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Hatgaonkar AM, Mahajan SM, Hatgoankar KA, Bandre GR. MRI Insights in Chiari Malformation Type 1 and Variations With Hydrosyringomyelia. Cureus 2024; 16:e55676. [PMID: 38586684 PMCID: PMC10996883 DOI: 10.7759/cureus.55676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Chiari malformation (CM) type 1 is a complex neurological disorder characterized by the displacement of the cerebellar tonsils into the upper spinal canal. Hydrosyringomyelia (HSM), which frequently coexists with this condition, presents diagnostic and treatment problems due to its broad spectrum of symptoms. There are various forms of CMs, with CM type 1 (CM1) being the most common type. Magnetic resonance imaging (MRI) is the best imaging technique to properly identify and diagnose CM1 and HSM. Important imaging findings include downward displacement of the cerebellar tonsils across the foramen magnum, the appearance of the syrinx in the spinal cord, and the alteration of the flow dynamics of the cerebrospinal fluid. This study was conducted at Datta Meghe Medical College, Nagpur, and Government Medical College & Super Speciality Hospital, Nagpur, India. It focuses on the diagnostic use of MRI in CM1 and its variations associated with HSM. Individuals who are asymptomatic may not need any treatment; however, those who are symptomatic or have HSM may require surgical decompression and restoration of the flow. We discuss the findings of MRI of six cases of CM1 and its variants with HSM and search for possible underlying causes. We conclude that magnetic resonance imaging is an imaging modality for the identification and evaluation of CM1 in cases of HSM.
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Affiliation(s)
- Anand M Hatgaonkar
- Radiodiagnosis, Datta Meghe Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Nagpur, IND
| | - Sandeep M Mahajan
- Radiodiagnosis, Government Medical College & Super Speciality Hospital, Nagpur, IND
| | - Kajal A Hatgoankar
- Pathology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Nagpur, IND
| | - Gulshan R Bandre
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
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2
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Kedia N, McDowell MM, Yang J, Wu J, Friedlander RM, Kainerstorfer JM. Pulsatile microvascular cerebral blood flow waveforms change with intracranial compliance and age. NEUROPHOTONICS 2024; 11:015003. [PMID: 38250664 PMCID: PMC10799239 DOI: 10.1117/1.nph.11.1.015003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024]
Abstract
Significance Diffuse correlation spectroscopy (DCS) is an optical method to measure relative changes in cerebral blood flow (rCBF) in the microvasculature. Each heartbeat generates a pulsatile signal with distinct morphological features that we hypothesized to be related to intracranial compliance (ICC). Aim We aim to study how three features of the pulsatile rCBF waveforms: the augmentation index (AIx), the pulsatility index, and the area under the curve, change with respect to ICC. We describe ICC as a combination of vascular compliance and extravascular compliance. Approach Since patients with Chiari malformations (CM) (n = 30 ) have been shown to have altered extravascular compliance, we compare the morphology of rCBF waveforms in CM patients with age-matched healthy control (n = 30 ). Results AIx measured in the supine position was significantly less in patients with CM compared to healthy controls (p < 0.05 ). Since physiologic aging also leads to changes in vessel stiffness and intravascular compliance, we evaluate how the rCBF waveform changes with respect to age and find that the AIx feature was strongly correlated with age (R healthy subjects = - 0.63 , R preoperative CM patient = - 0.70 , and R postoperative CM patients = - 0.62 , p < 0.01 ). Conclusions These results suggest that the AIx measured in the cerebral microvasculature using DCS may be correlated to changes in ICC.
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Affiliation(s)
- Nikita Kedia
- University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pittsburgh, Pennsylvania, United States
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
| | - Michael M. McDowell
- University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pittsburgh, Pennsylvania, United States
| | - Jason Yang
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
| | - Jingyi Wu
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
| | - Robert M. Friedlander
- University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pittsburgh, Pennsylvania, United States
| | - Jana M. Kainerstorfer
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
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3
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Ingale GD, Zade RJ, Timothy RP. Physiotherapeutic Intervention in a 19-Year-Old Female Patient With Syringohydromyelia: A Case Report. Cureus 2023; 15:e50419. [PMID: 38222187 PMCID: PMC10784427 DOI: 10.7759/cureus.50419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Syringomyelia is a rare disorder in which a syrinx is formed in the spine that grows with time, causing damage to the entire spine. It is most commonly associated with type 1 Chiari malformations and has the potential to cause considerable impairment and a lower quality of life. It can be idiopathic or secondary to trauma. Arachnoiditis, spinal cord compression, and/or a narrow spinal canal, as well as kyphosis all play a role in the development of syringomyelia. The patient reported here was unable to walk and swallow food. She had partial sensory loss in the right hand, difficulty speaking, and weakness in both hands and legs. In this case, there was atlanto-occipital assimilation with C2-C3 fusion and tonsillar herniation, causing sryingohydromyelia of the entire cord. After medical and surgical interventions, a 12-week well-structured physical therapy rehabilitation protocol was initiated. This case study demonstrates how physical therapy plays a critical role in a patient's extensive rehabilitation, enhancing strength and range of motion, improving coordination, improving daily living tasks, and decreasing pain.
