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Friedlander RM. Congenital and Acquired Chiari Syndrome. N Engl J Med 2024; 390:2191-2198. [PMID: 38899696 DOI: 10.1056/nejmra2308055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Affiliation(s)
- Robert M Friedlander
- From the Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh
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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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Bogdanov EI, Heiss JD. Evaluation and Treatment of Patients with Small Posterior Cranial Fossa and Chiari Malformation, Types 0 and 1. Adv Tech Stand Neurosurg 2024; 50:307-334. [PMID: 38592536 DOI: 10.1007/978-3-031-53578-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
The diagnosis of Chiari I malformation is straightforward in patients with typical signs and symptoms of Chiari I malformation and magnetic resonance imaging (MRI) confirming ≥5 mm of cerebellar tonsillar ectopia, with or without a syrinx. However, in many cases, Chiari I malformation is discovered incidentally on MRI to evaluate global headache, cervical radiculopathy, or other conditions. In those cases, the clinician must consider if cerebellar tonsillar ectopia is related to the presenting symptoms. Surgical decompression of the cerebellar tonsils and foramen magnum in patients with symptomatic Chiari I malformation effectively relieves suboccipital headache, reduces syrinx distension, and arrests syringomyelia progression. Neurosurgeons must avoid operative treatments decompressing incidental tonsillar ectopia, not causing symptoms. Such procedures unnecessarily place patients at risk of operative complications and tissue injuries related to surgical exploration. This chapter reviews the typical signs and symptoms of Chiari I malformation and its variant, Chiari 0 malformation, which has <5 mm of cerebellar tonsillar ectopia and is often associated with syringomyelia. Chiari I and Chiari 0 malformations are associated with incomplete occipital bone development, reduced volume and height of the posterior fossa, tonsillar ectopia, and compression of the neural elements and cerebrospinal fluid (CSF) pathways at the foramen magnum. Linear, angular, cross-sectional area, and volume measurements of the posterior fossa, craniocervical junction, and upper cervical spine identify morphometric abnormalities in Chiari I and Chiari 0 malformation patients. Chiari 0 patients respond like Chiari I patients to foramen magnum decompression and should not be excluded from surgical treatment because their tonsillar ectopia is <5 mm. The authors recommend the adoption of diagnostic criteria for Chiari 0 malformation without syringomyelia. This chapter provides updated information and guidance to the physicians managing Chiari I and Chiari 0 malformation patients and neuroscientists interested in Chiari malformations.
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Affiliation(s)
- Enver I Bogdanov
- Department of Neurology and Rehabilitation, Kazan State Medical University, Kazan, Russia
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - John D Heiss
- Department of Neurology and Rehabilitation, Kazan State Medical University, Kazan, Russia.
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 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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García M, Amayra I, Pérez M, Salgueiro M, Martínez O, López-Paz JF, Allen PA. Cognition in Chiari Malformation Type I: an Update of a Systematic Review. Neuropsychol Rev 2023:10.1007/s11065-023-09622-2. [PMID: 37798373 DOI: 10.1007/s11065-023-09622-2] [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: 03/31/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Chiari malformation has been classified as a group of posterior cranial fossa disorders characterized by hindbrain herniation. Chiari malformation type I (CM-I) is the most common subtype, ranging from asymptomatic patients to those with severe disorders. Research about clinical manifestations or medical treatments is still growing, but cognitive functioning has been less explored. The aim of this systematic review is to update the literature search about cognitive deficits in CM-I patients. A literature search was performed through the following electronic databases: MEDLINE, PsychINFO, Pubmed, Cochrane Library, Scopus, and Web of Science. The date last searched was February 1, 2023. The inclusion criteria were as follows: (a) include pediatric or adult participants with a CM-I diagnosis, (b) include cognitive or neuropsychological assessment with standardized tests, (c) be published in English or Spanish, and (d) be empirical studies. Articles that did not report empirical data, textbooks and conference abstracts were excluded. After the screening, twenty-eight articles were included in this systematic review. From those, twenty-one articles were focused on adult samples and seven included pediatric patients. There is a great heterogeneity in the recruited samples, followed methodology and administered neurocognitive protocols. Cognitive functioning appears to be affected in CM-I patients, at least some aspects of attention, executive functions, visuospatial abilities, episodic memory, or processing speed. However, these results require careful interpretation due to the methodological limitations of the studies. Although it is difficult to draw a clear profile of cognitive deficits related to CM-I, the literature suggests that cognitive dysfunction may be a symptom of CM-I. This suggest that clinicians should include cognitive assessment in their diagnostic procedures used for CM-I. In summary, further research is needed to determine a well-defined cognitive profile related to CM-I, favoring a multidisciplinary approach of this disorder.
