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Kilinç MC, Zaimoglu M, Eroglu U, Özpişkin ÖM, Erdin E, Güngör B, Beger O. Vidian Canal in Chiari Type I Malformation: A Computed Tomography Study. J Craniofac Surg 2024:00001665-990000000-01852. [PMID: 39207159 DOI: 10.1097/scs.0000000000010587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE To evaluate the position and dimension of the Vidian canal (VC) in Chiari type I malformation (CIM). MATERIALS AND METHODS Radiologic views of 49 CIM (mean age: 23.58±15.62 y, sex: 23 males/26 females) and 51 healthy subjects (mean age: 42.50±20.12 y, sex: 21 males/30 females) were included in this computed tomography study. RESULTS In comparison with controls, the VC angle and the distance of the round foramen to VC were greater in CIM, but VC length and the distances of the superior wall of the bony sphenoidal sinus, midsagittal plane, and vomerine crest to VC were smaller in CIM. Relative to the sphenoid bone, the position of VC in CIM was determined as type 1 (59.2%) >type 2 (28.6%) >type 3 (12.2%), whereas in controls as type 1 (54.9%) >type 3 (25.5%) >type 2 (19.6%). Relative to the medial pterygoid plate, the position of VC in CIM was determined as type A (63.3%) >type B (20.4%) >type C (16.3%), while in controls as type B (43.1%) >type A (40.2%) >type C (16.7%). CONCLUSION VC size and position correlated with CIM. Compared with controls, CIM patients had more partially protruded VC into the bony sphenoidal sinus and more medially located VC according to the medial pterygoid plate.
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Affiliation(s)
- Mustafa Cemil Kilinç
- Department of Neurosurgery, Çorum Erol Olçok Training and Research Hospital, Hitit University, Çorum, Turkey
| | - Murat Zaimoglu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ömer Mert Özpişkin
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Engin Erdin
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Berkay Güngör
- Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Orhan Beger
- Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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Günerhan G, Çağıl E, Dağlar Z, Dalgıç A, Belen AD. A comparative analysis of neuroendoscopic foramen magnum decompression versus traditional open surgery for Chiari Malformation Type I. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3049-3059. [PMID: 38773017 DOI: 10.1007/s00586-024-08299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE Chiari Malformation Type I (CM1) is characterized by the downward displacement of the cerebellar tonsils below the foramen magnum. The standard surgical treatment for CM1 is foramen magnum decompression and atlas laminectomy (FMD-AL). However, there is a growing interest in exploring minimally invasive techniques, such as neuroendoscopically assisted FMD-AL, to optimize surgical outcomes. The aim is to present the results of the less invasive neuroendoscopic-assisted system application as an alternative to decompression surgery in patients with CM-1 with/without syringomyelia. PATIENTS AND METHODS A retrospective analysis was conducted on 76 patients with CMI who underwent either neuroendoscopic-assisted FMD-AL (n = 23) or open surgery (n = 53). Preoperative and postoperative assessments were performed, including pain levels, functional assessment, outcome and serum creatinine kinase (CK) levels. Surgical parameters and radiological imaging were also evaluated and compared. RESULTS Both surgical groups showed improvements in pain levels and increase in postoperative CK levels. There were no statistically significant differences between the groups in terms of postoperative JOA scores, VAS scores, CCOS, or syrinx resolution. However, the neuroendoscopic group had significantly lower CK levels, shorter hospital stays, less blood loss, and shorter operation times compared to the open surgery group, indicating reduced muscle damage and potential benefits of the neuroendoscopic assisted approach. CONCLUSION Both neuroendoscopy and open surgery groups can effectively alleviate symptoms and improve outcomes in patients with CM1. The neuroendoscopic assisted technique offers the advantage of reduced muscle damage and shorter hospital stays. The choice of surgical technique should be based on individual patient characteristics and preferences. LEVEL OF EVIDENCE 3 (Retrospective case-control study) according to using the Oxford Centre for Evidence-Based Medicine (CEBM) Table.
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Affiliation(s)
- Göksal Günerhan
- Department of Neurosurgery, Ankara City Hospital, University of Health Science, Üniversiteler Mah. 1604. Cad., No:9, 06800, Çankaya, Ankara, Turkey.
| | - Emin Çağıl
- Department of Neurosurgery, Ankara City Hospital, University of Health Science, Üniversiteler Mah. 1604. Cad., No:9, 06800, Çankaya, Ankara, Turkey
| | - Zeynep Dağlar
- Department of Neurosurgery, Dörtyol State Hospital, Hatay, Turkey
| | - Ali Dalgıç
- Department of Neurosurgery, Medicana International Hospital, Ankara, Turkey
| | - Ahmet Deniz Belen
- Department of Neurosurgery, Ankara City Hospital, University of Health Science, Üniversiteler Mah. 1604. Cad., No:9, 06800, Çankaya, Ankara, Turkey
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Dherijha MSA, Waqar M, Palin MS, Bukhari S. Foramen magnum decompression in adults with Chiari type 1 malformation: use of intraoperative ultrasound to guide extent of surgery. Br J Neurosurg 2024; 38:853-856. [PMID: 34605339 DOI: 10.1080/02688697.2021.1981238] [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: 10/20/2020] [Revised: 04/30/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Foramen magnum decompression (FMD) is an established technique for patients with Chiari-1 malformation. However, the extent of decompressive surgery is controversial, in particular whether dural opening is undertaken. OBJECTIVE In this study, we report outcomes with our technique utilising intraoperative ultrasound (iOU) findings. Decision to proceed for further decompression was based on CSF flow around foramen magnum and visualisation of tip of tonsils. METHODS Review of adults with CM-1 undergoing FMD 2013-2018. Patients underwent a suboccipital craniectomy ± partial C1 superior laminectomy ± duraplasty in a stepwise manner. Favourable iOU findings of CSF flow around the foramen magnum and pulsation of the tonsillar tips were sought at each step. Post-operative outcomes were assessed using the Chicago Chiari Outcome Score (CCOS). RESULTS Fifty-seven patients were included. The mean age was 47 years (range 18-77 years). There was a strong female preponderance (48 females to nine males). The mean follow-up was 3.2 years (range 1-5 years). Surgery included: suboccipital craniectomy (52/57, 91%), plus partial C1 superior laminectomy (2/57, 4%), and plus duraplasty (3/57, 6%). Redo surgery was undertaken in 7/57 patients (12%). At final follow-up, 56/57 (98%) patients achieved a good (CCOS 13-16) or satisfactory (CCOS 9-12) outcome based on COSS. CONCLUSIONS A patient centred approach to surgery utilising findings from iOU can achieve favourable outcomes. Dural opening is not routinely required.
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Affiliation(s)
| | - Mueez Waqar
- Salford Royal NHS Foundation Trust, Salford, UK
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Poca MA, Lopez-Bermeo D, Moncho D, Ferre A, Sanchez-Montañez A, Mestres O, Galve S, Sahuquillo J. Surgical Outcomes in Chiari 1 and Chiari 1.5 Malformation Treated by Posterior Fossa Reconstruction: A Comprehensive Analysis of 110 Pediatric Cases and Literature Review. J Clin Med 2024; 13:3852. [PMID: 38999418 PMCID: PMC11242314 DOI: 10.3390/jcm13133852] [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: 05/14/2024] [Revised: 06/18/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: The management of Chiari malformations (CMs) remains a clinical challenge and a topic of great controversy. Results may vary between children and adults. The purpose of the current single-center study is to critically assess the one-year surgical outcomes of a cohort of 110 children with CM-1 or CM-1.5 who were treated using "posterior fossa reconstruction" (PFR), a surgical technique described in 1994 that has since been used in both adults and children. We also review the literature and discuss the possible causes of the drawbacks and pitfalls in children in whom PFR was ineffective in controlling the disease. Methods: The present cohort was selected from a prospective registry of adults and children with CMs collected since 2006. Patients included in this study were selected from a group of children with CMs who were operated on in our Pediatric Neurosurgical Unit between 1 January 2007 and 31 November 2023. Surgical outcome was defined based on clinical and neuroradiological results as very good, good, or bad. Results: The mean age of our child cohort was 9.9 ± 4.7 years, with 54 girls (49%) and 56 boys (51%). Sixty-six children had CM-1 (60%) while forty-four had CM-1.5 (40%). Following surgery, there was no neurological worsening or death among the children. Most children (70%) had an uneventful recovery and were discharged home on average one week after surgery. However, in 33 children (30%), we recorded at least one postoperative adverse event. Aseptic meningitis syndrome was the most frequent adverse event (n = 25, 22.7%). The final surgical outcome was evaluated one year after PFR by using both clinical and neuroradiological results. The one-year surgical outcome was excellent in 101 children (91.9%), good in 5 (4.5%), and bad in 4 (3.6%). Conclusions: PFR significantly enlarges the volume of the posterior fossa and recreates a CSF environment that generates buoyancy of the cerebellum, with a high percentage of excellent and good clinical results evaluated one year post-surgery.
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Affiliation(s)
- Maria A. Poca
- Department of Neurosurgery, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.L.-B.); (J.S.)
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.M.); (A.F.); (O.M.)
- Department of Surgery (Neurosurgery), Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Diego Lopez-Bermeo
- Department of Neurosurgery, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.L.-B.); (J.S.)
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.M.); (A.F.); (O.M.)
| | - Dulce Moncho
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.M.); (A.F.); (O.M.)
- Clinical Neurophysiology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Alex Ferre
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.M.); (A.F.); (O.M.)
- Clinical Neurophysiology Department, Vall d’Hebron Hospital Universitari, 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
| | - Angel Sanchez-Montañez
- Department of Pediatric Neuroradiology, Institut de Diagnostic per la Imatge (IDI), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
| | - Olga Mestres
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.M.); (A.F.); (O.M.)
- Department of Surgery (Neurosurgery), Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Sandra Galve
- Pediatric Anesthesiology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
| | - Juan Sahuquillo
- Department of Neurosurgery, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.L.-B.); (J.S.)
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.M.); (A.F.); (O.M.)
