosis and Prognosis of Chiari Malformation Type I: A Systematic Review and Meta-analysis. Neurospine 2024; 21:510-524. [PMID: 38955528 PMCID: PMC11224727 DOI: 10.14245/ns.2347150.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/14/2024] [Accepted: 02/03/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE Imaging parameters of Chiari malformation type I (CMI) development are not well established. This study aimed to collect evidence of general or specific imaging measurements in patients with CMI, analyze indicators that may assist in determining the severity of CMI, and guide its diagnosis and treatment. METHODS A comprehensive search was conducted across various databases including the Cochrane Library, PubMed, MEDLINE, Scopus, and Embase, covering the period from January 2002 to October 2023, following predefined inclusion criteria. Meta-analyses were performed using RevMan (ver. 5.4). We performed a quantitative summary and systematic analysis of the included studies. This study was registered in the PROSPERO (International Prospective Register of Systematic Reviews) prior to initiation (CRD42023415454). RESULTS Thirty-three studies met our inclusion criteria. The findings indicated that out of the 14 parameters examined, 6 (clivus length, basal angle, Boogard's angle, supraocciput lengths, posterior cranial fossa [PCF] height, and volume) exhibited significant differences between the CMI group and the control group. Furthermore, apart from certain anatomical parameters that hold prognostic value for CMI, functional parameters like tonsillar movement, obex displacement, and cerebrospinal fluid dynamics serve as valuable indicators for guiding the clinical management of the disease. CONCLUSION We collated and established a set of linear, angular, and area measurements deemed essential for diagnosing CMI. However, more indicators can only be analyzed descriptively for various reasons, particularly in prognostic prediction. We posit that the systematic assessment of patients' PCF morphology, volume, and other parameters at a 3-dimensional level holds promising clinical application prospects.
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Affiliation(s)
- Zairan Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhimin Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shiyuan Han
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianghui Hu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Siyuan Pang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongning Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Al Samman MM, Garcia MA, García M, Houston JR, Loth D, Labuda R, Vorster S, Klinge PM, Loth F, Delahanty DL, Allen PA. Relationship of Morphometrics and Symptom Severity in Female Type I Chiari Malformation Patients with Biological Resilience. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1146-1156. [PMID: 37935987 DOI: 10.1007/s12311-023-01627-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
In the present study we report the relationship among MRI-based skull and cervical spine morphometric measures as well as symptom severity (disability-as measured by Oswestry Head and Neck Pain Scale and social isolation-as measured by the UCLA Loneliness scale) on biomarkers of allostatic load using estrogen, interleukin-6, C-reactive protein, and cortisol in a sample of 46 CMI patients. Correlational analyses showed that McRae line length was negatively associated with interleukin-6 and C-reactive protein levels, and Analysis of Variance (ANOVA) showed joint effects of morphometric measures (McRae line length, anterior CSF space) and symptom severity (disability and loneliness) on estrogen and intereukin-6 levels. These results are consistent with allostatic load. That is, when the combination of CSF crowding and self-report symptom (disability and loneliness) severity exceed the capacity of biological resilience factors, then biomarkers such as neuroprotective estrogen levels drop, rather than rise, with increasing symptom severity.
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Affiliation(s)
| | - Monica A Garcia
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Maitane García
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - James R Houston
- Department of Psychology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Dorothy Loth
- Conquer Chiari Research Center, Northeastern University, Boston, MA, USA
| | | | - Sarel Vorster
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Petra M Klinge
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School Brown University, Providence, RI, USA
| | - Francis Loth
- Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, MA, USA
| | | | - Philip A Allen
- Department of Psychology, Conquer Chiari Research Center, University of Akron, Akron, OH, USA.
