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Sahuquillo J, Moncho D, Ferré A, López-Bermeo D, Sahuquillo-Muxi A, Poca MA. A Critical Update of the Classification of Chiari and Chiari-like Malformations. J Clin Med 2023; 12:4626. [PMID: 37510741 PMCID: PMC10380265 DOI: 10.3390/jcm12144626] [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: 06/03/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Chiari malformations are a group of craniovertebral junction anomalies characterized by the herniation of cerebellar tonsils below the foramen magnum, often accompanied by brainstem descent. The existing classification systems for Chiari malformations have expanded from the original four categories to nine, leading to debates about the need for a more descriptive and etiopathogenic terminology. This review aims to examine the various classification approaches employed and proposes a simplified scheme to differentiate between different types of tonsillar herniations. Furthermore, it explores the most appropriate terminology for acquired herniation of cerebellar tonsils and other secondary Chiari-like malformations. Recent advances in magnetic resonance imaging (MRI) have revealed a higher prevalence and incidence of Chiari malformation Type 1 (CM1) and identified similar cerebellar herniations in individuals unrelated to the classic phenotypes described by Chiari. As we reassess the existing classifications, it becomes crucial to establish a terminology that accurately reflects the diverse presentations and underlying causes of these conditions. This paper contributes to the ongoing discussion by offering insights into the evolving understanding of Chiari malformations and proposing a simplified classification and terminology system to enhance diagnosis and management.
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Affiliation(s)
- Juan Sahuquillo
- Department of Neurosurgery, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Dulce Moncho
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Clinical Neurophysiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Alex Ferré
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Sleep Unit, Pneumology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Diego López-Bermeo
- Department of Neurosurgery, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Aasma Sahuquillo-Muxi
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Maria A Poca
- Department of Neurosurgery, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
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Obstructing Sleep Apnea in Children with Genetic Disorders-A Special Need for Early Multidisciplinary Diagnosis and Treatment. J Clin Med 2021; 10:jcm10102156. [PMID: 34067548 PMCID: PMC8156845 DOI: 10.3390/jcm10102156] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background—Children with genetic disorders have multiple anatomical and physiological conditions that predispose them to obstructive sleep apnea syndrome (OSAS). They should have priority access to polysomnography (PSG) before establishing their therapeutic protocol. We analyzed the prevalence and the severity of OSAS in a particular group of children with genetic disorders and strengthened their need for a multidisciplinary diagnosis and adapted management. Methods—The retrospective analysis included children with genetic impairments and sleep disturbances that were referred for polysomnography. We collected respiratory parameters from sleep studies: apnea–hypopnea index (AHI), SatO2 nadir, end-tidal CO2, and transcutaneous CO2. Subsequent management included non-invasive ventilation (NIV) or otorhinolaryngological (ENT) surgery of the upper airway. Results—We identified 108 patients with neuromuscular disorders or multiple congenital anomalies. OSAS was present in 87 patients (80.5%), 3 of whom received CPAP, 32 needed another form of NIV during sleep, and 15 patients were referred for ENT surgery. The post-therapeutic follow-up PSG parameters confirmed the success of the treatment. Conclusions—The upper airway obstruction diagnostics and management for children with complex genetic diseases need a multidisciplinary approach. Early detection and treatment of sleep-disordered breathing in children with genetic disorders is a priority for improving their quality of life.
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Dantas FLR, Dantas F, Caires AC, Botelho RV. Natural History and Conservative Treatment Options in Chiari Malformation Type I in Adults: A Literature Update. Cureus 2020; 12:e12050. [PMID: 33447479 PMCID: PMC7802397 DOI: 10.7759/cureus.12050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 11/30/2022] Open
Abstract
Over the years, knowledge regarding the natural history of Chiari malformation type I (CM-I) has improved. However, there are still uncertainties in the literature regarding asymptomatic and oligosymptomatic patients with CM-I. We performed a literature review in order to determine the natural history of CM-I in symptomatic patients who were not operated and in asymptomatic adult patients. Among symptomatic patients, the most frequent symptom was headache (77%). Cough-related headache alone (34%), migraine-related headache alone (21.4%), and both cough- and migraine-related headaches (21.8%) were the most prevalent forms of headache. Some symptoms improved more effectively with surgical treatment options; cough-related headaches improved by 95% following surgery and by 40% following conservative treatment. Other headache types improved by 93% and 61.5% following conservative and surgical treatments, respectively. Patients diagnosed with asymptomatic or oligosymptomatic CM-I may improve over time or stabilize with conservative treatment. There is great heterogeneity in the literature regarding the diagnostic criteria for CM-I. Owing to the heterogeneity among the articles identified for this review, there is no consensus regarding the precise indications for surgery in asymptomatic patients. The natural CM-I history in asymptomatic patients reveals a favorable evolution.