- Department of Surgery (Neurosurgery), Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Alpergin BC, Eroglu U, Zaimoglu M, Kılınç MC, Özpişkin ÖM, Erdin E, Beger O. Topographic Anatomy and Pneumatization of the Posterior Clinoid Process in Chiari Type I Malformation. World Neurosurg 2024; 185:e767-e773. [PMID: 38431212 DOI: 10.1016/j.wneu.2024.02.130] [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: 01/31/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE This study aimed to examine pneumatization and topographic location of the posterior clinoid process (PCP) in Chiari type I malformation (CIM) for skull base approaches. METHODS Computed tomography images of 52 (23 males/29 females) CIM subjects aged 23.87 ± 16.09 years and 71 (26 males/45 females) healthy subjects aged 42.48 ± 21.48 years constituted the study universe. RESULTS The distances of PCP to the foramen magnum (P = 0.037), superior orbital fissure (P < 0.001), foramen rotundum (P < 0.001), and foramen ovale (P < 0.001) were smaller, but the distance of PCP to the crista galli (P = 0.038) was greater in CIM patients, compared with normal subjects. In CIM, the fusion between PCP and the anterior clinoid process was observed in 9 sides (8.70%), while in controls it was observed in 12 sides (8.50%). PCP pneumatization was observed in 40 sides (38.50%) in CIM patients, while it was observed in 28 sides (19.70%) in normal subjects. These data displayed that PCP pneumatization was affected by CIM (P < 0.001). CONCLUSIONS The distances of PCP to the crista galli and foramen magnum indicate the anterior fossa length and the posterior fossa depth, respectively; thus CIM patients have a longer anterior fossa and a shallow posterior fossa. In addition, the distances of PCP to the superior orbital fissure, foramen rotundum, and foramen ovale indicate the middle fossa width; hence CIM patients have less middle fossa width than normal individuals. CIM patients have an approximately 50% higher PCP pneumatization rate, and this may increase the risk of complications such as cerebrospinal fluid fistula during the application of posterior clinoidectomy.
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Affiliation(s)
- Baran Can Alpergin
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Murat Zaimoglu
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Mustafa Cemil Kılınç
- Department of Neurosurgery, Hitit University, Çorum Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Ömer Mert Özpişkin
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Engin Erdin
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Orhan Beger
- Faculty of Medicine, Department of Anatomy, Gaziantep University, Gaziantep, Turkey.
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Palumbo G, Arrigoni F, Peruzzo D, Parazzini C, D'Errico I, Agazzi GM, Pinelli L, Triulzi F, Righini A. Onset of Chiari type 1 malformation: insights from a small series of intrauterine MR imaging cases. Neuroradiology 2023; 65:1387-1394. [PMID: 37329352 DOI: 10.1007/s00234-023-03183-0] [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: 09/17/2022] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Morphometric studies on idiopathic Chiari malformation type 1 (CM1) pathogenesis have been mainly based on post-natal neuroimaging. Prenatal clues related to CM1 development are lacking. We present pre- and post-natal imaging time course in idiopathic CM1 and assess fetal skull and brain biometry to establish if clues about CM1 development are present at fetal age. METHODS Multicenter databases were screened to retrieve intrauterine magnetic resonance (iuMR) of children presenting CM1 features at post-natal scan. Syndromes interfering with skull-brain growth were excluded. Twenty-two morphometric parameters were measured at fetal (average 24.4 weeks; range 21 to 32) and post-natal (average 15.4 months; range 1 to 45) age; matched controls were included. RESULTS Among 7000 iuMR cases, post-natal scans were available for 925, with postnatal CM1 features reported in seven. None of the fetuses presented CM1 features. Tonsillar descent was clear at a later post-natal scan in all seven cases. Six fetal parameters resulted to be statistically different between CM1 and controls: basal angle (p = 0.006), clivo-supraoccipital angle (p = 0.044), clivus' length (p = 0.043), posterior cranial fossa (PCF) width (p = 0.009), PCF height (p = 0.045), and PCFw/BPDb (p = 0.013). Postnatally, only the clivus' length was significant between CM1 cases and controls. CONCLUSION Pre- and post-natal CM1 cases did not share striking common features, making qualitative prenatal assessment not predictive; however, our preliminary results support the view that some of the pathogenetic basis of CM1 may be embedded to some extent already in intrauterine life.
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Affiliation(s)
- Giovanni Palumbo
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy.
| | - Filippo Arrigoni
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Denis Peruzzo
- Neuroimaging Unit, Scientific Institute, IRCCS "Eugenio Medea", Bosisio Parini, Lecco, Italy
| | - Cecilia Parazzini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | | | | | | | - Fabio Triulzi
- Neuroradiology Department, Fondazione IRRCS Ca' Granda Ospedale Policlinico Di Milano, Milan, Italy
| | - Andrea Righini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
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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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Atallah O, Wolff Fernandes F, Krauss JK. The Chiari Malformations: A Bibliometric Analysis of the 100 Most Cited Articles. World Neurosurg 2023; 175:e754-e768. [PMID: 37037368 DOI: 10.1016/j.wneu.2023.04.015] [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: 01/20/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE The Chiari malformations present heterogeneous entities, raising many questions regarding their natural history, pathophysiology, treatment options, and prognosis. Bibliometric analyses have emerged as a method to assess the impact of articles in current clinical practice. METHODS The most cited articles were identified via Scopus Library by using the keywords "Chiari," "Arnold-Chiari," and "Chiari malformation." The 100 most cited articles were then assembled and analyzed in detail. RESULTS The top 100 articles yielded a mean of 155,28 citations per article, ranging from 87 to 896 citations, and from 1.63 to 38.96 per year. Years of publications ranged from 1950 to 2015. Oakes was the most cited author (n = 7), followed by Tubbs and Milhorat. The country with the highest cited articles was the United States (n = 63), followed by the United Kingdom (n = 6), Italy (n = 5), Spain (n = 5), Japan (n = 4), and Germany (n = 3). Neurosurgery is the journal with the most highly cited articles (n = 21), followed by Journal of Neurosurgery (n = 19). Most articles focused on Chiari malformation type I (n = 83). The topic discussed most often was imaging (n = 63), followed by the evaluation of treatment outcome (n = 58), clinical signs and symptoms (n = 57), and the role of surgery (n = 56). CONCLUSIONS The present bibliometric analysis provides a succinct appraisal of the most cited articles concerning Chiari malformation, allowing a deeper insight in this area and its main influential articles with their impact on current clinical practice and future research.
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Affiliation(s)
- Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
| | | | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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Özalp H, Özgüral O, Alpergin BC, İnceoğlu A, Özalp S, Armağan E, Uçar H, Beger O. Analysis of the Prechiasmatic Sulcus in Chiari Malformation Type I. World Neurosurg 2023; 175:e1149-e1157. [PMID: 37116784 DOI: 10.1016/j.wneu.2023.04.083] [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: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To assess morphologic features of the prechiasmatic sulcus (PS) in Chiari malformation type I (CM-I). METHODS Computed tomography images were obtained in patients with CM-1 (mean age: 21.26 ± 16.46 years; sex: 25 females and 17 males) and 58 healthy control subjects (mean age: 28.12 ± 22.60 years; sex: 29 females and 29 males). The following parameters were measured to determine the anatomy of the PS: planum length, sulcal length, sulcal angle (SA), and interoptic distance. Considering sulcal length and SA measurements, 4 types of PS were identified: narrow-steep-groove (NSG), narrow-flat-groove (NFG), wide-steep-groove, and wide-flat-groove. RESULTS SA was greater in the CM-I group (32.80 ± 18.21°) compared with the control group (23.05 ± 14.53°) (P = 0.004), but the other parameters were similar in both groups. Distribution ranking of PS types was as follows: NFG (31%) > NSG (26.20%) > wide-steep-groove (23.80%) > wide-flat-groove (19%) in the CM-I group; wide-flat-groove (37.90%) > wide-steep-groove (20.70%) = NFG (20.70%) = NSG (20.70%) in the control group. Distribution rate of PS types relative to both groups showed that the classification system was not affected by CM-I (P = 0.226). CONCLUSIONS SA value was approximately 25% greater in the CM-I group than in the control group; thus, CM-I patients had more vertical groove. The percentage of narrow-type (NSG + NFG) PS in the CM-I group was higher than in the control group.
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Affiliation(s)
- Hakan Özalp
- Department of Neurosurgery, Istanbul Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Onur Özgüral
- Department of Neurosurgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Baran Can Alpergin
- Department of Neurosurgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ayşenur İnceoğlu
- Department of Anatomy, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Sibel Özalp
- Department of Medical Laboratory Techniques, Istanbul Medipol University School of Vocation, İstanbul, Turkey
| | - Ercan Armağan
- Department of Neurosurgery, Silivri Anadolu Hospital, İstanbul, Turkey
| | - Hadice Uçar
- Department of Anatomy, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Orhan Beger
- Department of Anatomy, Gaziantep University Faculty of Medicine, Gaziantep, Turkey.
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10
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Nair BR, Rajshekhar V. Posterior fossa morphometry in 170 South Asian children and adults with Chiari malformation and its correlation with tonsillar descent. Br J Neurosurg 2022; 36:762-769. [PMID: 34894927 DOI: 10.1080/02688697.2021.2008873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIM Patients with Chiari I malformations (CM1) have posterior fossa hypoplasia with crowding of the neural structures. We aimed to study the posterior fossa measurements to analyse the posterior fossa morphology, presence of basilar invagination (BI) and correlated the measurements with the degree of tonsillar descent. METHODS We retrospectively reviewed data in170 patients who underwent foramen magnum decompression (FMD) for CM1. The posterior fossa measurements were compared with 30 controls. Patients were divided into those with and without BI. The variables measured included clival length, posterior fossa height, supraocciput length, posterior fossa diameter, foramen magnum width, Boogard's angle, clival angle, clival slope and the newly introduced foramen magnum (FM) angle. RESULTS The average clivus length and posterior fossa height were significantly shorter with a significant increase in the Boogard's and FM angle in the patient groups. Tonsillar descent showed a negative correlation with posterior fossa height (r = -0.498, p ≤ 0.001) and clivus length (r = -0.325, p ≤ 0.001) and a positive correlation with Boogard's angle (r = 0.469, p ≤ 0.001) and FM angle (r = 0.330, p ≤ 0.001). Patients with BI had statistically significant reduced posterior fossa height (p ≤ 0.001) and increased extent of tonsillar herniation (p = 0.001) compared to patients without BI. CONCLUSION Patients with CM1 have significantly shorter clival length and posterior fossa height with smaller posterior fossa in support of published data. The presence of BI shortens the posterior fossa height and worsens the extent of tonsillar herniation. An increased Boogard's angle and FM angle result in a more horizontally placed suboccipital bone compared to a slanting bone in normal persons.