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Karamzadeh M, Al Samman MM, Vargas AI, Bhadelia RA, Oshinski J, Barrow DL, Amini R, Loth F. The Effect of Posterior Fossa Decompression Surgery on Brainstem and Cervical Spinal Cord Dimensions in Adults with Chiari Malformation Type 1. World Neurosurg 2023; 180:149-154.e2. [PMID: 37783305 PMCID: PMC10841825 DOI: 10.1016/j.wneu.2023.09.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Posterior fossa decompression (PFD) surgery creates more space at the skull base, reduces the resistance to the cerebrospinal fluid motion, and alters craniocervical biomechanics. In this paper, we retrospectively examined the changes in neural tissue dimensions following PFD surgery on Chiari malformation type 1 adults. METHODS Measurements were performed on T2-weighted brain magnetic resonance images acquired before and 4 months after surgery. Measurements were conducted for neural tissue volume and spinal cord/brainstem width at 4 different locations; 2 width measurements were made on the brainstem and 2 on the spinal cord in the midsagittal plane. Cerebellar tonsillar position (CTP) was also measured before and after surgery. RESULTS Twenty-five adult patients, with a mean age of 38.9 ± 8.8 years, were included in the study. The cervical cord volume increased by an average of 2.3 ± 3.3% (P = 0.002). The width at the pontomedullary junction increased by 2.2 ± 3.5% (P < 0.01), while the width 10 mm caudal to this junction increased by 4.2 ± 3.9% (P < 0.0001). The spinal cord width at the base of second cervical vertebra and third cervical vertebra did not significantly change after surgery. The CTP decreased by 60 ± 37% (P < 0.0001) after surgery, but no correlation was found between CTP change and dimension change. CONCLUSIONS The brainstem width and cervical cord volume showed a modest increase after PFD surgery, although standard deviations were large. A reduction in compression after PFD surgery may allow for an increase in neural tissue dimension. However, clinical relevance is unclear and should be assessed in future studies with high-resolution imaging.
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Affiliation(s)
- Mahsa Karamzadeh
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA.
| | | | - Ana I Vargas
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Rafeeque A Bhadelia
- Department of Radiology, Beth Israel Deaconess Medical Center & Harvard University School of Medicine, Boston, Massachusetts, USA
| | - John Oshinski
- Departments of Radiology & Imaging Sciences and Biomedical Engineering, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel L Barrow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rouzbeh Amini
- Departments of Mechanical and Industrial Engineering and Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Francis Loth
- Departments of Mechanical and Industrial Engineering and Bioengineering, Northeastern University, Boston, Massachusetts, USA
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Ibrahimy A, Wu T, Mack J, Scott GC, Cortes MX, Cantor FK, Loth F, Heiss JD. Prospective, Longitudinal Study of Clinical Outcome and Morphometric Posterior Fossa Changes after Craniocervical Decompression for Symptomatic Chiari I Malformation. AJNR Am J Neuroradiol 2023; 44:1150-1156. [PMID: 37709353 PMCID: PMC10549945 DOI: 10.3174/ajnr.a7993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/16/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND PURPOSE The time course of changes in posterior fossa morphology, quality of life, and neurologic function of patients with Chiari I malformation after craniocervical decompression requires further elaboration. To better understand the pace of these changes, we longitudinally studied patients with Chiari I malformation, with or without syringomyelia, before and after the operation for up to 5 years. MATERIALS AND METHODS Thirty-eight symptomatic adult patients (35 women, 3 men) diagnosed with Chiari I malformation only (n = 15) or Chiari I malformation and syringomyelia (n = 23) and without previous Chiari I malformation surgery were enrolled in a clinical study. Patients underwent outpatient study visits and MR imaging at 7 time points (ie, initial [before the operation], 3 months, 1 year, 2 years, 3 years, 4 years, and 5 years) during 5 years. The surgical procedure for all patients was suboccipital craniectomy, C1 laminectomy, and autologous duraplasty. RESULTS Morphometric measurements demonstrated an enlargement of the CSF areas posterior to the cerebellar tonsils after the operation, which remained largely stable through the following years. There was a decrease in pain and improved quality of life after the operation, which remained steady during the following years. Reduction in pain and improved quality of life correlated with CSF area morphometrics. CONCLUSIONS Most changes in MR imaging morphometrics and quality of life measures occurred within the first year after the operation. A 1-year follow-up period after Chiari I malformation surgery is usually sufficient for evaluating surgical efficacy and postoperative MR imaging changes.