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Affiliation(s)
| | - François Dantas
- Neurological Surgery, Biocor Instituto, Belo Horizonte, BRA
- Neurological Surgery, Hospital Vila da Serra, Belo Horizonte, BRA
| | | | - Ricardo V Botelho
- Neurological Surgery, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, BRA
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Strang A, Katwa U. Persistent Central Apnea and Long-Term Outcome After Posterior Fossa Decompressive Surgery for Arnold Chiari Type 1 Malformation in a Pediatric Patient. J Clin Sleep Med 2019; 15:667-671. [PMID: 30952227 DOI: 10.5664/jcsm.7740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/06/2019] [Indexed: 11/13/2022]
Abstract
ABSTRACT Arnold Chiari malformation (ACM) is the most common cause of central sleep apnea (CSA) in otherwise healthy children. Although there are several case reports and series reported on this topic, there are limited descriptions of the long-term course of these children after the surgical interventions. Posterior fossa decompression surgery to relieve pressure of the herniating cerebellum on the brainstem is generally thought to significantly improve CSA in most cases, however, there are very limited data on the natural course of CSA in children following decompression surgery. There may be a subset of children in whom it may take much longer for CSA to resolve, and in some it may not resolve completely. Hence, these children need to be followed closely with sleep studies to document resolution of CSA. In this case report, we describe a 10-year-old male with severe CSA who was subsequently diagnosed with type 1 ACM and underwent posterior fossa decompressive surgery. However after surgery, although there was improvement in his CSA, he still had a significant degree of residual CSA which required bilevel positive pressure therapy and took more than 7.5 years to resolve. This case report illustrates the need for close follow-up in these children and for providers to understand the natural course so they can accurately counsel families about expectations after surgical treatments.
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Affiliation(s)
- Abigail Strang
- Sleep Center, Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Umakanth Katwa
- Sleep Center, Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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5
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Ferré Á, Poca MA, de la Calzada MD, Moncho D, Urbizu A, Romero O, Sampol G, Sahuquillo J. A Conditional Inference Tree Model for Predicting Sleep-Related Breathing Disorders in Patients With Chiari Malformation Type 1: Description and External Validation. J Clin Sleep Med 2019; 15:89-99. [PMID: 30621833 DOI: 10.5664/jcsm.7578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 09/13/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim of this study is to generate and validate supervised machine learning algorithms to detect patients with Chiari malformation (CM) 1 or 1.5 at high risk of the development of sleep-related breathing disorders (SRBD) using clinical and neuroradiological parameters. METHODS We prospectively included two independent datasets. A training dataset (n = 90) was used to obtain the best model, whereas a second dataset was used to validate it (n = 74). In both cohorts, the same clinical, neuroradiological, and sleep studies were carried out. We used two supervised machine learning approaches, multiple logistic regression (MLR) and the unbiased recursive partitioning technique conditional inference tree (URP-CTREE), to detect patients at high risk of SRBD. We then compared the accuracy, sensitivity, and specificity of the two prediction models. RESULTS Age (odds ratio [OR] 1.1 95% confidence interval [CI] 1.05-1.17), sex (OR 0.19 95% CI 0.05-0.67), CM type (OR 4.36 95% CI 1.14-18.5), and clivus length (OR 1.14 95% CI 1.01-1.31) were the significant predictor variables for a respiratory disturbance index (RDI) cutoff that was ≥ 10 events/h using MLR. The URP-CTREE model predicted that patients with CM-1 who were age 52 years or older and males with CM-1 who were older than 29 years had a high risk of SRBD. The accuracy of predicting patients with an RDI ≥ 10 events/h was similar in the two cohorts but in the URP-CTREE model, specificity was significantly greater when compared to MLR in both study groups. CONCLUSIONS Both MLR and URP-CTREE predictive models are useful for the diagnosis of SRBD in patients with CM. However, URP-CTREE is easier to apply and interpret in clinical practice.