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Affiliation(s)
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, India
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11
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VURALLI D, OKSÜZLER M. Chiari malformasyonu Tip-I’de fossa cranii posterior morfometrisinin radyolojik olarak değerlendirilmesi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç:. Bu çalışmada, Chiari Malformasyonu Tip-I hastaları ve kontrol grubuna ait Manyetik Rezonans (MR) görüntülerinde fossa cranii posterior (FCP) ve cranium’ a ait morfometrik ölçümler yapılarak oluşan morfolojik değişiklikleri değerlendirmek amaçlandı.
Gereç ve Yöntem: Çalışmamız retrospektif nitelikte olup çalışmaya 21 ve 47 yaş aralığında 32 kişilik kontrol grubu (16 kadın, 16 erkek) ve 12 kişilik CMI’ lı hasta grubu (6 erkek, 6 kadın) dahil edildi. CMI’ lı hasta ve kontrol grubuna ait T2 ağırlıklı MR görüntüleri üzerinde ölçümler yapıldı.
Bulgular: Maksimum cranial uzunluk, maksimum cranial yükseklik, foramen magnum sagittal çapı, basis cranii uzunluğu, supraocciput uzunluğu, clivus uzunluğu, fossa cranii posterior’ un ön-arka çapı, occipital cord uzunluğu, cerebellum yüksekliği, herniasyon miktarı CMI’ lı hastalarda sırasıyla 164.13±10.67mm, 134.60 ±10.71 mm, 36.89±5.28 mm, 108.5±7.9 mm, 38.5±3.7 mm, 36.7±7.1 mm, 84.9±8.8 mm, 79.7±11.5 mm, 53.3±4.2 mm, 7.8±4.9 mm olarak ölçüldü.
Sonuç: Sağlıklı bireylere ait değerlerle karşılaştırıldığında, CMI’lı hastalarda foramen magnum ön-arka çapında ve tonsiller herniasyonda artış; clivus uzunluğu, occipital cord uzunluğu ve supraocciput uzunluğunda azalma olduğu görüldü. CMI‘lı hastalara ait FCP morfometrisinin bilinmesinin hastaların takibine ve cerrahisine katkı sağlayacağı düşünüldü.
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12
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Barros DPM, Ribeiro ECO, Nascimento JJC, Silva-Neto EJ, Araújo-Neto SA. Reliability and Agreement in the Cerebellar Tonsil Tip Localization: Two Methods Using the McRae Line Concept in MRI. World Neurosurg 2022; 165:e611-e618. [PMID: 35772711 DOI: 10.1016/j.wneu.2022.06.108] [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: 04/13/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The cerebellar tonsil tip position (TP) is a common parameter used for the radiologic diagnosis of Chiari malformation type 1 (CM1). However, these paramedian structures are usually not properly visualized in the midsagittal section. Such mismatch may be a source of bias in TP measurements based on the McRae line (ML) traced between median craniometric points. This study aims to evaluate the intraoperator and interoperator reliability and agreement of 2 protocols to trace the ML in magnetic resonance imaging (MRI) for the cerebellar tonsil tip localization, adding a 3-dimensional multiplanar reconstruction (MPR) approach to the midsagittal plane. METHODS Sixty-two T1-weighted head MRIs were obtained for 32 CM1 patients and 30 controls. Two operators independently applied 2 TP measurement protocols, one considering only the visualization of the sagittal plane and the other using MPR. The intraclass correlation coefficient was used to assess intraoperator and interoperator reliability, and the Bland-Altman graphical method was used to evaluate the agreement between the measurement protocols. RESULTS The sagittal method significantly underestimated ML and tonsillar herniation when compared with the MPR method. The MPR method provided better reliability of the ML measurement when compared to the sagittal method, but this did not influence the reliability of the TP. Analysis of the Bland-Altman plot showed that the limits of agreement were close to acceptable for the ML, but not for measures of TP. CONCLUSIONS The standardization of the LM tracing by the MPR method improves the acquisition of data regarding the position of the tonsils.
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Affiliation(s)
- Daniel P M Barros
- Medical Sciences Center, Federal University of Paraiba, João Pessoa, Brazil.
| | - Elayne C O Ribeiro
- Department of Morphology, Federal University of Paraiba, João Pessoa, Brazil
| | - José J C Nascimento
- Postgraduate Program in Neuropsychiatry, Federal University of Pernambuco, Recife, Brazil
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13
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Yuksel U, Burulday V, Akkaya S, Baser S, Ogden M, Alhan A, Bakar B. Possible predictive clinical and radiological markers in decision making for surgical intervention in patients with Chiari Malformation type 1. Neurol Res 2022; 44:975-988. [PMID: 35758154 DOI: 10.1080/01616412.2022.2089402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The first aim of this study was to compare the clinical data and posterior fossa morphometry obtained during the admission to the hospital between control group individuals (who had not Chiari Malformation (CM) type 1) and CM type 1 patients treated surgically or not. The second aim was to create a valid and reliable scale that can predict the decision-making for surgical intervention simply and easily in these patients. MATERIALS Medical data and radiological images of 70 CM type 1 patients during their admission to the hospital were compared with the data of 69 control group individuals. RESULTS Conservative treatment and/or follow-up was applied to 58 (82.9%) patients, and 12 (17.1%) patients underwent surgery. ROC analysis showed that the presence of myelopathy, tonsillar herniation >8 mm, Chamberlain line >84 mm, McRae line >44.50 mm, and odontoid process-McRae line angle <10.50 degrees could be used as predictive markers in decision-making for surgical intervention (p < 0.05). Logistic Regression analysis revealed that symptoms severity, and McRae line value would be the 'best parameters' in decision-making for surgical intervention (p < 0.05). A scale named the CHIASURG scale developed using this study's parameters showed that the parameters of 'depth of tonsillar herniation', 'Chamberlain line', and 'McRae line' could predict the surgical intervention risk. CONCLUSION It was found that symptoms severity and McRae line value could be used as predictive markers in decision-making for surgical intervention. Additionally, it was concluded that a new scale called CHIASURG could predict surgical intervention risk validly and reliably.
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Affiliation(s)
- Ulaş Yuksel
- Kirikkale University Faculty of Medicine, Department of Neurosurgery, Kirikkale, Turkey
| | - Veysel Burulday
- Inonu University Faculty of Medicine, Department of Radiology, Kirikkale, Turkey
| | - Suleyman Akkaya
- Kirikkale University Faculty of Medicine, Department of Neurosurgery, Kirikkale, Turkey
| | - Selcuk Baser
- Kirikkale University Faculty of Medicine, Department of Radiology, Kirikkale, Turkey
| | - Mustafa Ogden
- Kirikkale University Faculty of Medicine, Department of Neurosurgery, Kirikkale, Turkey
| | - Aslihan Alhan
- Ufuk University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Bulent Bakar
- Kirikkale University Faculty of Medicine, Department of Neurosurgery, Kirikkale, Turkey
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14
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Lloyd RA, Stoodley MA, Bilston LE. Statistical shape models of the posterior cranial fossa and hindbrain volumes may provide a more robust clinical metric for Chiari malformation. J Biomech 2022; 137:111093. [DOI: 10.1016/j.jbiomech.2022.111093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
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15
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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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Al-Habib AF, Al Abdulsalam H, Ahmed J, Albadr F, Alhothali W, Alzahrani A, Abojamea A, Altowim A, Ullah A, Alkubeyyer M. Association between craniovertebral junction abnormalities and syringomyelia in patients with chiari malformation type-1. ACTA ACUST UNITED AC 2021; 25:308-315. [PMID: 33130812 PMCID: PMC8015613 DOI: 10.17712/nsj.2020.4.20200008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: To assess the correlation between craniovertebral junction (CVJ) abnormalities and syringomyelia in patients with Chiari malformation type-1 (CM1). Methods: This was a retrospective study including patients with CM1. Identification of cases was done by searching a radiology database at a university hospital from 2012 to 2017. Patients were divided into 2 groups based on whether CVJ abnormalities were present (CVJ+) or absent (CVJ-). The patients’ demographic and clinical data were reviewed. All magnetic resonance imaging studies were examined by a certified neuroradiologist. Results: Sixty-four consecutive patients with CM1 were included. The mean age was 24±17 years; 59% were females. The CVJ+ group had more female patients (p = 0.012). The most frequent CVJ abnormality was platybasia (71%), followed by short clivus (44%) and cervical kyphosis (33%). The CVJ abnormalities were more in Syringomyelia cases (p = 0.045). However, the results were not significant when hydrocephalus cases were excluded. Conclusion: Among CM1 patients, CVJ abnormalities were found more in patients with syringomyelia. Future studies with larger sample size are required to further study the correlation between CVJ abnormalities and both syringomyelia and hydrocephalus in CM1 patients.
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Affiliation(s)
- Amro F Al-Habib
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail:
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Kim J, Lee DW, Jang DH. Case Report: Pansynostosis, Chiari I Malformation and Syringomyelia in a Child With Frontometaphyseal Dysplasia 1. Front Pediatr 2021; 9:574402. [PMID: 34277511 PMCID: PMC8280522 DOI: 10.3389/fped.2021.574402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Frontometaphyseal dysplasia 1 (FMD1) is a rare otopalatodigital spectrum disorder (OPDSD) that is inherited as an X-linked trait and it is caused by gain-of-function mutations in the FLNA. It is characterized by generalized skeletal dysplasia, and craniofacial abnormalities including facial dysmorphism (supraorbital hyperostosis, hypertelorism, and down-slanting palpebral fissures). The involvement of the central nervous system in patients with OPDSD is rare. Herein, we present the case of a 12-year-old boy with facial dysmorphism, multiple joint contractures, sensorineural hearing loss, scoliosis, craniosynostosis, and irregular sclerosis with hyperostosis of the skull. Brain and whole-spine magnetic resonance imaging revealed Chiari I malformation with extensive hydrosyringomyelia from the C1 to T12 levels. Targeted next-generation sequencing identified a hemizygous pathologic variant (c.3557C>T/p.Ser1186Leu) in the FLNA, confirming the diagnosis of FMD1. This is the first report of a rare case of OPDSD with pansynostosis and Chiari I malformation accompanied by extensive syringomyelia.