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Affiliation(s)
- Maitane García
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain.
| | - Imanol Amayra
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - Manuel Pérez
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
- Faculty of Health Sciences, Isabel I University, Burgos, Spain
| | - Monika Salgueiro
- Department of Clinical and Health Psychology, and Research Methodology, Faculty of Psychology, University of the Basque Country, Donostia, Spain
| | - Oscar Martínez
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - Juan Francisco López-Paz
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - Philip A Allen
- Conquer Chiari Research Center, Department of Psychology, University of Akron, Akron, OH, 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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Al Samman MMF, Ibrahimy A, Nwotchouang BST, Oshinski JN, Barrow DL, Allen PA, Amini R, Bhadelia RA, Loth F. The Relationship Between Imbalance Symptom and Cardiac Pulsation Induced Mechanical Strain in the Brainstem and Cerebellum for Chiari Malformation Type I. J Biomech Eng 2023; 145:081005. [PMID: 37295931 PMCID: PMC10782862 DOI: 10.1115/1.4062723] [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: 01/05/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
Chiari malformation Type I (CMI) is known to have an altered biomechanical environment for the brainstem and cerebellum; however, it is unclear whether these altered biomechanics play a role in the development of CMI symptoms. We hypothesized that CMI subjects have a higher cardiac-induced strain in specific neurological tracts pertaining to balance, and postural control. We measured displacement over the cardiac cycle using displacement encoding with stimulated echoes magnetic resonance imaging in the cerebellum, brainstem, and spinal cord in 37 CMI subjects and 25 controls. Based on these measurements, we computed strain, translation, and rotation in tracts related to balance. The global strain on all tracts was small (<1%) for CMI subject and controls. Strain was found to be nearly doubled in three tracts for CMI subjects compared to controls (p < 0.03). The maximum translation and rotation were ∼150 μm and ∼1 deg, respectively and 1.5-2 times greater in CMI compared to controls in four tracts (p < 0.005). There was no significant difference between strain, translation, and rotation on the analyzed tracts in CMI subjects with imbalance compared to those without imbalance. A moderate correlation was found between cerebellar tonsillar position and strain on three tracts. The lack of statistically significant difference between strain in CMI subjects with and without imbalance could imply that the magnitude of the observed cardiac-induced strain was too small to cause substantial damage to the tissue (<1%). Activities such as coughing, or Valsalva may produce a greater strain.