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Affiliation(s)
- Álex Ferré
- Clinical Neurophysiology Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.,Multidisciplinary Sleep Unit, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.,Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Barcelona, Spain
| | - María A Poca
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Barcelona, Spain.,Neurosurgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - María Dolore de la Calzada
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dulce Moncho
- Clinical Neurophysiology Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.,Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Aintzane Urbizu
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Ohio
| | - Odile Romero
- Clinical Neurophysiology Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.,Multidisciplinary Sleep Unit, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Madrid, Spain
| | - Gabriel Sampol
- Multidisciplinary Sleep Unit, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Madrid, Spain.,Pneumology Department, Vall d'Hebron Research institute, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Juan Sahuquillo
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Barcelona, Spain.,Neurosurgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
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Goel A, Prasad A, Shah A, Gore S, Dharurkar P. Voice Quality Affection as a Symptom of Chiari Formation. World Neurosurg 2019; 121:e296-e301. [DOI: 10.1016/j.wneu.2018.09.099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 11/29/2022]
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Ferré Á, Poca MA, de la Calzada MD, Moncho D, Romero O, Sampol G, Sahuquillo J. Sleep-Related Breathing Disorders in Chiari Malformation Type 1: A Prospective Study of 90 Patients. Sleep 2017; 40:3766874. [DOI: 10.1093/sleep/zsx069] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pomeraniec IJ, Ksendzovsky A, Yu PL, Jane JA. Surgical History of Sleep Apnea in Pediatric Patients with Chiari Type 1 Malformation. Neurosurg Clin N Am 2015; 26:543-53. [PMID: 26408064 DOI: 10.1016/j.nec.2015.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sleep apnea represents a relative indication for posterior fossa decompression in pediatric patients with Chiari malformation type 1. Duraplasty was associated with improvement of sleep apnea in 100% of patients and dural splitting with improvement in 50% of patients. Duraplasty and dural splitting were associated with a similar reduction in tonsillar herniation on radiographic imaging of 58% (37% excluding tonsillectomy) and 35%, respectively. Longitudinal follow-up studies of patients with either neurologic deficits or severe symptoms will further elucidate the natural history of Chiari malformation type 1 and more appropriately gauge the risk-benefit tradeoff of surgical intervention.
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Affiliation(s)
- Isaac Jonathan Pomeraniec
- Department of Neurological Surgery, University of Virginia Health Science Center, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Alexander Ksendzovsky
- Department of Neurological Surgery, University of Virginia Health Science Center, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Pearl L Yu
- Department of Neurological Surgery, University of Virginia Health Science Center, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - John A Jane
- Department of Neurological Surgery, University of Virginia Health Science Center, 1215 Lee Street, Charlottesville, VA 22908, USA.
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Guerreiro RB, Bittencourt L, Reis RC, Rotta JM, Tufik S, Botelho RV. Upper airway dimensions in patients with craniocervical junction malformations with and without sleep apnea. A pilot case-control study. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:336-41. [PMID: 25992525 DOI: 10.1590/0004-282x20150008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 12/19/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with craniocervical junction malformations (CCJM) tend to suffer more frequently from sleep respiratory disturbances, which are more frequent and severe in patients with basilar invagination. Here we evaluate if patients with CCJM and sleep respiratory disorders (SRD) present smaller airway dimensions than patients without SRD. METHOD Patients with CCCM with and without sleep respiratory disturbances were evaluated clinically by Bindal's score, modified Mallampati classification, full-night polysomnography and upper airway cone beam tomography. RESULTS Eleven patients had sleep respiratory disorders (SRD), and nine patients performed control group without SRD. CCJM patients with SRD were predominantly female, older, had higher BMI, were more likely to have Mallampati grades 3 and 4 and had statistically significant smaller anteroposterior diameter of the upper airway than patients without SRD. CONCLUSION Patients with CCJM and sleep respiratory disturbances have higher BMI, higher Mallampati score and smaller anterior posterior diameter of the upper airway.