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Affiliation(s)
- Jaewon Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong-Woo Lee
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dae-Hyun Jang
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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18
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Milano JB, Barcelos ACES, Daniel JW, Joaquim AF, Dantas FLR, Brock RS, Rusafa Neto E, Bertolini EDF, Mudo ML, Onishi FJ, Oliveira RS, Botelho RV. Chiari malformation Type I - effect of the section of the filum terminale. Rev Assoc Med Bras (1992) 2020; 66:1021-1025. [DOI: 10.1590/1806-9282.66.7.1021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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19
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Chiari I malformation-neuropsychological functions and quality of life. Acta Neurochir (Wien) 2020; 162:1575-1582. [PMID: 30955083 DOI: 10.1007/s00701-019-03897-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/28/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the neuropsychological (NP) functioning and quality of life (QOL) before and 3 months after surgery on adults with Chiari I malformation (CMI). PATIENTS AND METHODS All adult patients who had been diagnosed with CMI were invited to participate. Those who participated were assessed using a Hospital Anxiety and Depression scale (HAD) and NP examinations. Their QOL was assessed using the self-reported life satisfaction checklist, LiSat-11 and the five-dimensional EuroQol measurement of health outcome, EQ-5D-5L. All assessments were carried out both before and 3 months after surgery was performed. Demographic data and comorbidities were also registered. RESULTS Of the 11 patients who underwent NP assessment, the majority demonstrated cognitive functioning within the normal range. However, postoperatively, their performance in verbal learning, psychomotor speed, colour naming speed and the ability to manage interference through response selection and inhibition (aspects of executive functioning) was significantly improved. Thirteen patients completed QOL assessments. When LiSat-11 item domains were compared with those of healthy subjects, patients reported a lower level of satisfaction with their life quality both before and after surgery. However, the EQ-5D-5L measurements, i.e., the descriptive system and the visual analogue, indicated that their QOL of life was significantly improved after surgery. CONCLUSION There is scarcely any literature documenting effects of surgery on the QOL of CMI patients. The study we present here breaks new ground by comparing pre- and postoperative NP functions in CMI. We also examine the value of surgery for improving both NP functions and QOL in CMI.
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20
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Butensky S, Rodgers S, Baron S, Schneider S, Mittler M. Comparison of surgical outcomes in patients with Chiari Type I malformation receiving posterior fossa decompression with and without duraplasty. Childs Nerv Syst 2020; 36:1399-1405. [PMID: 32451665 DOI: 10.1007/s00381-020-04667-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The goals of this study were to compare clinical outcomes in patients with Chiari Malformation Type I (CMI) receiving posterior fossa decompression with (PFDD) or without duraplasty (PFD). METHODS We conducted a retrospective analysis of 178 consecutive cases of 157 patients undergoing PFDD or PFD for CMI at Cohen Children's Medical Center between 2007 and 2017. Clinical improvement was defined as a clear reduction of preoperative symptoms after surgery as reported by patients and parents. An improvement of syrinx was derived from radiologic comparison of pre- and postoperative MR imaging. Chi-square analysis was performed to analyze the association between duraplasty and clinical parameters (alpha = 0.05). RESULTS The primary presenting complaint was headache (142/178; 80%), followed by neck, back, and upper extremity pain, and numbness or tingling (49/178; 28%). Seventy patients (78/178; 44%) underwent PFD, and 100 patients (100/178; 56%) underwent PFDD. Overall, 143 patients (143/178; 80%) experienced subjective improvement with no statistically significant difference between the two surgical techniques (p = 0.705). The number of patients receiving PFDD with syrinx improvement or stabilization (55/59; 93%) was statistically larger than those that received PFD (8/13; 62%) (p = 0.008). PFDD was associated with greater complications than PFD alone. There were 35 cases of reoperation overall (35/178; 19%), and there was no statistically significant difference in reoperation rate between PFD and PFDD (p = 0.255). CONCLUSIONS There appears to be a role for PFDD in patients with severe syringomyelia, but overall, PFD alone may be safely offered as the initial surgical intervention for symptomatic CMI patients.
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Affiliation(s)
- Samuel Butensky
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA
| | - Shaun Rodgers
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA. .,Division of Pediatric Neurosurgery, Cohen Children's Medical Center of New York, New Hyde Park, NY, 11040, USA.
| | - Shanna Baron
- Division of Pediatric Neurosurgery, Cohen Children's Medical Center of New York, New Hyde Park, NY, 11040, USA
| | - Steven Schneider
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA.,Division of Pediatric Neurosurgery, Cohen Children's Medical Center of New York, New Hyde Park, NY, 11040, USA
| | - Mark Mittler
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA.,Division of Pediatric Neurosurgery, Cohen Children's Medical Center of New York, New Hyde Park, NY, 11040, USA
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Demiral M, Salih Karaca M, Unal E, Baysal B, Taner Baran R, Demirbilek H, Nuri Ozbek M. A novel diagnostic tool for the evaluation of hypothalamic-pituitary region and diagnosis of growth hormone deficiency: pons ratio. J Pediatr Endocrinol Metab 2020; 33:735-742. [PMID: 32436858 DOI: 10.1515/jpem-2019-0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 03/21/2020] [Indexed: 11/15/2022]
Abstract
Backgrounds Limitations in the evaluation of the pituitary size and changes according to pubertal status make its validity questionable. Recently, in a small-scale study, pons ratio (PR) has been suggested as a more sensitive tool for diagnosis and etiological evaluation of growth hormone deficiency (GHD). The aim of the study is to evaluate the diagnostic value of PR in the diagnosis of GHD. Methods We retrospectively evaluated the pituitary magnetic resonance imaging (MRI) of 133 patients with a diagnosis of GHD. Primary axis (PA) was assigned as a line crossing the mid-sagittal dorsum sella and fourth ventricle. PR was defined as the pons height above the PA divided by total pons height. The PR of patients with GHD was compared to subjects without GHD. Results Study included 133 patients with GHD and 47 controls. In total, 121 (91%) patients had isolated GHD and 12 (9%) patients had multiple pituitary hormone deficiency. The PR of the patient group (mean: 0.32 ± 0.89; range: 0.14-0.63) was significantly higher than controls (mean: 0.26 ± 0.067; range 0.19-0.44) (p: 0.000). The optimal cut-off value of PR for GHD diagnosis was 0.27 (sensitivity 71% specificity 56%). There was a negative correlation between anterior pituitary height (APH)-SDS and PR (p: 0.002; r: -0.27). APH was increased, but PR remained unchanged in pubertal patients (p: 0.089). Conclusions PR measurement is a noninvasive, practical method with a cost-benefit clinical value. As it is not affected by pubertal status, PR is potentially a more sensitive tool for evaluation of pituitary gland in GHD patients compared to APH.
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Affiliation(s)
- Meliha Demiral
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Mehmet Salih Karaca
- Gazi Yasargil Training and Research Hospital Clinics of Radiology, Diyarbakir, Turkey
| | - Edip Unal
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Birsen Baysal
- Gazi Yasargil Training and Research Hospital Clinics of Paediatrics, Diyarbakır, Turkey
| | - Rıza Taner Baran
- Antalya Training and Research Hospital Clinics of Paediatric Endocrinology, Antalya, Turkey
| | - Huseyin Demirbilek
- Hacettepe University, Faculty of Medicine, Department of Paediatric Endocrinology, Ankara, Turkey
| | - Mehmet Nuri Ozbek
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
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Botelho RV, Heringer LC, Botelho PB, Lopes RA, Waisberg J. Posterior Fossa Dimensions of Chiari Malformation Patients Compared with Normal Subjects: Systematic Review and Meta-Analysis. World Neurosurg 2020; 138:521-529.e2. [PMID: 32156591 DOI: 10.1016/j.wneu.2020.02.182] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chiari malformation (CM) is defined as a herniation of cerebellar tonsils below the foramen magnum and is considered to be due to underdevelopment of posterior fossa (PF) bone components. There is overcrowding of neural structures, and normal cerebrospinal fluid circulation is frequently blocked. Although several publications exist of measurements of dimensions and volumes from bone components of PF in CM, there is no systematic review evaluating quantitatively these dimensions. The aim of this study was to evaluate PF dimensions and volumes in a meta-analysis. METHODS An electronic search using PubMed and Google Scholar was done. Study eligibility criteria were defined by the PICO strategy, which selected patients and interventions. Studies comparing PF dimensions between patients with CM and normal subjects were selected. A meta-analysis of pooled data was done using statistical software. RESULTS Data for pooled analysis were obtained from 12 studies. Data synthesis was based on small published sample sizes in the majority of studies. Key findings included smaller measurements of clivus, supraoccipital bone, and PF area dimensions in patients with CM compared with normal subjects. Brainstem and cerebellar length was not different between groups. CONCLUSIONS This review provides evidence of smaller measurements of clivus, supraoccipital bone, and PF area dimensions in patients with CM compared with normal subjects. An implication of the key findings is that surgical treatment of CMs should consider the smaller dimensions of PF in planning.
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Affiliation(s)
- Ricardo Vieira Botelho
- Post-Graduate Program, Instituto de Assistência Médica ao Servidor Público do Estado de São Paulo, São Paulo, São Paulo, Brazil.
| | - Lindolfo Carlos Heringer
- Post-Graduate Program, Instituto de Assistência Médica ao Servidor Público do Estado de São Paulo, São Paulo, São Paulo, Brazil
| | - Pedro B Botelho
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
| | - Rosimary Amorim Lopes
- Post-Graduate Program, Instituto de Assistência Médica ao Servidor Público do Estado de São Paulo, São Paulo, São Paulo, Brazil
| | - Jaques Waisberg
- Post-Graduate Program, Instituto de Assistência Médica ao Servidor Público do Estado de São Paulo, São Paulo, São Paulo, Brazil
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Milano JB, Barcelos ACES, Onishi FJ, Daniel JW, Botelho RV, Dantas FR, Neto ER, de Freitas Bertolini E, Mudo ML, Brock RS, de Oliveira RS, Joaquim AF. The effect of filum terminale sectioning for Chiari 1 malformation treatment: systematic review. Neurol Sci 2019; 41:249-256. [DOI: 10.1007/s10072-019-04056-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/28/2019] [Indexed: 10/25/2022]
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Thompson DNP. Chiari I-a 'not so' congenital malformation? Childs Nerv Syst 2019; 35:1653-1664. [PMID: 31292759 DOI: 10.1007/s00381-019-04296-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 02/07/2023]
Abstract
The term Chiari I malformation (CIM) is imbedded in the paediatric neurosurgical lexicon; however, the diagnostic criteria for this entity are imprecise, its pathophysiology variable, and the treatment options diverse. Until recently, CIM has been considered to be a discrete congenital malformation requiring a uniform approach to treatment. Increasingly, it is recognised that this is an oversimplification and that a more critical, etiologically based approach to the evaluation of children with this diagnosis is essential, not only to select those children who might be suitable for surgical treatment (and, of course those who might be better served by conservative management) but also to determine the most appropriate surgical strategy. Whilst good outcomes can be anticipated in the majority of children with CIM following foramen magnum decompression, treatment failures and complication rates are not insignificant. Arguably, poor or suboptimal outcomes following treatment for CIM reflect, not only a failure of surgical technique, but incorrect patient selection and failure to acknowledge the diverse pathophysiology underlying the phenomenon of CIM. The investigation of the child with 'hindbrain herniation' should be aimed at better understanding the mechanisms underlying the herniation so that these may be addressed by an appropriate choice of treatment.