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Affiliation(s)
- Gunjan D Ingale
- Neuro-physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ruchika J Zade
- Neuro-physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rebecca P Timothy
- Neuro-physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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García M, Amayra I, Pérez M, Salgueiro M, Martínez O, López-Paz JF, Allen PA. Cognition in Chiari Malformation Type I: an Update of a Systematic Review. Neuropsychol Rev 2023:10.1007/s11065-023-09622-2. [PMID: 37798373 DOI: 10.1007/s11065-023-09622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Chiari malformation has been classified as a group of posterior cranial fossa disorders characterized by hindbrain herniation. Chiari malformation type I (CM-I) is the most common subtype, ranging from asymptomatic patients to those with severe disorders. Research about clinical manifestations or medical treatments is still growing, but cognitive functioning has been less explored. The aim of this systematic review is to update the literature search about cognitive deficits in CM-I patients. A literature search was performed through the following electronic databases: MEDLINE, PsychINFO, Pubmed, Cochrane Library, Scopus, and Web of Science. The date last searched was February 1, 2023. The inclusion criteria were as follows: (a) include pediatric or adult participants with a CM-I diagnosis, (b) include cognitive or neuropsychological assessment with standardized tests, (c) be published in English or Spanish, and (d) be empirical studies. Articles that did not report empirical data, textbooks and conference abstracts were excluded. After the screening, twenty-eight articles were included in this systematic review. From those, twenty-one articles were focused on adult samples and seven included pediatric patients. There is a great heterogeneity in the recruited samples, followed methodology and administered neurocognitive protocols. Cognitive functioning appears to be affected in CM-I patients, at least some aspects of attention, executive functions, visuospatial abilities, episodic memory, or processing speed. However, these results require careful interpretation due to the methodological limitations of the studies. Although it is difficult to draw a clear profile of cognitive deficits related to CM-I, the literature suggests that cognitive dysfunction may be a symptom of CM-I. This suggest that clinicians should include cognitive assessment in their diagnostic procedures used for CM-I. In summary, further research is needed to determine a well-defined cognitive profile related to CM-I, favoring a multidisciplinary approach of this disorder.
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Affiliation(s)
- Maitane García
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain.
| | - Imanol Amayra
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - Manuel Pérez
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
- Faculty of Health Sciences, Isabel I University, Burgos, Spain
| | - Monika Salgueiro
- Department of Clinical and Health Psychology, and Research Methodology, Faculty of Psychology, University of the Basque Country, Donostia, Spain
| | - Oscar Martínez
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - Juan Francisco López-Paz
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - Philip A Allen
- Conquer Chiari Research Center, Department of Psychology, University of Akron, Akron, OH, USA
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5
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Massuyama BK, Vale TC, Rezende Filho FM, Barsottini OGP, Pedroso JL. Downbeat nystagmus and progressive ataxia in adults: consider Chiari malformation type 1. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:937-938. [PMID: 37774743 PMCID: PMC10631855 DOI: 10.1055/s-0043-1771171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/16/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Breno Kazuo Massuyama
- Universidade Federal de São Paulo, Departamento de Neurologia, Unidade de Ataxia, São Paulo SP, Brazil.
| | - Thiago Cardoso Vale
- Universidade Federal de Juiz de Fora, Departamento de Medicina Interna, Juiz de Fora MG, Brazil.
| | | | | | - José Luiz Pedroso
- Universidade Federal de São Paulo, Departamento de Neurologia, Unidade de Ataxia, São Paulo SP, Brazil.