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Affiliation(s)
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - José Marcus Rotta
- Departamento de Neurocirurgia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Sérgio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Vale JMD, Silva E, Pereira IG, Marques C, Sanchez-Serrano A, Torres AS. Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation. J Bras Pneumol 2015; 40:574-8. [PMID: 25410846 PMCID: PMC4263339 DOI: 10.1590/s1806-37132014000500014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/20/2013] [Indexed: 12/03/2022] Open
Abstract
The Chiari malformation type I (CM-I) has been associated with sleep-disordered
breathing, especially central sleep apnea syndrome. We report the case of a
44-year-old female with CM-I who was referred to our sleep laboratory for suspected
sleep apnea. The patient had undergone decompressive surgery 3 years prior. An
arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory
disturbance index of 108 events/h, and all were central apnea events. Treatment with
adaptive servo-ventilation was initiated, and central apnea was resolved. This report
demonstrates the efficacy of servo-ventilation in the treatment of central sleep
apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a
history of decompressive surgery.
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St Louis EK, Jinnur P, McCarter SJ, Duwell EJ, Benarroch EE, Kantarci K, Pichelmann MA, Silber MH, Boeve BF, Olson EJ, Morgenthaler TI, Somers VK. Chiari 1 Malformation Presenting as Central Sleep Apnea during Pregnancy: A Case Report, Treatment Considerations, and Review of the Literature. Front Neurol 2014; 5:195. [PMID: 25386156 PMCID: PMC4208407 DOI: 10.3389/fneur.2014.00195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 09/16/2014] [Indexed: 12/05/2022] Open
Abstract
Purpose: Chiari malformation (CM) type-1 frequently causes obstructive or central sleep-disordered breathing (SDB) in both adults and children, although SDB is relatively rare as a presenting manifestation in the absence of other neurological symptoms. The definitive treatment of symptomatic CM is surgical decompression. We report a case that is, to our knowledge, a novel manifestation of central sleep apnea (CSA) due to CM type-1 with severe exacerbation and initial clinical presentation during pregnancy. Methods: Case report from tertiary care comprehensive sleep medicine center with literature review of SDB manifestations associated with CM type-1. PubMed search was conducted between January 1982 and October 2013. Results: We report a 25-year-old woman with severe CSA initially presenting during her first pregnancy that eventually proved to be caused by CM type-1. The patient was successfully treated preoperatively by adaptive servoventilation (ASV), with effective resolution of SDB following surgical decompression, and without recurrence in a subsequent pregnancy. Our literature review found that 58% of CM patients with SDB had OSA alone, 28% had CSA alone, 8 (10%) had mixed OSA/CSA, and 6 (8%) had hypoventilation. Of CM patients presenting with SDB, 50% had OSA, 42% had CSA, 8% had mixed OSA/CSA, and 10.4% had hypoventilation. We speculate that CSA may develop in CM patients in whom brainstem compression results in excessive central chemoreflex sensitivity with consequent hypocapnic CSA. Conclusion: Chiari malformation type-1 may present with a diversity of SDB manifestations, and timely recognition and surgical referral are necessary to prevent further neurological deficits. ASV therapy can effectively manage CSA caused by CM type-1, which may initially present during pregnancy.