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Affiliation(s)
- Dominic N P Thompson
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK.
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Bartoli A, Soleman J, Berger A, Wisoff JH, Hidalgo ET, Mangano FT, Keating RF, Thomale UW, Boop F, Roth J, Constantini S. Treatment Options for Hydrocephalus Following Foramen Magnum Decompression for Chiari I Malformation: A Multicenter Study. Neurosurgery 2019; 86:500-508. [DOI: 10.1093/neuros/nyz211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/24/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andrea Bartoli
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel
| | - Jehuda Soleman
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel
- Department of Neurosurgery and Division of Pediatric Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Assaf Berger
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey H Wisoff
- Division of Pediatric Neurosurgery, NYU Langone Health, New York, New York
| | | | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert F Keating
- Department of Neurosurgery, Children's National Medical Center, Washington, DC
| | - Ulrich W Thomale
- Pediatric Neurosurgery, Charité Universitätsmedizin, Berlin, Germany
| | - Frederick Boop
- Department of Pediatrics, Neuroscience Institute, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Jonathan Roth
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel
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Cha BK, Choi DS, Jang IS, Yook HT, Lee SY, Lee SS, Lee SK. Aberrant growth of the anterior cranial base relevant to severe midface hypoplasia of Apert syndrome. Maxillofac Plast Reconstr Surg 2018; 40:40. [PMID: 30591916 PMCID: PMC6289935 DOI: 10.1186/s40902-018-0179-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/31/2018] [Indexed: 02/04/2023] Open
Abstract
Background A 9-year-old male showed severe defects in midface structures, which resulted in maxillary hypoplasia, ocular hypertelorism, relative mandibular prognathism, and syndactyly. He had been diagnosed as having Apert syndrome and received a surgery of frontal calvaria distraction osteotomy to treat the steep forehead at 6 months old, and a surgery of digital separation to treat severe syndactyly of both hands at 6 years old. Nevertheless, he still showed a turribrachycephalic cranial profile with proptosis, a horizontal groove above supraorbital ridge, and a short nose with bulbous tip. Methods Fundamental aberrant growth may be associated with the cranial base structure in radiological observation. Results The Apert syndrome patient had a shorter and thinner nasal septum in panthomogram, PA view, and Waters' view; shorter zygomatico-maxillary width (83.5 mm) in Waters' view; shorter length between the sella and nasion (63.7 mm) on cephalogram; and bigger zygomatic axis angle of the cranial base (118.2°) in basal cranial view than a normal 9-year-old male (94.8 mm, 72.5 mm, 98.1°, respectively). On the other hand, the Apert syndrome patient showed interdigitating calcification of coronal suture similar to that of a normal 30-year-old male in a skull PA view. Conclusion Taken together, the Apert syndrome patient, 9 years old, showed retarded growth of the anterior cranial base affecting severe midface hypoplasia, which resulted in a hypoplastic nasal septum axis, retruded zygomatic axes, and retarded growth of the maxilla and palate even after frontal calvaria distraction osteotomy 8 years ago. Therefore, it was suggested that the severe midface hypoplasia and dysostotic facial profile of the present Apert syndrome case are closely relevant to the aberrant growth of the anterior cranial base supporting the whole oro-facial and forebrain development.
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Affiliation(s)
- Bong Kuen Cha
- 1Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
| | - Dong Soon Choi
- 1Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
| | - In San Jang
- 1Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
| | - Hyun Tae Yook
- Department of Orthodontics, College of Dentistry, Chunbuk National University, Jeonju, South Korea
| | - Seung Youp Lee
- Department of Orthodontics, College of Dentistry, Chunbuk National University, Jeonju, South Korea
| | - Sang Shin Lee
- 3Department of Oral Pathology, College of Dentistry, Gangneung-Wonju National University, 123 Chibyun-dong, Gangneung, 210-702 South Korea
| | - Suk Keun Lee
- 3Department of Oral Pathology, College of Dentistry, Gangneung-Wonju National University, 123 Chibyun-dong, Gangneung, 210-702 South Korea
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Doruk E, Ozay R, Sekerci Z, Durmaz HA, Gunes SO, Hanalioglu S, Sorar M. Cervico-medullary compression ratio: A novel radiological parameter correlating with clinical severity in Chiari type 1 malformation. Clin Neurol Neurosurg 2018; 174:123-128. [PMID: 30236638 DOI: 10.1016/j.clineuro.2018.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/06/2018] [Accepted: 09/09/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Chiari malformation type 1 (CM-1) is associated with cough headache, intracranial hypertension, cerebellar and spinal cord symptoms/signs. Herniated cerebellar tonsil length (HCTL) is widely used radiological parameter to determine the severity of CM-1, but with limited utility due to its weak correlation with some clinico-radiological findings. In this study, we aimed to evaluate a novel, practical parameter (cervico-medullary compression ratio; "CMCR") for its relationship with clinico-radiological findings in CM-1. PATIENTS AND METHODS Thirty-five adult patients (17 F, 18 M) with CM-1 were included in this retrospective study. Head CT and craniospinal MR images were assessed. CMCR was calculated as the ratio of herniated cerebellar tonsil surface area to foramen magnum surface area, and HCTL was measured. These two parameters were correlated with clinical and radiological findings. RESULTS The mean CMCR was 0.60 ± 0.15 and mean HCTL was 8.91 ± 3.4 mm with no significant difference between gender and age groups for both parameters. For cough headache (0.64 ± 0.14 vs 0.52 ± 0.15, p = 0.043) and syringomyelia (0.67 ± 0.11 vs 0.56 ± 0.16, p = 0.039), only CMCR; for intracranial hypertension (CMCR: 0.64 ± 0.14 vs 0.55 ± 0.16, p = 0.049; HCTL: 9.66 ± 3.59 mm vs 7.79 ± 3.03 mm; p = 0.045) and cerebellar symptoms (CMCR: 0.65 ± 0.14 vs 0.54 ± 0.16, p = 0.048; HCTL: 10.4 ± 3.5 mm vs 7.4 ± 2.8 mm, p = 0.041), both CMCR and HTCL were significantly different between patients with and without respective findings. However, neither CMCR nor HTCL was different between patients with and without spinal cord symptoms and hydrocephalus. CONCLUSION CMCR is a superior numerical parameter than HCTL for the assessment of clinical severity in CM-1 cases and needs further validation with larger studies.
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Affiliation(s)
- Ebru Doruk
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey; Ministry of Health, Health Sciences University, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Rafet Ozay
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey.
| | - Zeki Sekerci
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey; Medipol University Hospital, Department of Neurosurgery, Istanbul, Turkey
| | - Hasan Ali Durmaz
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Serra Ozbal Gunes
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Sahin Hanalioglu
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey
| | - Mehmet Sorar
- Ministry of Health, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey
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Long-Term Outcomes of a New Minimally Invasive Approach in Chiari Type 1 and 1.5 Malformations: Technical Note and Preliminary Results. World Neurosurg 2018; 115:407-413. [DOI: 10.1016/j.wneu.2018.04.100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 11/21/2022]
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29
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Morphometric analysis of posterior fossa and craniovertebral junction in subtypes of Chiari malformation. Clin Neurol Neurosurg 2018; 169:1-11. [DOI: 10.1016/j.clineuro.2018.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 11/19/2022]
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30
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Shoja MM, Ramdhan R, Jensen CJ, Chern JJ, Oakes WJ, Tubbs RS. Embryology of the craniocervical junction and posterior cranial fossa, part I: Development of the upper vertebrae and skull. Clin Anat 2018; 31:466-487. [PMID: 29345006 DOI: 10.1002/ca.23049] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/15/2018] [Indexed: 01/29/2023]
Abstract
Although the embryology of the posterior cranial fossa can have life altering effects on a patient, a comprehensive review on this topic is difficult to find in the peer-reviewed medical literature. Therefore, this review article, using standard search engines, seemed timely. The embryology of the posterior cranial fossa is complex and relies on a unique timing of various neurovascular and bony elements. Derailment of these developmental processes can lead to a wide range of malformations such as the Chiari malformations. Therefore, a good working knowledge of this embryology as outlined in this review of its bony architecture is important for those treating patients with involvement of this region of the cranium. Clin. Anat. 31:466-487, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Mohammadali M Shoja
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rebecca Ramdhan
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada
| | - Chad J Jensen
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada
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31
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Shoja MM, Ramdhan R, Jensen CJ, Chern JJ, Oakes WJ, Tubbs RS. Embryology of the craniocervical junction and posterior cranial fossa, part II: Embryogenesis of the hindbrain. Clin Anat 2018; 31:488-500. [PMID: 29344994 DOI: 10.1002/ca.23048] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/15/2018] [Indexed: 11/07/2022]
Abstract
Although pathology of the hindbrain and its derivatives can have life altering effects on a patient, a comprehensive review on its embryology is difficult to find in the peer-reviewed medical literature. Therefore, this review article, using standard search engines, seemed timely. The embryology of the hindbrain is complex and relies on a unique timing of various neurovascular and bony elements. Derailment of these developmental processes can lead to a wide range of malformations such as the Chiari malformations. Therefore, a good working knowledge of this embryology as outlined in this review of the hindbrain is important for those treating patients with involvement of this region of the central nervous system. Clin. Anat. 31:488-500, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Mohammadali M Shoja
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rebecca Ramdhan
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada
| | - Chad J Jensen
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada
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Syed HR, Jean WC. A Novel Method to Measure the Tentorial Angle and the Implications on Surgeries of the Pineal Region. World Neurosurg 2017; 111:e213-e220. [PMID: 29258947 DOI: 10.1016/j.wneu.2017.12.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/04/2017] [Accepted: 12/08/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is no standard way to define the angle of the tentorium. The current trend to use the Twining line to define this angle has significant pitfalls. The goal of the current study was to provide a new and accurate way to measure the tentorial angle and demonstrate its impact on surgeries of the pineal region. METHODS A new technique (n-angle) to measure the tentorial angle was introduced using the floor of the fourth ventricle and the torcula. Comparisons with older techniques were made to illustrate reliability. Midline sagittal MR images were used to measure the tentorial angle in 240 individuals to obtain population-based data. A cohort of 8 patients who underwent either the infratentorial or the transtentorial approach to the pineal or upper vermian region were examined in search of correlations between tentorial angle and surgical approach. RESULTS The data in this study showed that the Twining line technique understates the tentorial angle in people with low-lying torcula. The n-angle is more reliable in reflecting the true steepness of the tentorium regardless of torcula position. On average, men have slightly steeper tentoriums. In the clinical cohort, all patients who underwent infratentorial surgery had tentorial angles <55°, whereas the majority of patients who underwent transtentorial surgeries had angles >67°. CONCLUSION The n-angle provides a reliable and accurate way to describe the slope of the tentorium. The population-based average of 60° may be a useful measurement to influence the choice of surgical approach, either under or through the tentorium, to the pineal region.