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Affiliation(s)
| | - Alaaddin Ibrahimy
- Department of Biomedical Engineering, Yale University, 17 Hillhouse Ave, New Haven, CT 06520
| | | | - John N. Oshinski
- Departments of Radiology & Imaging Sciences and Biomedical Engineering, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322
| | - Daniel L. Barrow
- Department of Neurosurgery, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322
| | - Philip A. Allen
- Department of Psychology, The University of Akron, 302 E Buchtel Ave, Akron, OH 44325
| | - Rouzbeh Amini
- Departments of Mechanical and Industrial Engineering, and Bioengineering, Northeastern University, 805 Columbus Ave, ISEC 508, Boston, MA 02120
| | - Rafeeque A. Bhadelia
- Department of Radiology, Beth Israel Deaconess Medical Center & Harvard University School of Medicine, 330 Brookline Ave, Boston, MA 02215
| | - Francis Loth
- Departments of Mechanical and Industrial Engineering, and Bioengineering, Northeastern University, 360 Huntington Ave, SN 257, Boston, MA 02115
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Labuda R, Loth D, Loth F, Allen PA. Pain and Depression Account for More Than One Half of the Neck Disability Variance Among Adult Women with Chiari I. World Neurosurg 2023; 171:e478-e485. [PMID: 36526226 DOI: 10.1016/j.wneu.2022.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We sought to quantify the neck-related disability in adult women with Chiari malformation type I and identify the significantly related variables. METHODS A total of 70 variables were selected from the self-report history questionnaires (12 variables; n = 474), standardized scales (15 variables; n = 474), and morphometric data (43 variables; n = 293-474) of adult women with Chiari malformation type I. The variables were tested independently to identify those with a significant relationship to the Neck Disability Index (NDI; P < 0.00071) and those that might be associated with the NDI (P < 0.05). A forward selection regression model was constructed to identify the variables contributing unique variance to the NDI. In addition, a mediation analysis was performed to determine whether depression mediated the relationship between pain and disability. RESULTS Overall, 79.5% of the patients had scored at a moderate level of disability or higher. Independent testing identified 16 significant variables, including symptom duration, tonsillar position, and measures of psychological distress. The short-form McGill pain questionnaire-2 (r = 0.69; P < 0.00001) and CES-D scale for depression (r = 0.56; P < 0.00001) exhibited the highest correlations with the NDI. The forward selection regression model produced an R2 of 0.6178. Pain and depression accounted for more than one half of the NDI variance. CONCLUSIONS We found that high levels of disability are common among adult women with Chiari malformation type I, independent of surgical status. Pain and depression were the primary factors related to this disability. Depression mediated the relationship between pain intensity and disability at a modest level (5%). Patients who had experienced symptoms for >2 years before diagnosis had had, on average, 77% higher NDI scores, highlighting the importance of a timely diagnosis.
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Affiliation(s)
| | - Dorothy Loth
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, Ohio, USA
| | - Francis Loth
- Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Philip A Allen
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, Ohio, USA
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The Small Posterior Cranial Fossa Syndrome and Chiari Malformation Type 0. J Clin Med 2022; 11:jcm11185472. [PMID: 36143119 PMCID: PMC9503629 DOI: 10.3390/jcm11185472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Patients showing typical Chiari malformation type 1 (CM1) signs and symptoms frequently undergo cranial and cervical MRI. In some patients, MRI documents >5 mm of cerebellar tonsillar herniation (TH) and the diagnosis of CM1. Patients with 3−5 mm TH have “borderline” CM1. Patients with less than 3 mm of TH and an associated cervical syrinx are diagnosed with Chiari “zero” malformation (CM0). However, patients reporting CM1 symptoms are usually not diagnosed with CM if MRI shows less than 3−5 mm of TH and no syrinx. Recent MRI morphometric analysis of the posterior fossa and upper cervical spine detected anatomical abnormalities in and around the foramen magnum (FM) that explain these patients’ symptoms. The abnormalities include a reduced size of the posterior fossa, FM, and upper cervical spinal canal and extension of the cerebellar tonsils around the medulla rather than inferior to the foramen magnum, as in CM1. These morphometric findings lead some neurologists and neurosurgeons to diagnose CM0 in patients with typical CM1 signs and symptoms, with or without cervical syringes. This article reviews recent findings and controversies about CM0 diagnosis and updates current thinking about the clinical and radiological relationship between CM0, borderline CM1, and CM1.