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Affiliation(s)
- Erik K St Louis
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Section of Sleep Neurology, Mayo Clinic , Rochester, MN , USA ; Department of Neurology, Mayo Clinic , Rochester, MN , USA ; Department of Medicine, Mayo Clinic , Rochester, MN , USA ; Sleep Clinical Research Unit Laboratory, Mayo Clinic Hospital, Mayo Clinic , Rochester, MN , USA
| | - Praveen Jinnur
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Department of Medicine, Mayo Clinic , Rochester, MN , USA
| | - Stuart J McCarter
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Department of Neurology, Mayo Clinic , Rochester, MN , USA ; Department of Medicine, Mayo Clinic , Rochester, MN , USA ; Sleep Clinical Research Unit Laboratory, Mayo Clinic Hospital, Mayo Clinic , Rochester, MN , USA
| | - Ethan J Duwell
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Department of Neurology, Mayo Clinic , Rochester, MN , USA ; Department of Medicine, Mayo Clinic , Rochester, MN , USA ; Sleep Clinical Research Unit Laboratory, Mayo Clinic Hospital, Mayo Clinic , Rochester, MN , USA
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic , Rochester, MN , USA
| | | | - Michael H Silber
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Section of Sleep Neurology, Mayo Clinic , Rochester, MN , USA ; Department of Neurology, Mayo Clinic , Rochester, MN , USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Section of Sleep Neurology, Mayo Clinic , Rochester, MN , USA ; Department of Neurology, Mayo Clinic , Rochester, MN , USA
| | - Eric J Olson
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Department of Medicine, Mayo Clinic , Rochester, MN , USA
| | - Timothy I Morgenthaler
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Department of Medicine, Mayo Clinic , Rochester, MN , USA
| | - Virend K Somers
- Department of Medicine, Mayo Clinic , Rochester, MN , USA ; Sleep Clinical Research Unit Laboratory, Mayo Clinic Hospital, Mayo Clinic , Rochester, MN , USA
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Mangubat EZ, Wilson T, Mitchell BA, Byrne RW. Chiari I malformation associated with atlanto-occipital assimilation presenting as orthopnea and cough syncope: a case report and review of literature. J Neurol Surg Rep 2014; 75:e1-4. [PMID: 25083365 PMCID: PMC4110142 DOI: 10.1055/s-0033-1348953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 04/13/2013] [Indexed: 12/03/2022] Open
Abstract
Although it is not uncommon for patients with Chiari I malformations to present with respiratory complaints, cough syncope is a rare presenting symptom. We report an adult patient who harbored both a Chiari I malformation and atlanto-occipital assimilation who complained of cough syncope, orthopnea, and central sleep apnea. The patient underwent decompressive craniectomy of the posterior fossa and cervical level 2 laminectomy. However, due to a possible initial underappreciation of the profound narrowing of the foramen magnum as a result of these concomitant pathologies, the patient may have had continued impaired cerebrospinal fluid flow, leading to a symptomatic pseudomeningocele and requiring a more extensive decompression that included a cervical level 3 laminectomy as well as a temporary lumbar drain. On 2-year follow-up, he has remained asymptomatic.
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Affiliation(s)
- Erwin Zeta Mangubat
- Department of Neurosurgery, Rush Professional Office Building, Chicago, Illinois, United States
| | - Tom Wilson
- Department of Neurosurgery, Rush Professional Office Building, Chicago, Illinois, United States
| | - Brian A. Mitchell
- Department of Neurosurgery, Rush Professional Office Building, Chicago, Illinois, United States
| | - Richard W. Byrne
- Department of Neurosurgery, Rush Professional Office Building, Chicago, Illinois, United States
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Sleep disturbance: A forgotten syndrome in patients with Chiari I malformation. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2010.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ferré Masó A, Poca M, de la Calzada M, Solana E, Romero Tomás O, Sahuquillo J. Alteraciones del sueño, un síndrome olvidado en los pacientes con malformación de Chiari tipo I. Neurologia 2014; 29:294-304. [DOI: 10.1016/j.nrl.2011.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022] Open
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Chiari I malformation associated with atlanto-occipital assimilation presenting as orthopnea and cough syncope. J Clin Neurosci 2014; 21:320-3. [DOI: 10.1016/j.jocn.2013.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 03/10/2013] [Indexed: 11/20/2022]
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Losurdo A, Dittoni S, Testani E, Di Blasi C, Scarano E, Mariotti P, Paternoster G, Di Rocco C, Massimi L, Della Marca G. Sleep disordered breathing in children and adolescents with Chiari malformation type I. J Clin Sleep Med 2013; 9:371-7. [PMID: 23585753 DOI: 10.5664/jcsm.2592] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVES Chiari malformation Type I (CM-I) has been associated with sleep disordered breathing (SDB). The aim of this study was to evaluate the prevalence of SDB in CM-I and its clinical correlates in a population of children and adolescents. METHODS Fifty-three consecutive children and adolescents affected by CM-I were enrolled (27 girls and 26 boys, mean age 10.3 ± 4.3, range: 3-18 years). All patients underwent neurological examination, MRI, and polysomnography (PSG). Otorhinolaryngologic clinical evaluation was performed in patients with polysomnographic evidence of sleep-related upper airway obstruction. RESULTS Mean size of the herniation was 9.5 ± 5.4 mm. Fourteen patients had syringomyelia, 5 had hydrocephalus, 31 presented neurological signs, 14 had epileptic seizures, and 7 reported poor sleep. PSG revealed SDB in 13 subjects. Patients with SDB, compared to those without SDB, had a higher prevalence hydrocephalus (p = 0.002), syringomyelia (p = 0.001), and neurological symptoms (p = 0.028). No significant difference was observed in age, gender, prevalence of epilepsy, and size of the herniation. Obstructive SDB was associated with syringomyelia (p = 0.004), whereas central SDB was associated with hydrocephalus (p = 0.034). CONCLUSIONS In our population of CM-I patients the prevalence of SDB was 24%, lower than that reported in literature. Moreover, our findings suggest that abnormalities in cerebrospinal fluid dynamics in CM-I, particularly syringomyelia and hydro-cephalus, are associated with SDB.