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Affiliation(s)
- Hasan R Syed
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
| | - Walter C Jean
- Department of Neurosurgery, George Washington University, Washington, District of Columbia, USA
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Shoja MM, Johal J, Oakes WJ, Tubbs RS. Embryology and pathophysiology of the Chiari I and II malformations: A comprehensive review. Clin Anat 2017; 31:202-215. [PMID: 28612426 DOI: 10.1002/ca.22939] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 12/17/2022]
Abstract
Although the Chiari malformations are well-studied and described developmental anomalies, there remains some incongruity in regards to their underlying etiologies. A number of theories have been proposed with the purpose of accounting for the embryology and pathogenesis of the Chiari I and II malformations and their associated complications and clinical syndromes. The present review aims to review the pertinent literature for all of the main theories that have been proposed, and outline their validity and relevance to our contemporary understanding of these anomalies. Clin. Anat. 31:202-215, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Mohammadali M Shoja
- Department of Neurosciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jaspreet Johal
- Department of Anatomical Sciences, St. George's University, School of Medicine Grenada, West Indies
| | - W Jerry Oakes
- Department of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama, USA
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, School of Medicine Grenada, West Indies.,Seattle Science Foundation, Seattle, Washington, USA
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Coll G, Lemaire JJ, Di Rocco F, Barthélémy I, Garcier JM, De Schlichting E, Sakka L. Human Foramen Magnum Area and Posterior Cranial Fossa Volume Growth in Relation to Cranial Base Synchondrosis Closure in the Course of Child Development. Neurosurgery 2017; 79:722-735. [PMID: 27341342 DOI: 10.1227/neu.0000000000001309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND To date, no study has compared the evolution of the foramen magnum area (FMA) and the posterior cranial fossa volume (PCFV) with the degree of cranial base synchondrosis ossification. OBJECTIVE To illustrate these features in healthy children. METHODS The FMA, the PCFV, and the ossification of 12 synchondroses according to the Madeline and Elster scale were retrospectively analyzed in 235 healthy children using millimeter slices on a computed tomography scan. RESULTS The mean FMA of 6.49 cm in girls was significantly inferior to the FMA of 7.67 cm in boys (P < .001). In both sexes, the growth evolved in a 2-phase process, with a phase of rapid growth from birth to 3.75 years old (yo) followed by a phase of stabilization. In girls, the first phase was shorter (ending at 2.6 yo) than in boys (ending at 4.33 yo) and proceeded at a higher rate. PCFV was smaller in girls (P < .001) and displayed a biphasic pattern in the whole population, with a phase of rapid growth from birth to 3.58 yo followed by a phase of slow growth until 16 yo. In girls, the first phase was more active and shorter (ending at 2.67 yo) than in boys (ending at 4.5 yo). The posterior interoccipital synchondroses close first, followed by the anterior interoccipital and occipitomastoidal synchondroses, the lambdoid sutures simultaneously, then the petro-occipital and spheno-occipital synchondroses simultaneously. CONCLUSION The data provide a chronology of synchondrosis closure. We showed that FMA and PCFV are constitutionally smaller in girls at birth (P ≤ .02) and suggest that a sex-related difference in the FMA is related to earlier closure of anterior interoccipital synchondroses in girls (P = .01). ABBREVIATIONS AIOS, anterior interoccipital synchondrosesFMA, foramen magnum areaLS, lambdoid suturesOMS, occipitomastoidal synchondrosesPCFV, posterior cranial fossa volumePIOS, posterior interoccipital synchondrosesPOS, petro-occipital synchondrosesSOS, spheno-occipital synchondrosisyo, years old.
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Affiliation(s)
- Guillaume Coll
- *Service de Neurochirurgie, Hôpital Gabriel Montpied, Clermont-Ferrand, France;‡Laboratoire d'anatomie, Université Clermont Auvergne, Université d'Auvergne, Clermont-Ferrand, France;§Université Clermont Auvergne, Université d'Auvergne, EA 7282, Image Guided Clinical Neurosciences and Connectomics, Clermont-Ferrand, France;¶Unité de Chirurgie Craniofaciale, Service de Neurochirurgie Pédiatrique, Centre de Référence National des Dysostoses Crâniofaciales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France;‖Service de Chirurgie Maxillo-Faciale, Hôpital Estaing, Clermont-Ferrand, France;#Service de Radiologie Pédiatrique, Hôpital Estaing, Clermont-Ferrand, France
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Johnson-Tesch BA, Gawande RS, Zhang L, MacMillan ML, Nascene DR. Fanconi anemia: correlating central nervous system malformations and genetic complementation groups. Pediatr Radiol 2017; 47:868-876. [PMID: 28283722 DOI: 10.1007/s00247-017-3817-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/28/2017] [Accepted: 02/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Congenital central nervous system abnormalities in children with Fanconi anemia are poorly characterized, especially with regard to specific genetic complementation groups. OBJECTIVE To characterize the impact of genetic complementation groups on central nervous system anatomy. MATERIALS AND METHODS Through chart review we identified 36 patients with Fanconi anemia with available brain MRIs at the University of Minnesota (average age, 11.3 years; range, 1-43 years; M:F=19:17), which we reviewed and compared to 19 age- and sex-matched controls (average age, 7.9 years; range, 2-18 years; M:F=9:10). Genotypic information was available for 27 patients (15 FA-A, 2 FA-C, 3 FA-G, and 7 FA-D1 [biallelic mutations in BRCA2 gene]). RESULTS Of the 36 patients, 61% had at least one congenital central nervous system or skull base abnormality. These included hypoplastic clivus (n=12), hypoplastic adenohypophysis (n=11), platybasia (n=8), pontocerebellar hypoplasia (n=7), isolated pontine hypoplasia (n=4), isolated vermis hypoplasia (n=3), and ectopic neurohypophysis (n=6). Average pituitary volume was significantly less in patients with Fanconi anemia (P<0.0001) than in controls. Basal angle was significantly greater in Fanconi anemia patients (P=0.006), but the basal angle of those with FA-D1 was not significantly different from controls (P=0.239). Clivus length was less in the Fanconi anemia group (P=0.002), but significance was only observed in the FA-D1 subgroup (P<0.0001). Of the seven patients meeting criteria for pontocerebellar hypoplasia, six belonged to the FA-D1 group. CONCLUSION Patients with Fanconi anemia have higher incidences of ectopic neurohypophysis, adenohypophysis hypoplasia, platybasia and other midline central nervous system skull base posterior fossa abnormalities than age- and sex-matched controls. Patients with posterior fossa abnormalities, including pontocerebellar hypoplasia, are more likely to have biallelic BRCA2 mutations.
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Affiliation(s)
- Benjamin A Johnson-Tesch
- Department of Radiology, University of Minnesota, MMC 292, 420 Delaware St. SE, Minneapolis, MN, 55455, USA.
| | - Rakhee S Gawande
- Department of Radiology, Neuroradiology Section, University of Minnesota, Minneapolis, MN, USA
| | - Lei Zhang
- Biostatistical Design and Analysis Centre, University of Minnesota, Minneapolis, MN, USA
| | - Margaret L MacMillan
- Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - David R Nascene
- Department of Radiology, Neuroradiology Section, University of Minnesota, Minneapolis, MN, USA
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Chen YY, Lirng JF, Fuh JL, Chang FC, Cheng HC, Wang SJ. Primary Cough Headache is Associated with Posterior Fossa Crowdedness: A Morphometric MRI Study. Cephalalgia 2016; 24:694-9. [PMID: 15315524 DOI: 10.1111/j.1468-2982.2004.00739.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aetiology of primary cough headache (PCH) is obscure. The aim of this study was to investigate the magnetic resonance (MR) morphometric characteristics of the posterior cranial fossa (PCF) in patients with PCH. Eighteen consecutive patients with PCH (14M/4F, mean age 75.1 + 6.0 years) and 18 sex- and age-matched control subjects were recruited for study. Based on the midline sagittal MR images, parameters indicating posterior fossa crowdedness were measured. Compared with controls, patients with PCH had a similar size of hindbrain tissue area but a significantly smaller PCF area, resulting in a higher mean hindbrain/PCF ratio (0.78 + 0.04 vs. 0.73 + 0.06, P = 0.005). In addition, these patients also had a lower position of the cerebellar tonsillar tip, a shorter clivus length and shorter distances from the clivus to the mid-pons and from the basion to the medulla than the control group. Patients with PCH were associated with a more crowded PCF, which might be a contributing factor for the pathogenesis of this headache syndrome.
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Affiliation(s)
- Yen-Yu Chen
- The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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Alkoç OA, Songur A, Eser O, Toktas M, Gönül Y, Esi E, Haktanir A. Stereological and Morphometric Analysis of MRI Chiari Malformation Type-1. J Korean Neurosurg Soc 2015; 58:454-61. [PMID: 26713146 PMCID: PMC4688315 DOI: 10.3340/jkns.2015.58.5.454] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 08/07/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022] Open
Abstract
Objective In this study, we aimed to investigate the underlying ethiological factors in chiari malformation (CM) type-I (CMI) via performing volumetric and morphometric length-angle measurements. Methods A total of 66 individuals [33 patients (20-65 years) with CMI and 33 control subjects] were included in this study. In sagittal MR images, tonsillar herniation length and concurrent anomalies were evaluated. Supratentorial, infratentorial, and total intracranial volumes were measured using Cavalieri method. Various cranial distances and angles were used to evaluate the platybasia and posterior cranial fossa (PCF) development. Results Tonsillar herniation length was measured 9.09±3.39 mm below foramen magnum in CM group. Tonsillar herniation/concurrent syringomyelia, concavity/defect of clivus, herniation of bulbus and fourth ventricle, basilar invagination and craniovertebral junction abnormality rates were 30.3, 27, 18, 2, 3, and 3 percent, respectively. Absence of cisterna magna was encountered in 87.9% of the patients. Total, IT and ST volumes and distance between Chamberlain line and tip of dens axis, Klaus index, clivus length, distance between internal occipital protuberance and opisthion were significantly decreased in patient group. Also in patient group, it was found that Welcher basal angle/Boogard angle increased and tentorial slope angle decreased. Conclusion Mean cranial volume and length-angle measurement values significantly decreased and there was a congenital abnormality association in nearly 81.5 percent of the CM cases. As a result, it was concluded that CM ethiology can be attributed to multifactorial causes. Moreover, congenital defects can also give rise to this condition.