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Affiliation(s)
- Alaaddin Ibrahimy
- From the Surgical Neurology Branch (A.I., J.M., G.C.S., M.X.C., F.K.C., J.D.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
- Department of Biomedical Engineering (A.I.), Yale University, New Haven, Connecticut
| | - Tianxia Wu
- Clinical Trials Unit (T.W.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Jessica Mack
- From the Surgical Neurology Branch (A.I., J.M., G.C.S., M.X.C., F.K.C., J.D.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Gretchen C Scott
- From the Surgical Neurology Branch (A.I., J.M., G.C.S., M.X.C., F.K.C., J.D.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Michaela X Cortes
- From the Surgical Neurology Branch (A.I., J.M., G.C.S., M.X.C., F.K.C., J.D.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Fredric K Cantor
- From the Surgical Neurology Branch (A.I., J.M., G.C.S., M.X.C., F.K.C., J.D.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Francis Loth
- Departments of Mechanical and Industrial Engineering, and Bioengineering (F.L.), Northeastern University College of Engineering, Boston, Massachusetts
| | - John D Heiss
- From the Surgical Neurology Branch (A.I., J.M., G.C.S., M.X.C., F.K.C., J.D.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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A Clinical Study on the Treatment of Recurrent Chiari (Type I) Malformation with Syringomyelia Based on the Dynamics of Cerebrospinal Fluid. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9770323. [DOI: 10.1155/2022/9770323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
Objective. Combining the dynamics of cerebrospinal fluid, our study investigates the clinical effects of syringomyelia after the combination of fourth ventricle-subarachnoid shunt (FVSS) for recurrent Chiari (type I) malformations after cranial fossa decompression (foramen magnum decompression (FMD)). Methods. From December 2018 to December 2020, 15 patients with recurrent syringomyelia following posterior fossa decompression had FVSS surgery. Before and after the procedure, the clinical and imaging data of these individuals were retrospectively examined. Results. Following FVSS, none of the 15 patients experienced infection, nerve injury, shunt loss, or obstruction. 13 patients improved dramatically after surgery, while 2 patients improved significantly in the early postoperative period, but the primary symptoms returned 2 months later. The Japanese Orthopedic Association (JOA) score was
, which was considerably better than preoperatively (
,
0.001). The MRI results revealed that the cavities in 13 patients were reduced by at least 50% compared to the cavities measured preoperatively. The shrinkage rate of syringomyelia was 86.67% (13/15). One patient’s cavities nearly vanished following syringomyelia. The size of the cavity in the patient remain unchanged, and the cavity’s maximal diameter was significantly smaller than the size measured preoperatively (
) PC-MRI results indicated that the peak flow rate of cerebrospinal fluid at the central segment of the midbrain aqueduct and the foramen magnum in patients during systole and diastole were significantly reduced after surgery (
). Conclusion. After posterior fossa decompression, FVSS can effectively restore the smooth circulation of cerebrospinal fluid and alleviate clinical symptoms in patients with recurrent Chiari (type I) malformation and syringomyelia. It is a highly effective way of treatment.
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Lin WW, Liu TJ, Dai WL, Wang QW, Hu XB, Gu ZW, Zhu YJ. Diagnostic performance evaluation of adult Chiari malformation type I based on convolutional neural networks. Eur J Radiol 2022; 151:110287. [DOI: 10.1016/j.ejrad.2022.110287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 03/02/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
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Influence of Pain on Cognitive Dysfunction and Emotion Dysregulation in Chiari Malformation Type I. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1378:155-178. [DOI: 10.1007/978-3-030-99550-8_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Thakar S, Kanneganti V, Talla Nwotchouang BS, Salem SJ, Eppelheimer M, Loth F, Allen PA, Aryan S, Hegde AS. Are Two-Dimensional Morphometric Measures Reflective of Disease Severity in Adult Chiari I Malformation? World Neurosurg 2022; 157:e497-e505. [PMID: 34710575 PMCID: PMC8692430 DOI: 10.1016/j.wneu.2021.10.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Two-dimensional (2D) morphometric measures have been previously used to diagnose Chiari I malformation (CMI) and distinguish patients from healthy subjects. There is, however, a paucity of literature regarding whether morphometric differences exist across the range of CMI disease severity. We evaluated whether 2D morphometrics demonstrate significant changes across standardized grades of CMI severity in adults. METHODS This retrospective observational study comprised 76 patients with symptomatic CMI with or without syringomyelia. Patients matched for age, sex, and body mass index were selected from each of the 3 severity grades of the Chiari Severity Index (CSI). The study used 17 2D craniocervical and posterior fossa morphometric variables that were previously found to differentiate patients with CMI from healthy subjects. The measurements were performed on midsagittal T1-weighted magnetic resonance imaging sequences using 2 custom in-house software tools, MorphPro and CerePro, and compared across CSI grades. RESULTS Analysis of variance showed that none of the 17 morphometric variables were significantly different across the 3 CSI grades (P > 0.003). Bayes factor 10 scores ranged from 0.11 to 0.82. Of variables, 9 had Bayes factor 10 scores between 0.10 and 0.30, while 8 had scores between 0.30 and 1. None of the Bayes factor 10 scores provided support for the alternative hypothesis that the morphometric measures differed across the CSI grades. CONCLUSIONS Our study indicated that 2D morphometrics are not reflective of CMI disease severity as indicated by the CSI grading system. The findings of our study support the need for further investigation into whether non-2D morphometric variables can be used as markers of disease severity.