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Tanaka M, Sharma S, Fujiwara Y, Arataki S, Omori T, Kanamaru A, Kodama Y, Saad H, Yamauchi T. Accurate Posterior Fossa Decompression Technique for Chiari Malformation Type I and a Syringomyelia With Navigation: A Technical Note. Int J Spine Surg 2023; 17:615-622. [PMID: 37460242 PMCID: PMC10478704 DOI: 10.14444/8483] [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: 08/27/2023] Open
Abstract
BACKGROUND Posterior fossa decompression (PFD) has been widely accepted for the surgical treatment for Chiari malformation type I (CM1). However, inadequate decompression causes surgical mortality and complications such as cerebrospinal fluid leakage, meningitis, or progression of syrinx and symptoms. The authors report a novel technique of PFD under navigation. METHODS Five female patients with CM1 who developed severe symptoms and underwent surgical treatment were evaluated (mean age 14.0 years; mean follow-up 1.3 years). Surgical outcomes, surgical time, intraoperative blood loss, and operative complications were assessed. RESULTS Four patients with CM1 who developed severe symptoms and underwent surgery were evaluated (mean age 14 years; mean follow-up 1.2 years). All patients were treated with PFD, C1 (and partial C2) laminoplasty to decompress the spinal cord under navigation guidance. Suboccipital craniectomy with 3 cm in diameter around the foramen magnum was performed. The postoperative radiograms and computed tomographic images showed adequate bony resection for CM1. Average surgical time was 114 minutes and average blood loss was 82 mL. There were no postoperative complications. After surgery, the numbness and muscle weakness of the patients were improved. The final follow-up magnetic resonance imaging displayed a good decompression of cerebral tonsile, and cervical syringomyelia was decreased. CONCLUSIONS PFD under navigation guidance can reduce inappropriate decompression and may decrease a revision surgery. During decompression surgery, cerebrospinal fluid leakage can be prevented using an ultrasonic bone cutter and navigation. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Masato Tanaka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Sneha Sharma
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Yoshihiro Fujiwara
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Shinya Arataki
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Toshinori Omori
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Akihiro Kanamaru
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Yuya Kodama
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Hossam Saad
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Taro Yamauchi
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, Japan
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7
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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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8
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Barpujari A, Kiley A, Ross JA, Veznedaroglu E. A Systematic Review of Non-Opioid Pain Management in Chiari Malformation (Type 1) Patients: Current Evidence and Novel Therapeutic Opportunities. J Clin Med 2023; 12:jcm12093064. [PMID: 37176505 PMCID: PMC10179593 DOI: 10.3390/jcm12093064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Chiari Malformation Type I (CM) includes a range of cranial abnormalities at the junction of the skull with the spine, with common symptoms including pain and headaches. Currently, CM pain is managed medically through anti-inflammatory drugs, muscle relaxants, and opioids, while surgical management includes posterior fossa decompression. Given the adverse effects of opioid use, and an ongoing opioid epidemic, there is a need for safe, non-opioid alternatives for clinical pain management. This systematic review was performed to provide an update on the current literature pertaining to the treatment of CM pain with non-opioid alternatives. A literature search was performed in June 2022 utilizing the PubMed and Google Scholar databases, and articles were identified that included information regarding non-opioid pain management in CM patients. A total of 90 articles were obtained from this search, including 10 relevant, drug-specific studies. Two independent reviewers selected and included all relevant articles based on the chosen search criteria to minimize bias risk. Currently available treatments for neurosurgical pain management include anticonvulsants, corticosteroids, NSAIDs, anti-inflammatory drugs, NMDA receptor antagonists, local anesthetics, nerve blocks, scalp blocks, and neuromuscular blocks. While more information is needed on the use of non-opioid pain management, the present literature provides potential evidence of its efficacy amongst the CM patient population, on account of the success that non-opioid pain management has demonstrated within other neurological pain syndromes. Further research into non-pharmacological pain management would also benefit the CM population and could be generalized to related conditions.