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Morkos M, Eppelheimer M, Nwotchouang BST, Ebrahimzadeh SA, Bhadelia RA, Loth D, Allen PA, Loth F. The importance of precise plane selection for female adult Chiari Type I malformation midsagittal morphometrics. PLoS One 2022; 17:e0272725. [PMID: 35947605 PMCID: PMC9365159 DOI: 10.1371/journal.pone.0272725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Morphometric assessment of Chiari malformation type I (CMI) is typically performed on a midsagittal MRI. However, errors arising from an imprecise selection of the midsagittal plane are unknown. We define absolute parasagittal error as the absolute difference between morphometric measurements at the midsagittal and parasagittal planes. Our objective was to determine the absolute parasagittal error at various lateral distances for morphometric parameters commonly used in CMI research. Methods Sagittal T1-weighted MRI scans of 30 CMI adult female subjects were included. Image sets were evaluated to assess 14 CMI morphometric parameters in the midsagittal plane and four parasagittal planes located 1 and 2 mm lateral (left and right). Comparisons between measurements at the midsagittal and parasagittal planes were conducted to determine the mean individual absolute and mean group parasagittal errors for all 14 parameters. Results The mean individual absolute parasagittal error was > 1 unit (1 mm for lengths and 1 degree for angles) for 9/14 parameters within a lateral distance of 2 mm. No significant group parasagittal errors were seen in 14/14 parameters, including tonsillar position within a lateral distance of 2 mm. Conclusion Our results show that the absolute errors for imprecise midsagittal plane selection may impact the clinical assessment of an individual patient. However, the impact on group measurements, such as in a research setting, will be minimal.
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Affiliation(s)
- Mark Morkos
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, United States of America
- * E-mail:
| | - Maggie Eppelheimer
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, United States of America
| | | | - Seyed Amir Ebrahimzadeh
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, United States of America
| | - Rafeeque A. Bhadelia
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, United States of America
| | - Dorothy Loth
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, OH, United States of America
| | - Philip A. Allen
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, OH, United States of America
| | - Francis Loth
- Departments of Mechanical and Industrial Engineering and Bioengineering, Northeastern University, Boston, MA, United States of America
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Factors Associated With Patient Reported Post-surgical Symptom Improvement in Adult Females with Chiari Malformation Type I: A Report from the Chiari1000 Dataset. World Neurosurg 2022; 161:e682-e687. [DOI: 10.1016/j.wneu.2022.02.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022]
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Labuda R, Nwotchouang BST, Ibrahimy A, Allen PA, Oshinski JN, Klinge P, Loth F. A new hypothesis for the pathophysiology of symptomatic adult Chiari malformation Type I. Med Hypotheses 2022; 158. [PMID: 34992329 PMCID: PMC8730378 DOI: 10.1016/j.mehy.2021.110740] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chiari malformation Type I (CMI) is characterized by herniation of the cerebellar tonsils through the foramen magnum. The pathophysiology of CMI is not well elucidated; however, the prevailing theory focuses on the underdevelopment of the posterior cranial fossa which results in tonsillar herniation. Symptoms are believed to be due to the herniation causing resistance to the natural flow of cerebrospinal fluid (CSF) and exerting a mass effect on nearby neural tissue. However, asymptomatic cases vastly outnumber symptomatic ones and it is not known why some people become symptomatic. Recently, it has been proposed that CMI symptoms are primarily due to instability of either the atlanto-axial (AA) or the atlanto-occipital (AO) joint and the cerebellar tonsils herniate to prevent mechanical pinching. However, only a small percentage of patients exhibit clinical instability and these theories do not account for asymptomatic herniations. We propose that the pathophysiology of adult CMI involves a combination of craniocervical abnormalities which leads to tonsillar herniation and reduced compliance of the cervical spinal canal. Specifically, abnormal AO and/or AA joint morphology leads to chronic cervical instability, often subclinical, in a large portion of CMI patients. This in turn causes overwork of the suboccipital muscles as they try to compensate for the instability. Over time, the repeated, involuntary activation of these muscles leads to mechanical overload of the myodural bridge complex, altering the mechanical properties of the dura it merges with. As a result, the dura becomes stiffer, reducing the overall compliance of the cervical region. This lower compliance, combined with CSF resistance at the same level, leads to intracranial pressure peaks during the cardiac cycle (pulse pressure) that are amplified during activities such as coughing, sneezing, and physical exertion. This increase in pulse pressure reduces the compliance of the cervical subarachnoid space which increases the CSF wave speed in the spinal canal, and further increases pulse pressure in a feedback loop. Finally, the abnormal pressure environment induces greater neural tissue motion and strain, causing microstructural damage to the cerebellum, brainstem, and cervical spinal cord, and leading to symptoms. This hypothesis explains how the combination of craniocervical bony abnormalities, anatomic CSF restriction, and reduced compliance leads to symptoms in adult CMI.