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Affiliation(s)
- Sumit Thakar
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Vidyasagar Kanneganti
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | | | - Sara J. Salem
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Akron, Ohio, United States
| | - Maggie Eppelheimer
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, Ohio, United States
| | - Francis Loth
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Akron, Ohio, United States,Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, Ohio, United States
| | - Philip A. Allen
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, Ohio, United States
| | - Saritha Aryan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Alangar S Hegde
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
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Mantha S, Coulthard LG, Campbell R. CSF-space volumetric change following posterior fossa decompression in paediatric Chiari type-I malformation: a correlation with outcome. Childs Nerv Syst 2021; 37:3861-3869. [PMID: 34390378 DOI: 10.1007/s00381-021-05307-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We have previously reported inferior post-operative clinical outcomes in younger children with Chiari type-I malformation (CIM). We sought to quantify the CSF volumetric changes pre- and post-decompression, in a paediatric cohort, to determine whether cisternal volume change is associated with clinical outcomes. METHODS In this retrospective clinical study, the CSF spaces of the posterior fossa (supracerebellar/quadrigeminal, prepontine, fourth ventricle, cisterna magna) were measured on magnetic resonance images pre- and post-operatively using a semi-automated method. Additionally, we describe a novel CSF space of the upper cervical canal incorporating the subarachnoid space from the foramen magnum to the inferior cortex of the C2 body, FM-C2 cistern. Morphometric measurements included the pB-C2 distance, clivoaxial angle, clival length, clival angle and Boogard's angle. Volumetric and morphometric data were correlated with clinical outcomes at 4-12 months post-operatively as measured by the Chicago Chiari Outcome Scale (CCOS). RESULTS Of 59 adequate clinical cases, 57 and 36 patients had acceptable imaging for morphometric and volumetric analysis respectively. All CSF spaces measured had a significant increase in volume post-operatively (p < 0.05). There was no correlation between the change in volume or post-operative CSF volumes and CCOS. The pre-operative volume of the FM-C2 was positively correlated with total CCOS (Wald [Formula: see text], [Formula: see text]) and was significantly smaller in the 0-6-year age group (2.38 ± 1.27 ml vs. 3.67 ± 1.56 ml, p = 0.014). No morphometric measurement changed significantly after surgery or demonstrated a relationship with CCOS. CONCLUSIONS Volumetric changes in the CSF cisterns of the posterior cranial fossa and upper cervical canal do not correlate with the age-related differences in clinical outcomes in paediatric CIM. The pre-operative volume of the FM-C2 cistern may have a role in predicting the likelihood of a beneficial post-operative outcome in paediatric CIM.
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Affiliation(s)
- Sidharth Mantha
- Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia. .,School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4029, Australia.
| | - Liam G Coulthard
- Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4029, Australia
| | - Robert Campbell
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4029, Australia.,Department of Neurosurgery, Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia.,Brisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, QLD, 4101, Australia
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Eppelheimer MS, Nwotchouang BST, Pahlavian SH, Barrow JW, Barrow DL, Amini R, Allen PA, Loth F, Oshinski JN. Cerebellar and Brainstem Displacement Measured with DENSE MRI in Chiari Malformation Following Posterior Fossa Decompression Surgery. Radiology 2021; 301:187-194. [PMID: 34313469 DOI: 10.1148/radiol.2021203036] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Posterior fossa decompression (PFD) surgery is a treatment for Chiari malformation type I (CMI). The goals of surgery are to reduce cerebellar tonsillar crowding and restore posterior cerebral spinal fluid flow, but regional tissue biomechanics may also change. MRI-based displacement encoding with stimulated echoes (DENSE) can be used to assess neural tissue displacement. Purpose To assess neural tissue displacement by using DENSE MRI in participants with CMI before and after PFD surgery and examine associations between tissue displacement and symptoms. Materials and Methods In a prospective, HIPAA-compliant study of patients with CMI, midsagittal DENSE MRI was performed before and after PFD surgery between January 2017 and June 2020. Peak tissue displacement over the cardiac cycle was quantified in the cerebellum and brainstem, averaged over each structure, and compared before and after surgery. Paired t tests and nonparametric Wilcoxon signed-rank tests were used to identify surgical changes in displacement, and Spearman correlations were determined between tissue displacement and presurgery symptoms. Results Twenty-three participants were included (mean age ± standard deviation, 37 years ± 10; 19 women). Spatially averaged (mean) peak tissue displacement demonstrated reductions of 46% (79/171 µm) within the cerebellum and 22% (46/210 µm) within the brainstem after surgery (P < .001). Maximum peak displacement, calculated within a circular 30-mm2 area, decreased by 64% (274/427 µm) in the cerebellum and 33% (100/300 µm) in the brainstem (P < .001). No significant associations were identified between tissue displacement and CMI symptoms (r < .74 and P > .012 for all; Bonferroni-corrected P = .0002). Conclusion Neural tissue displacement was reduced after posterior fossa decompression surgery, indicating that surgical intervention changes brain tissue biomechanics. For participants with Chiari malformation type I, no relationship was identified between presurgery tissue displacement and presurgical symptoms. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Maggie S Eppelheimer