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Affiliation(s)
| | - Alina Kiley
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
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Ciaramitaro P, Migliaretti G, Ferraris M, Garnero A, Morana G, Carucci P, Stura I, Massaro F, Garbossa D. Syringomyelia Associated with Chiari 1 Malformation in Adults: Positive Outcome Predictors after Posterior Fossa Decompression with Duraplasty. J Clin Med 2023; 12:jcm12083019. [PMID: 37109355 PMCID: PMC10143011 DOI: 10.3390/jcm12083019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Syringomyelia (Syr) in patients with Chiari 1 malformation (CM1) may be attributable to abnormal dynamics of cerebrospinal fluid (CSF) in the upper cervical segment; fourth ventricle enlargement has been reported in association with a worse clinical and radiological presentation, independently of the posterior fossa volume. In this study, we analyzed presurgery hydrodynamic markers to evaluate if their changes could be associated with clinical and radiological improvement after posterior fossa decompression and duraplasty (PFDD). As a primary endpoint, we aimed to correlate improvement in the fourth ventricle area with positive clinical outcomes. METHODS In total, in this study, we enrolled 36 consecutive adults with Syr and CM1 who were followed by a multidisciplinary team. All the patients were prospectively evaluated with clinical scales and neuroimaging, including CSF flow, the fourth ventricle area, and the Vaquero Index by using a phase-contrast MRI before (T0) and after surgical treatment (T1-Tlast, with a range of 12-108 months). The CSF flow at the craniocervical junction (CCJ), the fourth ventricle area, and the Vaquero Index changes were statistically analyzed and compared to the clinical and quality of life improvement after surgery. The good outcome prediction ability of presurgical radiological variables was tested. RESULTS Surgery was associated with positive clinical and radiological outcomes in more than 90% of cases. The fourth ventricle area significantly reduced after surgery (T0-Tlast, p = 0.0093), but no significant associations with clinical improvement were found. The presurgical presence of CSF flow at the CCJ was able to predict a good outcome (AUC = 0.68, 95% CI 0.50-0.87 and LH+ = 2.1, IC 95% 1.16-3.07) and was also significantly associated with post-surgical pain relief (rho = 0.61 and p = 0.0144). CONCLUSIONS Presurgery CSF flow at the CCJ is proposed as a radiological marker with the ability to predict a positive outcome after PFDD in adults with syringomyelia and CM1. Measurements of the fourth ventricle area could be useful additional information for evaluating surgical long-term follow-up; further experience on larger cohorts is required to better define the prognostic yield of this radiological parameter.
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Affiliation(s)
- Palma Ciaramitaro
- Neuroscience Department, University of Torino, 10126 Torino, Italy
- CRESSC, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Giuseppe Migliaretti
- Department of Public Health and Paediatric Sciences, University of Torino, 10126 Torino, Italy
| | - Marilena Ferraris
- Diagnostic Imaging Department, AOU Citta' della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Andrea Garnero
- Diagnostic Imaging Department, AOU Citta' della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Giovanni Morana
- Neuroscience Department, University of Torino, 10126 Torino, Italy
- Diagnostic Imaging Department, AOU Citta' della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Paolo Carucci
- Neuroscience Department, University of Torino, 10126 Torino, Italy
- CRESSC, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Ilaria Stura
- Neuroscience Department, University of Torino, 10126 Torino, Italy
| | - Fulvio Massaro
- Neuroscience Department, University of Torino, 10126 Torino, Italy
- Neurosurgery Unit, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Diego Garbossa
- Neuroscience Department, University of Torino, 10126 Torino, Italy
- Neurosurgery Unit, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy
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Park RJ, Unnikrishnan S, Berliner J, Magnussen J, Liu S, Stoodley MA. Cerebellar Tonsillar Descent Mimicking Chiari Malformation. J Clin Med 2023; 12:jcm12082786. [PMID: 37109124 PMCID: PMC10144607 DOI: 10.3390/jcm12082786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Chiari I malformation has been defined as cerebellar tonsillar descent greater than 5 mm below the foramen magnum. Suboccipital decompression remains the mainstay of treatment for symptomatic patients. Other conditions sometimes have imaging features that mimic Chiari I malformation. These patients are at risk of misdiagnosis and mismanagement, including surgery that may be unnecessary or may even worsen the underlying condition. The aim of this study was to analyse a series of Chiari I malformation mimics and identify differentiating imaging features. The mimics are categorised as post-traumatic cranio-cervical junction arachnoiditis, dural band, spontaneous intracranial hypotension, idiopathic intracranial hypertension, and cysts. Better understanding of these conditions will assist with diagnosis and optimal management, including avoiding unnecessary surgery.