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Affiliation(s)
- Rick Labuda
- Conquer Chiari, 320 Osprey Ct., Wexford, PA 15090, United States
| | - Blaise Simplice Talla Nwotchouang
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, 264 Wolf Ledges Pkwy Rm 211b, Akron, OH 44325, United States
| | - Alaaddin Ibrahimy
- Department of Biomedical Engineering, Yale University, 17 Hillhouse Avenue, New Haven, CT 06520, United States
| | - Philip A Allen
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, 302 Buchtel Hall, Akron, OH 44325, United States
| | - John N Oshinski
- Department of Radiology & Imaging Sciences, Emory University School of Medcinece, Atlanta, GA 30322, United States
| | - Petra Klinge
- The Warren Alpert Medical School of Brown University, United States
| | - Francis Loth
- Department of Mechanical & Industrial Engineering, Department of Bioengineering, Northeastern University, 334 Snell Engineering, 360 Huntington Ave, Boston, MA 02115, United States
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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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14
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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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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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16
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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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Houston ML, Houston JR, Sakaie K, Klinge PM, Vorster S, Luciano M, Loth F, Allen PA. Functional connectivity abnormalities in Type I Chiari: associations with cognition and pain. Brain Commun 2021; 3:fcab137. [PMID: 34278303 PMCID: PMC8279071 DOI: 10.1093/braincomms/fcab137] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/13/2021] [Accepted: 06/11/2021] [Indexed: 12/30/2022] Open
Abstract
There is initial evidence of microstructural abnormalities in the fibre-tract pathways of the cerebellum and cerebrum of individuals diagnosed with Type I Chiari malformation. However, it is unclear whether abnormal white matter architecture and macro-level morphological deviations that have been observed in Chiari translate to differences in functional connectivity. Furthermore, common symptoms of Chiari include pain and cognitive deficits, but the relationship between these symptoms and functional connectivity has not been explored in this population. Eighteen Type I Chiari patients and 18 age-, sex- and education-matched controls underwent resting-state functional MRI to measure functional connectivity. Participants also completed a neuropsychological battery and completed self-report measures of chronic pain. Group differences in functional connectivity were identified. Subsequently, pathways of significant difference were re-analyzed after controlling for the effects of attention performance and self-reported chronic pain. Chiari patients exhibited functional hypoconnectivity between areas of the cerebellum and cerebrum. Controlling for attention eliminated all deficits with the exception of that from the posterior cerebellar pathway. Similarly, controlling for pain also eliminated deficits except for those from the posterior cerebellar pathway and vermis VII. Patterns of Chiari hyperconnectivity were also found between regions of the cerebellum and cerebrum in Chiari patients. Hyperconnectivity in all regions was eliminated after controlling for attention except between left lobule VIII and the left postcentral gyrus and between vermis IX and the precuneus. Similarly, hyperconnectivity was eliminated after controlling for pain except between the default mode network and globus pallidus, left lobule VIII and the left postcentral gyrus, and Vermis IX and the precuneus. Evidence of both hyper- and hypoconnectivity were identified in Chiari, which is posited to support the hypothesis that the effect of increased pain in Chiari draws on neural resources, requiring an upregulation in inhibitory control mechanisms and resulting in cognitive dysfunction. Areas of hypoconnectivity in Chiari patients also suggest disruption in functional pathways, and potential mechanisms are discussed.