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Blaise Simplice Talla Nwotchouang
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Soroush Heidari Pahlavian
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Jack W Barrow
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Daniel L Barrow
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Rouzbeh Amini
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Philip A Allen
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Francis Loth
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - John N Oshinski
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
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11
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Shuman WH, DiRisio A, Carrasquilla A, Lamb CD, Quinones A, Pionteck A, Yang Y, Kurt M, Shrivastava RK. Is there a morphometric cause of Chiari malformation type I? Analysis of existing literature. Neurosurg Rev 2021; 45:263-273. [PMID: 34254195 DOI: 10.1007/s10143-021-01592-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023]
Abstract
Although many etiologies have been proposed for Chiari malformation type I (CM-I), there currently is no singular known cause of CM-I pathogenesis. Advances in imaging have greatly progressed the study of CM-I. This study reviews the literature to determine if an anatomical cause for CM-I could be proposed from morphometric studies in adult CM-I patients. After conducting a literature search using relevant search terms, two authors screened abstracts for relevance. Full-length articles of primary morphometric studies published in peer-reviewed journals were included. Detailed information regarding methodology and symptomatology, craniocervical instability, syringomyelia, operative effects, and genetics were extracted. Forty-six studies met inclusion criteria, averaging 93.2 CM-I patients and 41.4 healthy controls in size. To obtain measurements, 40 studies utilized MRI and 10 utilized CT imaging, whereas 41 analyzed parameters within the posterior fossa and 20 analyzed parameters of the craniovertebral junction. The most commonly measured parameters included clivus length (n = 30), tonsillar position or descent (n = 28), McRae line length (n = 26), and supraocciput length (n = 26). While certain structural anomalies including reduced clivus length have been implicated in CM-I, there is a lack of consensus on how several other morphometric parameters may or may not contribute to its development. Heterogeneity in presentation with respect to the extent of tonsillar descent suggests alternate methods utilizing morphometric measurements that may help to identify CM-I patients and may benefit future research to better understand underlying pathophysiology and sequelae such as syringomyelia.
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Affiliation(s)
- William H Shuman
- Department of Neurosurgery, Icahn School of Medicine At Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA.
| | - Aislyn DiRisio
- Department of Neurosurgery, Icahn School of Medicine At Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Alejandro Carrasquilla
- Department of Neurosurgery, Icahn School of Medicine At Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Colin D Lamb
- Department of Neurosurgery, Icahn School of Medicine At Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine At Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Aymeric Pionteck
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Yang Yang
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Mehmet Kurt
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine At Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
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12
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Imaging and health metrics in incidental cerebellar tonsillar ectopia: findings from the Adolescent Brain Cognitive Development Study (ABCD). Neuroradiology 2021; 63:1913-1924. [PMID: 34247260 DOI: 10.1007/s00234-021-02759-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Incidental cerebellar tonsillar ectopia (ICTE) that meets the radiographic criterion for Chiari malformation type I (CMI) is an increasingly common finding in the clinical setting, but its significance is unclear. The present study examined posterior cranial fossa (PCF) morphometrics and a broad range of health instruments of pediatric ICTE cases and matched controls extracted from the Adolescent Brain Cognitive Development (ABCD) dataset. METHODS One-hundred-six subjects with ICTE and 106 matched controls without ICTE were identified from 11,411 anatomical MRI of healthy screened pediatric subjects from the ABCD project. Subjects were matched by sex, age, body mass index, race, and ethnicity. Twenty-two brain morphometrics and 22 health instruments were compared between the two groups to identify unrecognized CMI symptoms and assess the general health impact of ICTE. RESULTS Twelve and 15 measures were significantly different between the ICTE and control groups for females and males, respectively. Notably, for females, the anterior CSF space was significantly smaller (p = 0.00005) for the ICTE group than controls. For males, the clivus bone length was significantly shorter (p = 0.0002) for the ICTE group compared to controls. No significant differences were found among the 22 health instruments between the two groups. CONCLUSION This study demonstrated that pediatric ICTE subjects have similar PCF morphometrics to adult CMI. ICTE alone did not appear to cause any unrecognized CMI symptoms and had no impact on the subjects' current mental, physical, or behavioral health. Still, given their cranial and brain morphology, these cases may be at risk for adult-onset symptomatic CMI.