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Affiliation(s)
- Anna Losurdo
- Institute of Neurology, Catholic University, Rome, Italy.
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Kijsirichareanchai K, Limsuwat C, Mankongpaisarnrung C, Nantsupawat N, Nugent K. Chiari Syndrome and Respiratory Failure. J Intensive Care Med 2013; 29:260-8. [DOI: 10.1177/0885066613485213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Patients with failed extubation requiring reintubation have increased morbidity and mortality. This situation may reflect the severity of the underlying disorder or may reflect an undiagnosed condition that was not apparent at the time of the initial intubation. Methods: Case report and literature review. Results: A 49-year-old man developed acute hypercapneic respiratory failure during an episode of community-acquired pneumonia. This patient failed extubation 4 times. Routine neurological evaluation, including computed tomography of the head, was within normal limits. A magnetic resonance imaging revealed a severe Chiari malformation type I. The patient eventually required tracheostomy and prolonged mechanical ventilation. We identified 28 cases with Chiari malformations (CM) in the medical literature, who presented with respiratory failure. The mean age was 29.5 years, 46% of the cases were male, 50% had an associated syringomyelia, and 64% required a decompressive surgery. Twenty-five percent had recurrent symptoms postsurgery. Conclusions: Patients with CMs can have repeated extubation failures. Some of these patients have normal neurological examinations and studies and are not identified until they have an MRI study. Clinicians need to consider this possibility in patients who are difficult to wean.
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Affiliation(s)
| | - Chok Limsuwat
- Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA
| | | | - Nopakoon Nantsupawat
- Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA
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19
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Navarro Patiño N, Rodríguez Cimadevilla JL, Peraita-Adrados R, Salcedo Posadas A. [Obstructive sleep apnea-hypopnea syndrome associated with type II Arnold-Chiari malformation. Benefits of neurosurgical intervention]. An Pediatr (Barc) 2012; 78:195-8. [PMID: 22898178 DOI: 10.1016/j.anpedi.2012.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 06/06/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022] Open
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20
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Martínez-Sabater A, Sancho-Cantus D. Malformación de Arnold-Chiari y siringomielia en atención primaria. A propósito de un caso. Semergen 2012; 38:331-4. [DOI: 10.1016/j.semerg.2011.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 08/30/2011] [Accepted: 09/01/2011] [Indexed: 11/16/2022]
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21
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Gala TR, Seaman DR. Lifestyle modifications and the resolution of obstructive sleep apnea syndrome: a case report. J Chiropr Med 2011; 10:118-25. [PMID: 22014867 PMCID: PMC3110415 DOI: 10.1016/j.jcm.2010.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 12/29/2010] [Accepted: 12/29/2010] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This purpose of this case study is to describe a natural method to help in management of obstructive sleep apnea syndrome (OSAS), which is known to be a common and debilitating condition. CLINICAL FEATURES Obstructive sleep apnea syndrome is typically managed with a continuous positive airway pressure (CPAP) device, which the patient wears during sleep to help maintain respiration. This report describes the chiropractic management and resolution of OSAS with dietary modifications in a 55-year-old man who wore a CPAP for 10 years. INTERVENTION AND OUTCOME After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later. CONCLUSION Dietary modifications may be an effective tool to improve the management of OSAS.