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Affiliation(s)
- Michelle L Houston
- Department of Psychology, The University of Akron, Akron, OH 44325, USA
- Department of Psychology, Middle Tennessee State University, Murfreesboro, TN 37132, USA
| | - James R Houston
- Department of Psychology, Middle Tennessee State University, Murfreesboro, TN 37132, USA
| | - Ken Sakaie
- Department of Diagnostic Radiology, The Cleveland Clinic, Cleveland, OH 44195, USA
| | - Petra M Klinge
- Department of Neurosurgery, Rhode Island Hospital, and Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Sarel Vorster
- Department of Neurological Surgery, The Cleveland Clinic, Cleveland, OH 44195, USA
| | - Mark Luciano
- Department of Neurosurgery, Johns Hopkins Medical Center, Baltimore, MD 21224, USA
| | - Francis Loth
- Department of Biomedical Engineering, The University of Akron, Akron, OH 44325, USA
- Department of Mechanical Engineering, The University of Akron, Akron, OH 44325, USA
| | - Philip A Allen
- Department of Psychology, The University of Akron, Akron, OH 44325, USA
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18
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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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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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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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21
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Gholampour S, Gholampour H. Correlation of a new hydrodynamic index with other effective indexes in Chiari I malformation patients with different associations. Sci Rep 2020; 10:15907. [PMID: 32985602 PMCID: PMC7523005 DOI: 10.1038/s41598-020-72961-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 09/09/2020] [Indexed: 12/13/2022] Open
Abstract
This study aimed to find a new CSF hydrodynamic index to assess Chiari type I malformation (CM-I) patients’ conditions and examine the relationship of this new index with morphometric and volumetric changes in these patients and their clinical symptoms. To this end, 58 CM-I patients in four groups and 20 healthy subjects underwent PC-MRI. Ten morphometric and three volumetric parameters were calculated. The CSF hydrodynamic parameters were also analyzed through computational fluid dynamic (CFD) simulation. The maximum CSF pressure was identified as a new hydrodynamic parameter to assess the CM-I patients’ conditions. This parameter was similar in patients with the same symptoms regardless of the group to which they belonged. The result showed a weak correlation between the maximum CSF pressure and the morphometric parameters in the patients. Among the volumetric parameters, PCF volume had the highest correlation with the maximum CSF pressure, which its value being higher in patients with CM-I/SM/scoliosis (R2 = 65.6%, P = 0.0022) than in the other patients. PCF volume was the more relevant volumetric parameter to assess the patients’ symptoms. The values of PCF volume were greater in patients that headache symptom was more obvious than other symptoms, as compared to the other patients.
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Affiliation(s)
- Seifollah Gholampour
- Department of Biomedical Engineering, North Tehran Branch, Islamic Azad University, Tehran, Iran.