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13
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García M, Eppelheimer MS, Houston JR, Houston ML, Nwotchouang BST, Kaut KP, Labuda R, Bapuraj JR, Maleki J, Klinge PM, Vorster S, Luciano MG, Loth F, Allen PA. Adult Age Differences in Self-Reported Pain and Anterior CSF Space in Chiari Malformation. THE CEREBELLUM 2021; 21:194-207. [PMID: 34106419 DOI: 10.1007/s12311-021-01289-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/30/2022]
Abstract
Chiari malformation type I (CMI) is a neural disorder with sensory, cognitive, and motor defects, as well as headaches. Radiologically, the cerebellar tonsils extend below the foramen magnum. To date, the relationships among adult age, brain morphometry, surgical status, and symptom severity in CMI are unknown. The objective of this study was to better understand the relationships among these variables using causal modeling techniques. Adult CMI patients (80% female) who either had (n = 150) or had not (n = 151) undergone posterior fossa decompression surgery were assessed using morphometric measures derived from magnetic resonance images (MRI). MRI-based morphometry showed that the area of the CSF pocket anterior to the cervico-medullary junction (anterior CSF space) correlated with age at the time of MRI (r = - .21). Also, self-reported pain increased with age (r = .11) and decreased with anterior CSF space (r = - .18). Age differences in self-reported pain were mediated by anterior CSF space in the cervical spine area-and this effect was particularly salient for non-decompressed CMI patients. As CMI patients age, the anterior CSF space decreases, and this is associated with increased pain-especially for non-decompressed CMI patients. It is recommended that further consideration of age-related decreases in anterior CSF space in CMI patients be given in future research.
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Affiliation(s)
- Maitane García
- Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Maggie S Eppelheimer
- Department of Biomedical Engineering, College of Engineering, The University of Akron, Akron, OH, USA
| | - James R Houston
- Department of Psychology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Michelle L Houston
- Department of Psychology, The University of Akron, Akron, OH, 44325-4301, USA
| | | | - Kevin P Kaut
- Department of Psychology, The University of Akron, Akron, OH, 44325-4301, USA
| | | | - J Rajiv Bapuraj
- Department of Radiology, Division of Neuroradiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jahangir Maleki
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Petra M Klinge
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School Brown University, Providence, RI, USA
| | - Sarel Vorster
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mark G Luciano
- Department of Neurosurgery, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Francis Loth
- Department of Biomedical Engineering, College of Engineering, The University of Akron, Akron, OH, USA.,Department of Mechanical Engineering, College of Engineering, The University of Akron, Akron, OH, USA
| | - Philip A Allen
- Department of Psychology, The University of Akron, Akron, OH, 44325-4301, USA.
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14
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Rare functional genetic variants in COL7A1, COL6A5, COL1A2 and COL5A2 frequently occur in Chiari Malformation Type 1. PLoS One 2021; 16:e0251289. [PMID: 33974636 PMCID: PMC8112708 DOI: 10.1371/journal.pone.0251289] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/24/2021] [Indexed: 11/19/2022] Open
Abstract
Chiari Malformation Type 1 (CM-1) is characterized by herniation of the cerebellar tonsils below the foramen magnum and the presence of headaches and other neurologic symptoms. Cranial bone constriction is suspected to be the most common biologic mechanism leading to CM-1. However, other mechanisms may also contribute, particularly in the presence of connective tissue disorders (CTDs), such as Ehlers Danlos Syndrome (EDS). Accumulating data suggest CM-1 with connective tissue disorders (CTD+) may have a different patho-mechanism and different genetic risk factors than CM-1 without CTDs (CTD-). To identify CM-1 genetic risk variants, we performed whole exome sequencing on a single large, multiplex family from Spain and targeted sequencing on a cohort of 186 unrelated adult, Caucasian females with CM-1. Targeted sequencing captured the coding regions of 21 CM-1 and EDS candidate genes, including two genes identified in the Spanish family. Using gene burden analysis, we compared the frequency of rare, functional variants detected in CM-1 cases versus publically available ethnically-matched controls from gnomAD. A secondary analysis compared the presence of rare variants in these genes between CTD+ and CTD- CM-1 cases. In the Spanish family, rare variants co-segregated with CM-1 in COL6A5, ADGRB3 and DST. A variant in COL7A1 was present in affected and unaffected family members. In the targeted sequencing analysis, rare variants in six genes (COL7A1, COL5A2, COL6A5, COL1A2, VEGFB, FLT1) were significantly more frequent in CM-1 cases compared to public controls. In total, 47% of CM-1 cases presented with rare variants in at least one of the four significant collagen genes and 10% of cases harbored variants in multiple significant collagen genes. Moreover, 26% of CM-1 cases presented with rare variants in the COL6A5 gene. We also identified two genes (COL7A1, COL3A1) for which the burden of rare variants differed significantly between CTD+ and CTD- CM-1 cases. A higher percentage of CTD+ patients had variants in COL7A1 compared to CTD+ patients, while CTD+ patients had fewer rare variants in COL3A1 than did CTD- patients. In summary, rare variants in several collagen genes are particularly frequent in CM-1 cases and those in COL6A5 co-segregated with CM-1 in a Spanish multiplex family. COL6A5 has been previously associated with musculoskeletal phenotypes, but this is the first association with CM-1. Our findings underscore the contribution of rare genetic variants in collagen genes to CM-1, and suggest that CM-1 in the presence and absence of CTD symptoms is driven by different genes.