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Affiliation(s)
| | - Sunil Unnikrishnan
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia
| | - Joel Berliner
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia
| | - John Magnussen
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia
| | - Shinuo Liu
- Statewide Neurosurgical Service, Sir Charles Gairdner and Perth Children's Hospitals, Perth, WA 6009, Australia
| | - Marcus A Stoodley
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia
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Türkmen C, Köse N, Bal E, Bilgin S, Çetin H, Zengin HY, Gümeler E, Mut M. Effects of Two Exercise Regimes on Patients with Chiari Malformation Type 1: a Randomized Controlled Trial. CEREBELLUM (LONDON, ENGLAND) 2023; 22:305-315. [PMID: 35325392 DOI: 10.1007/s12311-022-01397-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/25/2022]
Abstract
This study aims to measure the effects of two different exercise programs on neck pain, proprioception, balance, coordination, posture, and quality of life in patients with Chiari malformation (CM) type 1. Sixteen patients were randomized to two different exercise programs: a tailored exercise protocol for CM (TEP-CM) and cervical spinal stabilization exercises (CSSE). Both exercise programs were implemented by a physiotherapist 3 days a week for 6 weeks. The primary outcome was Neck Disability Index. Secondary outcomes were visual analogue scale for pain, joint position sense error measurement, Berg Balance Scale, Time Up and Go Test, International Coordination Ataxia Rating Scale, PostureScreen Mobile, and Short Form-36. Assessments were done immediately before and after the intervention programs. Both groups showed significant improvement in Neck Disability Index, and some secondary outcome measures (P < 0.05). However, there were no statistical differences in post-intervention changes between the groups (P > 0.05). This is the first study to examine the effects of different exercise programs on symptoms in patients with CM type 1. Our preliminary findings indicate that exercise programs can improve pain, balance, proprioception, posture, coordination, and quality of life in CM type 1. Therefore, exercise should be considered safe, beneficial, and low-cost treatment option for CM type 1 patients without surgical indications.
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Affiliation(s)
- Ceyhun Türkmen
- Faculty of Health Sciences, Çankırı Karatekin University, 18200 Sıhhiye St., Çankırı, Turkey.
| | - Nezire Köse
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Ankara, 06100, Turkey
| | - Ercan Bal
- Department of Neurosurgery, Ankara Yıldırım Beyazıt University, Ankara, 06100, Turkey
| | - Sevil Bilgin
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Ankara, 06100, Turkey
| | - Hatice Çetin
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Ankara, 06100, Turkey
| | - Hatice Yağmur Zengin
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Samanpazari, Ankara, 06100, Turkey
| | - Ekim Gümeler
- Department of Radiology, Faculty of Medicine, Hacettepe University, Samanpazari, Ankara, 06100, Turkey
| | - Melike Mut
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Samanpazari, Ankara, 06100, Turkey
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12
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Reyes-Ruiz JM, Manrique-Calvillo C, Martínez-Mier G, Servin-Monroy AO, Mota-García G, DE Maria Lugo-Miranda F, Villegas-Del Angel E, Zarate-Segura P, Bastida-Gonzalez F, Del Angel RM. Encephalitis Associated With SARS-CoV-2 Infection in a Child With Chiari Malformation Type I. In Vivo 2023; 37:933-939. [PMID: 36881093 PMCID: PMC10026637 DOI: 10.21873/invivo.13165] [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: 01/28/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM There is increasing evidence that patients infected with SARS-CoV-2 develop neurological manifestations such as encephalitis. The purpose of this article was to present a case of viral encephalitis associated with SARS-CoV-2 in a 14-year-old child with Chiari malformation type I. CASE REPORT The patient manifested frontal headache, nausea, vomiting, skin pallor, right side Babinski sign and was diagnosed with Chiari malformation type I. He was admitted with generalized seizures and suspected encephalitis. Brain inflammation and viral RNA in the cerebrospinal fluid suggested SARS-CoV-2 encephalitis. These findings indicate that the SARS-CoV-2 test in CSF of patients with neurological manifestations, confusion, and fever during the COVID-19 pandemic should be carried out even when there is no evidence of respiratory infection. To our knowledge, this presentation of encephalitis associated with COVID-19 has not yet been reported in a patient with a congenital syndrome such as Chiari malformation type I. CONCLUSION Further clinical data are needed to determine the complications of encephalitis due to SARS-CoV-2 in patients with Chiari malformation type I to standardize diagnosis and treatment.