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Affiliation(s)
- Ozan Alper Alkoç
- Department of Anatomy, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ahmet Songur
- Department of Anatomy, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - Olcay Eser
- Department of Neurological Surgery, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Muhsin Toktas
- Department of Anatomy, Faculty of Medicine, Turgut Özal University, Ankara, Turkey
| | - Yücel Gönül
- Department of Anatomy, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - Ertap Esi
- Department of Radiology, Afyonkarahisar State Hospital, Afyon, Turkey
| | - Alpay Haktanir
- Department of Radiology, Faculty of Medicine, Ordu University, Ordu, Turkey
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The Role of the Craniocervical Junction in Craniospinal Hydrodynamics and Neurodegenerative Conditions. Neurol Res Int 2015; 2015:794829. [PMID: 26770824 PMCID: PMC4681798 DOI: 10.1155/2015/794829] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/07/2015] [Accepted: 09/17/2015] [Indexed: 02/07/2023] Open
Abstract
The craniocervical junction (CCJ) is a potential choke point for craniospinal hydrodynamics and may play a causative or contributory role in the pathogenesis and progression of neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, MS, and ALS, as well as many other neurological conditions including hydrocephalus, idiopathic intracranial hypertension, migraines, seizures, silent-strokes, affective disorders, schizophrenia, and psychosis. The purpose of this paper is to provide an overview of the critical role of the CCJ in craniospinal hydrodynamics and to stimulate further research that may lead to new approaches for the prevention and treatment of the above neurodegenerative and neurological conditions.
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Kennedy BC, Nelp TB, Kelly KM, Phan MQ, Bruce SS, McDowell MM, Feldstein NA, Anderson RCE. Delayed resolution of syrinx after posterior fossa decompression without dural opening in children with Chiari malformation Type I. J Neurosurg Pediatr 2015; 16:599-606. [PMID: 26314201 DOI: 10.3171/2015.4.peds1572] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECT Chiari malformation Type I (CM-I) is associated with a syrinx in 25%-85% of patients. Although posterior fossa decompression (PFD) without dural opening is an accepted treatment option for children with symptomatic CM-I, many surgeons prefer to open the dura if a syrinx exists. The purpose of this study was to investigate the frequency and timing of syrinx resolution in children undergoing PFD without dural opening for CM-I. METHODS A retrospective review of 68 consecutive pediatric patients with CM-I and syringomyelia who underwent PFD without dural opening was conducted. Patient demographics, presenting symptoms and signs, radiographic findings, and intraoperative ultrasound and neuromonitoring findings were studied as well as the patients' clinical and radiographic follow-up. RESULTS During the mean radiographic follow-up period of 32 months, 70% of the syringes improved. Syrinx improvement occurred at a mean of 31 months postoperatively. All patients experienced symptom improvement within the 1st year, despite only 26% of patients showing radiographic improvement during that period. Patients presenting with sensory symptoms or motor weakness had a higher likelihood of having radiographic syrinx improvement postoperatively. CONCLUSIONS In children with CM-I and a syrinx undergoing PFD without dural opening, syrinx resolution occurs in approximately 70% of patients. Radiographic improvement of the syrinx is delayed, but this does not correlate temporally with symptom improvement. Sensory symptoms or motor weakness on presentation are associated with syrinx resolution after surgery.
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Affiliation(s)
| | | | | | | | | | - Michael M McDowell
- Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Neil A Feldstein
- Department of Neurological Surgery and.,Children's Hospital of New York, Columbia University, New York, New York; and
| | - Richard C E Anderson
- Department of Neurological Surgery and.,Children's Hospital of New York, Columbia University, New York, New York; and
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Tubbs RS. Definitions and Anatomic Considerations in Chiari I Malformation and Associated Syringomyelia. Neurosurg Clin N Am 2015; 26:487-93. [DOI: 10.1016/j.nec.2015.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kennedy BC, Kelly KM, Phan MQ, Bruce SS, McDowell MM, Anderson RCE, Feldstein NA. Outcomes after suboccipital decompression without dural opening in children with Chiari malformation Type I. J Neurosurg Pediatr 2015; 16:150-8. [PMID: 25932779 PMCID: PMC4593701 DOI: 10.3171/2014.12.peds14487] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Symptomatic pediatric Chiari malformation Type I (CM-I) is most often treated with posterior fossa decompression (PFD), but controversy exists over whether the dura needs to be opened during PFD. While dural opening as a part of PFD has been suggested to result in a higher rate of resolution of CM symptoms, it has also been shown to lead to more frequent complications. In this paper, the authors present the largest reported series of outcomes after PFD without dural opening surgery, as well as identify risk factors for recurrence. METHODS The authors performed a retrospective review of 156 consecutive pediatric patients in whom the senior authors performed PFD without dural opening from 2003 to 2013. Patient demographics, clinical symptoms and signs, radiographic findings, intraoperative ultrasound results, and neuromonitoring findings were reviewed. Univariate and multivariate regression analyses were performed to determine risk factors for recurrence of symptoms and the need for reoperation. RESULTS Over 90% of patients had a good clinical outcome, with improvement or resolution of their symptoms at last follow-up (mean 32 months). There were no major complications. The mean length of hospital stay was 2.0 days. In a multivariate regression model, partial C-2 laminectomy was an independent risk factor associated with reoperation (p = 0.037). Motor weakness on presentation was also associated with reoperation but only with trend-level significance (p = 0.075). No patient with < 8 mm of tonsillar herniation required reoperation. CONCLUSIONS The vast majority (> 90%) of children with symptomatic CM-I will have improvement or resolution of symptoms after a PFD without dural opening. A non-dural opening approach avoids major complications. While no patient with tonsillar herniation < 8 mm required reoperation, children with tonsillar herniation at or below C-2 have a higher risk for failure when this approach is used.
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Affiliation(s)
| | - Kathleen M. Kelly
- Department of Neurological Surgery, Columbia University, New York, New York
| | - Michelle Q. Phan
- Department of Neurological Surgery, Columbia University, New York, New York
| | - Samuel S. Bruce
- Department of Neurological Surgery, Columbia University, New York, New York
| | - Michael M. McDowell
- Department of Neurological Surgery, Pittsburgh University, Pittsburgh, Pennsylvania
| | - Richard C. E. Anderson
- Department of Neurological Surgery, Columbia University, New York, New York,Children’s Hospital of New York, Columbia University, New York, New York
| | - Neil A. Feldstein
- Department of Neurological Surgery, Columbia University, New York, New York,Children’s Hospital of New York, Columbia University, New York, New York
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Freeman AC, Platt SR, Kent M, Huguet E, Rusbridge C, Holmes S. Chiari-like malformation and syringomyelia in American Brussels Griffon dogs. J Vet Intern Med 2014; 28:1551-9. [PMID: 25145262 PMCID: PMC4895564 DOI: 10.1111/jvim.12421] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 06/11/2014] [Accepted: 06/19/2014] [Indexed: 11/29/2022] Open
Abstract
Background Although Chiari‐like malformation (CM) and syringomyelia (SM) have been described in many small breed dogs, the prevalence and clinical manifestations of this complex have not been documented in a large cohort of American Brussels Griffon (ABG) dogs. Objectives To characterize the clinical and magnetic resonance imaging (MRI) features of CM and SM in the ABG breed. Animals Eighty‐four American Kennel Club registered ABG dogs were recruited. Methods Prospective study. Complete histories and neurologic examinations were obtained before MRI. Images were blindly reviewed and calculations were made by using OsiriX. All analyses were performed by Student's t‐test, Spearman's correlation, ANOVA, and chi‐square test where appropriate. Results Chiari‐like malformation and SM were present in 65% and 52% of dogs, respectively. Twenty‐eight percent of dogs had neurologic deficits and 20% had neck pain. Mean central canal (CC) transverse height was 2.5 mm with a mean length of 3.6 cervical vertebrae. Neurologic deficits were significantly associated with a larger syrinx (P = .04, P = .08) and syrinx size increased with age (P = .027). SM was associated with a smaller craniocervical junction (CCJ) height (P = .04) and larger ventricles (P = .0001; P < .001). Conclusions and Clinical Importance Syringomyelia and CM are prevalent in American Brussels Griffon dogs. Syrinx size is associated with neurologic deficits, CM, larger ventricles, a smaller craniocervical junction height, neurologic deficits, and cerebellar herniation. Fifty‐two percent of dogs with a SM were clinically normal.
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Affiliation(s)
- A C Freeman
- Animal Health Trust, Centre for Small Animal Studies, Newmarket, Suffolk, UK
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Zhu Z, Sha S, Sun X, Liu Z, Yan H, Zhu W, Wang Z, Qiu Y. Tapering of the cervical spinal canal in patients with distended or nondistended syringes secondary to Chiari type I malformation. AJNR Am J Neuroradiol 2014; 35:2021-6. [PMID: 24831593 DOI: 10.3174/ajnr.a3967] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Steeper tapering of the cervical spinal canal as documented in recent studies is thought to have a role in the pathophysiology of Chiari malformation-associated syringomyelia. This study aimed to determine whether taper ratio of the cervical spinal canal differs between patients with distended and nondistended syringes. MATERIALS AND METHODS Seventy-seven adolescents (10-18 years) were divided into 2 groups: 44 with distended syrinx and 33 with nondistended syrinx. On T2-weighted MR images, anteroposterior diameter of the spinal canal was measured at each cervical level, and a linear trend line was fit by least squares regression to calculate the taper ratio. Taper ratios were compared between the 2 groups and further evaluated with respect to age and sex. RESULTS In the nondistended group ND, the taper ratios for C1-C7, C1-C4, and C4-C7 averaged -0.73 ± 0.57, -1.61 ± 0.98, and -0.04 ± 0.54, respectively, all of which were significantly steeper than those observed in the distended group (P = .001, .004, and .033, respectively). Regarding the average diameters plotted by cervical level, the narrowest region of the canal was found to occur at C4 in both groups. In addition, no significant differences in taper ratio were noted between males and females, or between older (>14 years) and younger patients (≤14 years). CONCLUSIONS Taper ratios of the cervical spinal canal were found to be different between patients with distended and nondistended syringes, indicating a reciprocal interaction between the syrinx and the cervical spine anatomy.