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Ibrahimy A, Huang CWC, Bezuidenhout AF, Allen PA, Bhadelia RA, Loth F. Association Between Resistance to Cerebrospinal Fluid Flow Near the Foramen Magnum and Cough-Associated Headache in Adult Chiari Malformation Type I. J Biomech Eng 2021; 143:051003. [PMID: 33454731 PMCID: PMC8086178 DOI: 10.1115/1.4049788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/18/2020] [Indexed: 01/03/2023]
Abstract
Cough-associated headaches (CAHs) are thought to be distinctive for Chiari malformation type I (CMI) patients and have been shown to be related to the motion of cerebrospinal fluid (CSF) near the foramen magnum (FM). We used computational fluid dynamics (CFD) to compute patient-specific resistance to CSF motion in the spinal canal for CMI patients to determine its accuracy in predicting CAH. Fifty-one symptomatic CMI patients with cerebellar tonsillar position (CTP) ≥ 5 mm were included in this study. The patients were divided into two groups based on their symptoms (CAH and non-CAH) by review of the neurosurgical records. CFD was utilized to simulate CSF motion, and the integrated longitudinal impedance (ILI) was calculated for all patients. A receiver operating characteristic (ROC) curve was evaluated for its accuracy in predicting CAH. The ILI for CMI patients with CAH (776 dyn/cm5, 288-1444 dyn/cm5; median, interquartile range) was significantly larger compared to non-CAH (285 dyn/cm5, 187-450 dyn/cm5; p = 0.001). The ILI was more accurate in predicting CAH in CMI patients than the CTP when the comparison was made using the area under the ROC curve (AUC) (0.77 and 0.70, for ILI and CTP, respectively). ILI ≥ 750 dyn/cm5 had a sensitivity of 50% and a specificity of 95% in predicting CAH. ILI is a parameter that is used to assess CSF blockage in the spinal canal and can predict patients with and without CAH with greater accuracy than CTP.
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Affiliation(s)
- Alaaddin Ibrahimy
- Department of Mechanical Engineering, The University of Akron, 302 E Buchtel Avenue, Akron, OH 44325
| | - Chi-Wen Christina Huang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City 110, Taiwan
| | - Abraham F. Bezuidenhout
- Beth Israel Deaconess Medical Center, Department of Radiology, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215
| | - Philip A. Allen
- Department of Psychology, The University of Akron, 302 E Buchtel Avenue, Akron, OH 44325
| | - Rafeeque A. Bhadelia
- Beth Israel Deaconess Medical Center, Department of Radiology, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215
| | - Francis Loth
- Department of Mechanical Engineering, The University of Akron, 302 E Buchtel Avenue, Akron, OH 44325
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16
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Impact of Surgical Status, Loneliness, and Disability on Interleukin 6, C-Reactive Protein, Cortisol, and Estrogen in Females with Symptomatic Type I Chiari Malformation. THE CEREBELLUM 2021; 20:872-886. [PMID: 33677786 DOI: 10.1007/s12311-021-01251-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
Chiari malformation type I (CMI) provides an opportunity for examining possible moderators of allostatic load. CMI patients who had (n = 43) and had not (n = 19) undergone decompression surgery completed questionnaires regarding pain, disability, and loneliness, and provided serum samples for IL-6, CRP, estrogen, and free estradiol assays, and saliva samples to assess diurnal cortisol curves. ANOVAs examining surgical status (decompressed versus non-decompressed), loneliness (high vs. low), and disability (high vs. low) as independent variables and biomarker variables as dependent factors found that loneliness was associated with higher levels of cortisol, F(1, 37) = 4.91, p = .04, η2P = .11, and lower levels of estrogen, F(1, 36) = 7.29, p = .01, η2P = .17, but only in decompressed patients. Results highlight the possible impact of loneliness on biological stress responses and the need to intervene to reduce loneliness in patients with symptomatic CMI.