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Affiliation(s)
- José Manuel Reyes-Ruiz
- Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
- Facultad de Medicina, Región Veracruz, Universidad Veracruzana (UV), Veracruz, Mexico
| | - Claudia Manrique-Calvillo
- Departamento de Pediatria, Centro Médico Ecatepec del Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM), Ecatepec de Morelos, Mexico
| | - Gustavo Martínez-Mier
- Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
| | - Arturo Osvaldo Servin-Monroy
- Departamento de Epidemiología, Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM), Toluca de Lerdo, Mexico
| | - Gilraed Mota-García
- Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
| | - Flor DE Maria Lugo-Miranda
- Unidad de Medicina Preventiva y Vigilancia Epidemiológica, Centro Médico Ecatepec del Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM), Ecatepec de Morelos, Mexico
| | | | - Paola Zarate-Segura
- Laboratorio de Medicina Traslacional, Escuela Superior de Medicina, Instituto Politécnico Nacional (IPN), Mexico City, Mexico
| | - Fernando Bastida-Gonzalez
- Laboratorio de Biología Molecular, Laboratorio Estatal de Salud Pública del Estado de México, Toluca de Lerdo, Mexico;
| | - Rosa Maria Del Angel
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City, Mexico
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Wrzosek MA, Banasik AE, Owsińska-Schmidt K, Zimny A. Diffusion Tensor Imaging in Syringomyelia Secondary to Chiari Malformation in Cavalier King Charles Spaniel-A Preliminary Study. Animals (Basel) 2022; 12:ani12233405. [PMID: 36496926 PMCID: PMC9740166 DOI: 10.3390/ani12233405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Syringomyelia secondary to Chiari-like malformation (so-called CM-SM syndrome) is a common disorder in Cavalier King Charles Spaniels (CKCS) that is diagnosed using standard structural MRI, though imaging findings often do not correlate with the severity of clinical symptoms. Diffusion tensor imaging (DTI) is a technique that defines subtle microstructural changes in the course of many brain and spinal cord diseases, that are not visible on standard MRI. The aim of the study was to identify the correlation between the presence of clinical symptoms and DTI parameters, such as apparent diffusion coefficient (ADC) and fractional anisotropy (FA) within the spinal cord in the course of CM-SM. Study subjects included 18 dogs, CKCS with MRI-confirmed SM (SM group), and 12 CKCS dogs without SM (non-SM group). The SM group was divided into SM-symptomatic group (n = 8) and SM-asymptomatic group, n = 10). All dogs underwent same clinical and neurological assessment followed by MRI examination. All MRI studies were performed on a 1.5T MRI scanner. The MRI spine protocol included: transverse and sagittal T2-weighted images followed by DTI performed in the sagittal plane. The measurements of FA and ADC values were performed manually using the region of interest (ROI) method at the level of three intervertebral discs between C1 and C4. Notable differences in age and body weight were found. No significant differences in FA and ADC values between the SM and non-SM groups were found, but between non-SM, SM-asymptomatic and SM-symptomatic groups significant differences were found in ADC values in all three ROIs and in FA values in ROI-1 and ROI-3. SM-symptomatic dogs compared to non-SM, showed decreased FA value in ROI-1 and ROI-3 also increased ADC value in ROI-1, ROI-2 and ROI-3. SM-symptomatic dogs compared to SM-asymptomatic showed also decreased FA value in ROI-1 and ROI-3, and also increased ADC value in ROI-1, ROI-2 and ROI-3. The results suggest that the values of DTI parameters correlate with the severity of clinical symptoms in the course of CM-SM in animals. The use of DTI evaluation of CM-SM patients carries a potential value as a clinically relevant protocol for an objective assessment of the spinal cord.
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Affiliation(s)
- Marcin Adam Wrzosek
- Department of Internal Diseases with a Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, 50-366 Wrocław, Poland
- Correspondence:
| | - Aleksandra Ewa Banasik
- Department of Internal Diseases with a Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, 50-366 Wrocław, Poland
| | - Karolina Owsińska-Schmidt
- Department of Internal Diseases with a Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, 50-366 Wrocław, Poland
| | - Anna Zimny
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, 50-551 Wrocław, Poland
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Vagianou F, Khirani S, De Saint Denis T, Beccaria K, Amaddeo A, Breton S, James S, Paternoster G, Arnaud E, Zerah M, Fauroux B. Impact of sleep-disordered breathing on the management of children with Chiari malformation type I. Pediatr Pulmonol 2022; 57:2954-2962. [PMID: 35962649 DOI: 10.1002/ppul.26113] [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: 03/25/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Children with Chiari malformation type I (CM-I) have an increased risk of sleep apnea. The aim of the study was to describe the management of CM-I patients in relation to symptoms, magnetic resonance imaging (MRI) findings and sleep apnea syndrome (SAS). METHODS We performed a retrospective analysis of clinical charts of all 57 CM-I patients seen between September 2013 and April 2017. RESULTS A total of 45 patients had isolated CM-I or associated co-morbidity (CM-Iia), 5 had craniosynostosis (CM-Ics), and 7 a polymalformative syndrome (CM-Ipm). The prevalence of SAS, defined as an apnea-hypopnea index >1 event/h, was high in CM-I ranging from 50% to 80% according to the CM-I group. The prevalence of central sleep apnea (CSA) was low, with 5 (9%) patients having CSA and only 3 patients with CM-Iia having isolated CSA. A total of 17 patients (30%) had foramen magnum decompression (FMD). Neither positive symptoms of CM-I nor MRI findings alone, nor both combined were good indicators for FMD. No correlation was observed between the cerebellar tonsil descent and SAS in CM-I. But all 5 patients with CSA had a FMD. The combination of MRI findings and/or symptoms of CM-I together with moderate-to-severe SAS best discriminated patients who needed a FMD. CONCLUSION Our findings highlight the importance of a combined evaluation of symptoms, MRI and polygraphy results in the management of CM-I patients.