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Affiliation(s)
| | - David R. Seaman
- Professor of Clinical Sciences, National University of Health Sciences, Pinellas Park, FL 33781
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22
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Botelho RV, Bittencourt LRA, Rotta JM, Tufik S. The effects of posterior fossa decompressive surgery in adult patients with Chiari malformation and sleep apnea. J Neurosurg 2010; 112:800-7. [DOI: 10.3171/2009.7.jns09174] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
One of the feared consequences of craniovertebral junction diseases is apnea. Although several cases of patients with central apnea have been described, obstructive sleep apnea has been identified as the most frequent manifestation of sleep respiratory disorder. Neuronal involvement may be responsible for both central and obstructive apneas. The objective of this work was to study the effect of posterior fossa decompressive surgery on respiratory parameters during sleep in patients with craniovertebral junction malformations and breathing-related sleep disorders.
Methods
In this study, prospectively enrolled consecutive symptomatic adult patients were monitored with full-night polysomnography before and after surgical decompression of the cranial posterior fossa.
Results
Of the 25 patients who were evaluated, 68% received a diagnosis of sleep apnea. After surgery, the mean number of respiratory events decreased from 180.70 to 69.29 (p = 0.005); the mean number of obstructive events decreased from 107.37 to 60.58 (p = 0.01); and the mean number of central events decreased from 38.45 to 8.05 (p = 0.01). The mean preoperative apnea/hypopnea index decreased from 26.68 to 12.98 (p = 0.06), and the mean central apnea index decreased from 13.81 to 1.68 (p = 0.01).
Conclusions
Decompressive surgery in patients with craniovertebral junction malformations resulted in decreased respiratory events during sleep, lowered sleep fragmentation, and enhanced the sleep apnea index in a significant number of patients. The effect was more pronounced in patients with central apnea.
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Affiliation(s)
- Ricardo Vieira Botelho
- 1Neurosurgical Service, Hospital do Servidor publico do Estado de São Paulo; and
- 2Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Lia Rita Azeredo Bittencourt
- 2Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - José Marcus Rotta
- 1Neurosurgical Service, Hospital do Servidor publico do Estado de São Paulo; and
| | - Sérgio Tufik
- 2Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
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Viu J, Armengou L, Jose-Cunilleras E, Cesarini C, Pumarola M, Monreal L. Cranioencephalic Malformation with Atlanto-Occipital Luxation in an Andalusian Neonate Foal. J Vet Intern Med 2010; 24:639-42. [DOI: 10.1111/j.1939-1676.2010.0478.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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24
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Effect of Midfacial Distraction on the Obstructed Airway in Patients With Syndromic Bilateral Coronal Synostosis. J Oral Maxillofac Surg 2008; 66:2318-21. [DOI: 10.1016/j.joms.2008.06.063] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Revised: 04/25/2008] [Accepted: 06/16/2008] [Indexed: 11/20/2022]
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25
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Miralbés Terraza S, García Oguiza A, López Pisón J, Sáenz Moreno I, Jiménez Escobar V, Peña Segura J, Marco Rived A. Síndrome de apnea central del sueño como primera manifestación de malformación de Chiari tipo I. An Pediatr (Barc) 2008; 68:277-81. [DOI: 10.1157/13116710] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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26
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Smadi T, Franco R. CHEYNE-STOKES RESPIRATION CAUSED BY SEVERE CERVICAL STENOSIS. Chest 2006. [DOI: 10.1378/chest.130.4_meetingabstracts.346s-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Murray C, Seton C, Prelog K, Fitzgerald DA. Arnold Chiari type 1 malformation presenting with sleep disordered breathing in well children. Arch Dis Child 2006; 91:342-3. [PMID: 16551789 PMCID: PMC2065999 DOI: 10.1136/adc.2005.085324] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Healthy children, aged 3, 9, and 13 years referred with sleep disordered breathing had marked central apnoea and bradypnoea on polysomnography, necessitating the use of non-invasive bilevel ventilation in two cases. Each had normal neurological examinations and an Arnold Chiari type 1 malformation was confirmed on magnetic resonance imaging. All underwent urgent posterior fossa decompression which normalised their sleep breathing.
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Affiliation(s)
- C Murray
- Children's Hospital at Westmead, Sydney, Australia
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