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17
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Wang S, Huang Z, Xu R, Liao Z, Yan Y, Tang W, Xia Y. Chiari Malformations Type I without Basilar Invagination in Adults: Morphometric and Volumetric Analysis. World Neurosurg 2020; 143:e640-e647. [PMID: 32791229 DOI: 10.1016/j.wneu.2020.08.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chiari malformation type I (CMI) cases are frequently associated with basilar invagination (BI), which complicates the understanding of the pathology of CMI. We specifically evaluated the morphometric and volumetric alterations in the bony structures of CMI patients without BI. METHODS Fifty adult CMI patients without BI treated at our institution from January 2015 to December 2019 were retrospectively studied. The morphometric and volumetric characteristics of the posterior cranial fossa (PCF) were analyzed using thin-slice computed tomography images. RESULTS Compared with the controls, the clivus length (P < 0.001), supraoccipital length (P < 0.001), Klaus height index (P < 0.001), axial length (P < 0.001), clivo-axial angle (P < 0.001), tentorial angle (P < 0.05), and bony PCF volume (P < 0.001) of the CMI-only group were significantly smaller, and the distance between the Chamberlain line and the dens axis (P < 0.001), clivus angle (P < 0.001), and basal angle (P < 0.001) of the CMI-only group were significantly larger, while the distance between the McRae line and the dens axis, McRae line, anteroposterior diameter of the PCF, occipital angle, occipital canal angle, and tentorial Twining line angle showed no significant difference between the 2 groups. CONCLUSIONS Hypoplasia of the clivus and occipital bone were confirmed in CMI patients without BI, thus providing further evidence for the notion that CMI is secondary to the underdevelopment of the PCF.
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Affiliation(s)
- Shengxi Wang
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhijian Huang
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Xu
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengbu Liao
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Yan
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenyuan Tang
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongzhi Xia
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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18
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Houston JR, Allen NJ, Eppelheimer MS, Bapuraj JR, Biswas D, Allen PA, Vorster SJ, Luciano MG, Loth F. Evidence for sex differences in morphological abnormalities in type I Chiari malformation. Neuroradiol J 2019; 32:458-466. [PMID: 31210559 DOI: 10.1177/1971400919857212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Relatively little is known about the influence of individual difference variables on the presentation of macro-level brain morphology in type I Chiari malformation (CMI). The goal of the present study is to examine how case-control differences in Chiari are affected by patient sex. MATERIALS AND METHODS Patient-provided magnetic resonance images were acquired through the Chiari 1000 database. Twenty-four morphometric measurements were taken using mid-sagittal images of 104 participants (26 male CMI, 26 female CMI, 26 male controls, and 26 female controls) using internally developed and validated custom software, Morphpro. Case-control comparisons were conducted separately by sex using healthy controls matched by age and body mass index. Probability-based t-tests, effect sizes (Cohen's d), and confidence intervals were used to compare case-control differences separately by sex. RESULTS Male and female case-control comparisons yielded largely the same trends of CMI-related morphometric abnormalities. Both groups yielded reductions in posterior cranial fossa (PCF) structure heights. However, there was evidence for greater PCF structure height reductions in male CMI patients as measured by Cohen's d. CONCLUSIONS Case-control differences indicated strong consistency in the morphometric abnormalities of CMI malformation in males and females. However, despite the higher prevalence rates of CMI in females, the results from the present study suggest that male morphometric abnormalities may be greater in magnitude. These findings also provide insight into the inconsistent findings from previous morphometric studies of CMI and emphasize the importance of controlling for individual differences when conducting case-control comparisons in CMI.
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Affiliation(s)
- James R Houston
- Department of Psychology, Middle Tennessee State University, USA
| | - Natalie J Allen
- Department of Biomedical Engineering, The University of Akron, USA
| | | | - Jayapalli Rajiv Bapuraj
- Department of Radiology, Division of Neuroradiology, University of Michigan Health System, USA
| | - Dipankar Biswas
- Department of Mechanical Engineering, The University of Akron, USA
| | | | - Sarel J Vorster
- Department of Neurological Surgery, Cleveland Clinic Foundation, USA
| | - Mark G Luciano
- Department of Neurosurgery, Johns Hopkins Medical Center, USA
| | - Francis Loth
- Department of Biomedical Engineering, The University of Akron, USA.,Department of Mechanical Engineering, The University of Akron, USA
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