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Affiliation(s)
- Foteini Vagianou
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,ASV Santé, Gennevilliers, France
| | - Timothée De Saint Denis
- Department of Pediatric Neurosurgery, Centre de référence Chiari, Syringomyélie et Malformations du Rachis et de la Moelle C-MAVEM, et Centre de référence des malformations craniofaciales-CRMR CRANIOST, AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, Centre de référence Chiari, Syringomyélie et Malformations du Rachis et de la Moelle C-MAVEM, et Centre de référence des malformations craniofaciales-CRMR CRANIOST, AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université Paris Cité, VIFASOM, Paris, France
| | - Sylvain Breton
- Department of Pediatric Radiology, AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Syril James
- Department of Pediatric Neurosurgery, Centre de référence Chiari, Syringomyélie et Malformations du Rachis et de la Moelle C-MAVEM, et Centre de référence des malformations craniofaciales-CRMR CRANIOST, AP-HP, Hôpital Necker-Enfants malades, Paris, France.,Clinique Marcel Sembat, Ramsay Générale de Santé, Boulogne Billancourt, France
| | - Giovanna Paternoster
- Department of Pediatric Neurosurgery, Centre de référence Chiari, Syringomyélie et Malformations du Rachis et de la Moelle C-MAVEM, et Centre de référence des malformations craniofaciales-CRMR CRANIOST, AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Eric Arnaud
- Department of Pediatric Neurosurgery, Centre de référence Chiari, Syringomyélie et Malformations du Rachis et de la Moelle C-MAVEM, et Centre de référence des malformations craniofaciales-CRMR CRANIOST, AP-HP, Hôpital Necker-Enfants malades, Paris, France.,Clinique Marcel Sembat, Ramsay Générale de Santé, Boulogne Billancourt, France
| | - Michel Zerah
- Department of Pediatric Neurosurgery, Centre de référence Chiari, Syringomyélie et Malformations du Rachis et de la Moelle C-MAVEM, et Centre de référence des malformations craniofaciales-CRMR CRANIOST, AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université Paris Cité, VIFASOM, Paris, France
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15
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Jbarah OF, Aburayya BI, Shatnawi AR, Alkhasoneh MA, Toubasi AA, Alharahsheh SM, Nukho SK, Nassar AS, Jamous MA. Risk of meningitis after posterior fossa decompression with duraplasty using different graft types in patients with Chiari malformation type I and syringomyelia: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:3537-3550. [PMID: 36180807 DOI: 10.1007/s10143-022-01873-6] [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: 07/23/2022] [Revised: 08/24/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022]
Abstract
Several complications have been reported after the use of grafts for duraplasty following posterior fossa decompression for the treatment of Chiari malformation type I. This study aims to investigate the rate of meningitis after posterior fossa decompression using different types of grafts in patients with Chiari malformation type I and associated syringomyelia. The search was conducted using multiple databases, including PubMed, Scopus, Web of Science, and Embase. Data on the rate of meningitis, syrinx change, and rate of reoperation were extracted and investigated. Quality of evidence was assessed using the Newcastle-Ottawa scale. Nineteen studies were included in the final meta-analysis, encompassing 1404 patients and investigating autografts, synthetic grafts, allografts, and xenografts (bovine collagen, bovine pericardium, and pig pericardium). Autografts were associated with the lowest rate of meningitis (1%) compared to allografts, synthetic grafts, and xenografts (2%, 5%, and 8% respectively). Autografts were also associated with the lowest rate of reoperation followed by xenografts, allografts, and synthetic grafts (4%, 5%, 9%, and 10% respectively). On the other hand, allografts were associated with the highest rate of syrinx improvement (83%) in comparison to autografts and synthetic grafts (77%, and 79% respectively). Autografts were associated with the lowest meningitis, reoperation, and syrinx improvement rates. Furthermore, synthetic grafts were associated with the highest reoperation and xenografts with the highest rate of meningitis, whereas allografts were associated with the best syrinx improvement rate and second-best meningitis rate. Future studies comparing autografts and allografts are warranted to determine which carries the best clinical outcome.