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Affiliation(s)
- Z Zhu
- From the Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - S Sha
- From the Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - X Sun
- From the Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Z Liu
- From the Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - H Yan
- From the Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - W Zhu
- From the Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Z Wang
- From the Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Y Qiu
- From the Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
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Botelho RV, Ferreira EDZ. Angular craniometry in craniocervical junction malformation. Neurosurg Rev 2013; 36:603-10; discussion 610. [PMID: 23640096 PMCID: PMC3910287 DOI: 10.1007/s10143-013-0471-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 03/14/2013] [Accepted: 03/17/2013] [Indexed: 11/26/2022]
Abstract
The craniometric linear dimensions of the posterior fossa have been relatively well studied, but angular craniometry has been poorly studied and may reveal differences in the several types of craniocervical junction malformation. The objectives of this study were to evaluate craniometric angles compared with normal subjects and elucidate the main angular differences among the types of craniocervical junction malformation and the correlation between craniocervical and cervical angles. Angular craniometries were studied using primary cranial angles (basal and Boogard’s) and secondary craniocervical angles (clivus canal and cervical spine lordosis). Patients with basilar invagination had significantly wider basal angles, sharper clivus canal angles, larger Boogard’s angles, and greater cervical lordosis than the Chiari malformation and control groups. The Chiari malformation group does not show significant differences when compared with normal controls. Platybasia occurred only in basilar invagination and is suggested to be more prevalent in type II than in type I. Platybasic patients have a more acute clivus canal angle and show greater cervical lordosis than non-platybasics. The Chiari group does not show significant differences when compared with the control, but the basilar invagination groups had craniometric variables significantly different from normal controls. Hyperlordosis observed in the basilar inavagination group was associated with craniocervical kyphosis conditioned by acute clivus canal angles.
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Urbizu A, Toma C, Poca MA, Sahuquillo J, Cuenca-León E, Cormand B, Macaya A. Chiari malformation type I: a case-control association study of 58 developmental genes. PLoS One 2013; 8:e57241. [PMID: 23437350 PMCID: PMC3578784 DOI: 10.1371/journal.pone.0057241] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 01/18/2013] [Indexed: 01/07/2023] Open
Abstract
Chiari malformation type I (CMI) is a disorder characterized by hindbrain overcrowding into an underdeveloped posterior cranial fossa (PCF), often causing progressive neurological symptoms. The etiology of CMI remains unclear and is most likely multifactorial. A putative genetic contribution to CMI is suggested by familial aggregation and twin studies. Experimental models and human morphometric studies have suggested an underlying paraxial mesoderm insufficiency. We performed a case-control association study of 303 tag single nucleotide polymorphisms (SNP) across 58 candidate genes involved in early paraxial mesoderm development in a sample of 415 CMI patients and 524 sex-matched controls. A subgroup of patients diagnosed with classical, small-PCF CMI by means of MRI-based PCF morphometry (n = 186), underwent additional analysis. The genes selected are involved in signalling gradients occurring during segmental patterning of the occipital somites (FGF8, Wnt, and retinoic acid pathways and from bone morphogenetic proteins or BMP, Notch, Cdx and Hox pathways) or in placental angiogenesis, sclerotome development or CMI-associated syndromes. Single-marker analysis identified nominal associations with 18 SNPs in 14 genes (CDX1, FLT1, RARG, NKD2, MSGN1, RBPJ1, FGFR1, RDH10, NOG, RARA, LFNG, KDR, ALDH1A2, BMPR1A) considering the whole CMI sample. None of these overcame corrections for multiple comparisons, in contrast with four SNPs in CDX1, FLT1 and ALDH1A2 in the classical CMI group. Multiple marker analysis identified a risk haplotype for classical CMI in ALDH1A2 and CDX1. Furthermore, we analyzed the possible contributions of the most significantly associated SNPs to different PCF morphometric traits. These findings suggest that common variants in genes involved in somitogenesis and fetal vascular development may confer susceptibility to CMI.
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Affiliation(s)
- Aintzane Urbizu
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Claudio Toma
- Departament de Genètica, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Rare Diseases, Barcelona, Spain
| | - Maria A. Poca
- Department of Neurosurgery, Research Unit Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Neurosurgery and Neurotraumatology, Research Unit Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Sahuquillo
- Department of Neurosurgery, Research Unit Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Neurosurgery and Neurotraumatology, Research Unit Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ester Cuenca-León
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bru Cormand
- Departament de Genètica, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Rare Diseases, Barcelona, Spain
- Institut de Biomedicina de la Universitat de Barcelona, Barcelona, Spain
| | - Alfons Macaya
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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Urbizu A, Poca MA, Vidal X, Rovira A, Sahuquillo J, Macaya A. MRI-based morphometric analysis of posterior cranial fossa in the diagnosis of chiari malformation type I. J Neuroimaging 2013; 24:250-6. [PMID: 23324118 DOI: 10.1111/jon.12007] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/12/2012] [Accepted: 10/28/2012] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The diagnosis of Chiari malformation type I (CMI) relies on MRI identification of a tonsillar descent (TD) through the foramen magnum, reflecting the overcrowding of an underdeveloped posterior cranial fossa (PCF). However, TD occurs in some patients with normal-sized PCF and, conversely, some patients with borderline or no TD have small PCF. We thus sought to identify a set of prototypic PCF measures for the diagnosis of CMI. METHODS We performed nineteen measurements of the PCF on sagittal MRI of 100 cases with cerebellar TD ≥5 mm and 50 control individuals, compared the average values in both cohorts and used logistic regression to devise a probability model to predict CMI status. RESULTS Significant decrements were detected for several PCF-related measures in the patients' cohort. We developed a probability model that combined seven of these parameters to predict diagnosis with 93% sensitivity and 92% specificity. CONCLUSIONS The addition of simple morphometric measurements in the diagnostic work-up of patients with suspected CMI may facilitate radiological diagnosis. Moreover, identification of the subset of CMI that arise from basichondrocranium underdevelopment is important for both, selection of the most appropriate therapeutic approach as well as proper CMI categorization in research studies.
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Affiliation(s)
- Aintzane Urbizu
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona
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Vurdem ÜE, Acer N, Ertekin T, Savranlar A, Inci MF. Analysis of the volumes of the posterior cranial fossa, cerebellum, and herniated tonsils using the stereological methods in patients with Chiari type I malformation. ScientificWorldJournal 2012; 2012:616934. [PMID: 22629166 PMCID: PMC3354683 DOI: 10.1100/2012/616934] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 01/22/2012] [Indexed: 11/17/2022] Open
Abstract
Objective. The aim of this study was to determine the posterior cranial fossa volume, cerebellar volume, and herniated tonsillar volume in patients with chiari type I malformation and control subjects using stereological methods. Material and Methods. These volumes were estimated retrospectively using the Cavalieri principle as a point-counting technique. We used magnetic resonance images taken from 25 control subjects and 30 patients with chiari type I malformation. Results. The posterior cranial fossa volume in patients with chiari type I malformation was significantly smaller than the volume in the control subjects (P < 0.05). In the chiari type I malformation group, the cerebellar volume was smaller than the control group, but this difference was not statistically significant (P > 0.05). In the chiari type I malformation group, the ratio of cerebellar volume to posterior cranial fossa volume was higher than in the control group. We also found a positive correlation between the posterior cranial fossa volume and cerebellar volume for each of the groups (r = 0.865, P < 0.001). The mean (±SD) herniated tonsillar volume and length were 0.89 ± 0.50 cm3 and 9.63 ± 3.37 mm in the chiari type I malformation group, respectively. Conclusion. This study has shown that posterior cranial fossa and cerebellum volumes can be measured by stereological methods, and the ratio of these measurements can contribute to the evaluation of chiari type I malformation cases.
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Affiliation(s)
- Ümit Erkan Vurdem
- Department of Radiology, Kayseri Education and Research Hospital, 38010 Kayseri, Turkey
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Schanker BD, Walcott BP, Nahed BV, Kahle KT, Li YM, Coumans JVCE. Familial Chiari malformation: case series. Neurosurg Focus 2012; 31:E1. [PMID: 21882906 DOI: 10.3171/2011.6.focus11104] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chiari malformations (Types I-IV) are abnormalities of the posterior fossa that affect the cerebellum, brainstem, and the spinal cord with prevalence rates of 0.1%-0.5%. Case reports of familial aggregation of Chiari malformation, twin studies, cosegregation of Chiari malformation with known genetic conditions, and recent gene and genome-wide association studies provide strong evidence of the genetic underpinnings of familial Chiari malformation. The authors report on a series of 3 family pairs with Chiari malformation Type I: 2 mother-daughter pairs and 1 father-daughter pair. The specific genetic causes of familial Chiari malformation have yet to be fully elucidated. The authors review the literature and discuss several candidate genes. Recent advances in the understanding of the genetic influences and pathogenesis of familial Chiari malformation are expected to improve management of affected patients and monitoring of at-risk family members.
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Affiliation(s)
- Benjamin D Schanker
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, 02114, USA
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Loukas M, Shayota BJ, Oelhafen K, Miller JH, Chern JJ, Tubbs RS, Oakes WJ. Associated disorders of Chiari Type I malformations: a review. Neurosurg Focus 2012; 31:E3. [PMID: 21882908 DOI: 10.3171/2011.6.focus11112] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A single pathophysiological mechanism of Chiari Type I malformations (CM-I) has been a topic of debate. To help better understand CM-I, the authors review disorders known to be associated with CM-I. The primary methodology found among most of them is deformation of the posterior cranial fossa, usually with subsequent decrease in volume. Other mechanisms exist as well, which can be categorized as either congenital or acquired. In understanding the relationship of such disorders with CM-I, we may gain further insight into the process by which cerebellar tonsillar herniation occurs. Some of these pathologies appear to be true associations, but many appear to be spurious.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada
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Marino DJ, Loughin CA, Dewey CW, Marino LJ, Sackman JJ, Lesser ML, Akerman MB. Morphometric features of the craniocervical junction region in dogs with suspected Chiari-like malformation determined by combined use of magnetic resonance imaging and computed tomography. Am J Vet Res 2012; 73:105-11. [DOI: 10.2460/ajvr.73.1.105] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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