| | - Hanie Gholampour
- Department of Electrical and Computer Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
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22
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Clivus length distinguishes between asymptomatic healthy controls and symptomatic adult women with Chiari malformation type I. Neuroradiology 2020; 62:1389-1400. [PMID: 32418026 DOI: 10.1007/s00234-020-02453-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/29/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE While the presence of cerebellar tonsillar descent in radiological images has been used as evidence of Chiari malformation type I (CMI), tonsillar ectopia alone is insufficient to identify individuals with symptomatic CMI. This study sought to identify differences in brain morphology between symptomatic CMI and healthy controls in adult females. METHODS Two hundred and ten adult females with symptomatic CMI and 90 age- and body mass index-matched asymptomatic female controls were compared using seven brain morphometric measures visible on magnetic resonance images. The CMI and control groups were divided into four subgroups based on the tonsillar position (TP) relative to the foramen magnum: group 1 was made up of healthy controls with normal TP (TP < 0 mm); group 2 was comprised of control individuals with low-lying TP (1-5 mm); group 3 was comprised of symptomatic CMI patients with low-lying TP (1-5 mm); group 4 contained symptomatic CMI patients with severe tonsillar descent (6-13 mm). RESULTS All morphometrics for symptomatic CMI with severe tonsillar descent were significantly different than those for both control groups. The CMI group with low-lying TP was significantly different for four measures when compared to controls with normal TP. However, only clivus length was statistically different between the CMI and healthy control groups with low-lying TP. CONCLUSION This study demonstrates that clivus length distinguishes adult female healthy individuals with low-lying tonsils from those with symptomatic CMI. Further investigation is required to understand the importance of a shorter clivus length on CMI symptomatology and pathophysiology.
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Mathkour M, Keen JR, Huang B, Werner C, Scullen T, Garces J, Skovgard M, Iwanaga J, Tubbs RS, Dumont A, Biro E, Bui CJ. “Two-Birds-One-Stone” Approach for Treating an Infant with Chiari I Malformation and Hydrocephalus: Is Cerebrospinal Fluid Diversion as Sole Treatment Enough? World Neurosurg 2020; 137:174-177. [DOI: 10.1016/j.wneu.2020.01.188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
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24
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Eppelheimer MS, Biswas D, Braun AM, Houston JR, Allen PA, Bapuraj JR, Labuda R, Loth DM, Frim D, Loth F. Quantification of changes in brain morphology following posterior fossa decompression surgery in women treated for Chiari malformation type 1. Neuroradiology 2019; 61:1011-1022. [PMID: 31119343 DOI: 10.1007/s00234-019-02206-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/01/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE While 84% of patients surgically treated for Chiari malformation type 1 (CM1) demonstrate improved quality of life after posterior fossa decompression surgery, there are many risks associated with this surgery. Surgical planning to identify candidates likely to improve postoperatively may benefit from an improved understanding of morphological changes after decompression surgery. To evaluate these changes, we quantified 59 morphological parameters on 42 CM1 adult female patients before and after CM1 decompression surgery. METHODS Fifty-nine morphological parameters in the posterior cranial fossa, cranio-cervical, and intracranial regions in the midsagittal plane were evaluated using 42 T1-weighted magnetic resonance images of female CM1 patients before and after surgery, and 42 healthy female controls. Morphological differences before and after surgery were compared through the development of a technique to establish the opisthion location, a key reference point not present after surgery. RESULTS In addition to the expected reduction of the cranio-caudal dimension of the cerebellum, objective analyses showed a significant increase in the area of the cerebrospinal fluid spaces, posterior (6×) and inferior (2.6×) to the cerebellum (+ 112 ± 102 and + 140 ± 127 mm2, respectively). This increased area was primarily impacted by an average reduction in the occipital bone length of 24.5 ± 7.3 mm following surgery. Based on multiple angles, results demonstrated a 2°-4° anterior rotation of the cerebellum after surgery. CONCLUSION Our results show that decompression surgery results in significant changes in the cerebellum and cerebrospinal fluid spaces. Further investigation should determine how these morphological changes impact clinical outcomes.
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Affiliation(s)
- Maggie S Eppelheimer
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, USA.
| | - Dipankar Biswas
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
| | - Audrey M Braun
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
| | - James R Houston
- Department of Psychology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Philip A Allen
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, OH, USA
| | | | | | - Dorothy M Loth
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, OH, USA
| | - David Frim
- Department of Neurosurgery, University of Chicago, Chicago, IL, USA
| | - Francis Loth
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, USA
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
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25
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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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Impact of morphological measurements on symptoms in Chiari malformation type 1. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.572881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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