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Affiliation(s)
- Omar F Jbarah
- Department of Neurosurgery, Faculty Of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, zip code 22110, Jordan
| | - Bahaa I Aburayya
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ayman R Shatnawi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mohab A Alkhasoneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ahmad A Toubasi
- Faculty of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Sondos M Alharahsheh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Saleem K Nukho
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Asil S Nassar
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mohammad A Jamous
- Department of Neurosurgery, Faculty Of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, zip code 22110, Jordan.
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Iampreechakul P, Wangtanaphat K, Hangsapruek S, Wattanasen Y, Lertbutsayanukul P, Siriwimonmas S. Acquired Chiari malformation Type I and holocord syringomyelia associated with a high-flow supratentorial fistulous arteriovenous malformations: A case report and literature review. Surg Neurol Int 2022; 13:217. [PMID: 35673663 PMCID: PMC9168309 DOI: 10.25259/sni_11_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/30/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Chiari malformation Type I (CMI) is generally considered a congenital lesion and typically associated with syringomyelia. Acquired CMI or adult Chiari malformation caused by intracranial mass is extremely rare. Brain arteriovenous malformations (AVMs) are characteristically symptomatic due to seizure, intracranial hemorrhage, or neurological deficit. We report an extremely rare case of an acquired CMI and extensive syringomyelia associated with a large supratentorial AVM. Case Description: A 35-year-old woman was referred to our institute after a diagnosis of CMI and extensive syringomyelia from whole-spine magnetic resonance imaging (MRI) due to complaining of low back pain radiating to the right leg for the past 1 month. She had intermittent headache for 2 years. The patient underwent suboccipital decompression and C1 laminectomy followed by duraplasty. Two months later, she developed severe right-sided sciatic pain and complete right foot drop. Follow-up MRI revealed progressive enlargement of a syrinx cavity at the lower spinal cord and a large right parieto-occipital AVM with markedly dilated cortical draining veins and diffuse engorgement of dural venous sinuses was detected. This AVM supplied mainly by enlarged cortical branches of the right middle cerebral artery and posterior cerebral artery with multiple dural supplies. Endovascular treatment of a high-flow fistulous AVM was successfully performed with N-butyl cyanoacrylate (NBCA) through the hypertrophic branches of the right middle cerebral artery. Four months after embolization, the patient had recovered completely from the right foot drop. Further staged embolization was planned to reduce the size and flow of the AVM before stereotactic radiosurgery. However, the patient was lost to follow-up due to financial reason. One year later, she developed sudden severe headache followed by alteration of conscious due to intraventricular hemorrhage from the AVM, leading to obstructive hydrocephalus requiring cerebrospinal fluid diversion. During a period of 2 years, the patient underwent several staged embolization with NBCA and Onyx. Final cerebral angiography after embolization demonstrated a significant reduction in size and flow of the brain AVM. A control whole-spine MRI revealed a significant reduction in syrinx size. At the end of embolization, the patient had no neurological deficit. However, she had suffered from persistent central neuropathic pain at the right lower extremity. The AVM remnant was further treated by stereotactic radiosurgery. Conclusion: Increased cerebral venous hypertension secondary to a high-flow supratentorial AVM leading to posterior fossa venous hypertension may play a major role in the pathogenesis of CMI, induced the formation of syringomyelia. Endovascular treatment of brain AVM, the underlying cause of CMI, resulted in a significant reduction of the size of the syrinx. The need for cranial imaging in initial evaluation of cases with adult Chiari malformation is important.
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Affiliation(s)
| | | | - Sunisa Hangsapruek
- Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand
| | - Yodkhwan Wattanasen
- Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand
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Conservative Treatment of Chiari Malformation Type I Based on the Phase-Contrast MRI: A Retrospective Study. World Neurosurg 2022; 163:e323-e334. [PMID: 35367644 DOI: 10.1016/j.wneu.2022.03.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The phase-contrast magnetic resonance image (PC-MRI) use is interestingly increased in diagnosis and follow-up patients with Chiari Type I Malformation (CM1). The current study aimed to elaborate the benefits of conservative treatment by evaluating consecutively treated adult patients with CM1 who were selected on basis of the PC-MRIs. METHODS Medical records of patients diagnosed with CM1 were retrospectively reviewed at two neurosurgical centers spanning eight years (2010-2017). Adult patients with CM1, who were treated conservatively and met study criteria, were selected to be the core sample for this study. Between-groups (benefited vs non-benefited) comparisons were performed to understand the factors that may affect the outcomes. RESULTS Ninety (68 females and 22 males) adult patients received conservative treatment for CM1. The mean age was 40.6. Headaches and pinprick loss were the most commonly recorded symptoms and clinical findings which were recorded in 58 (64.4%) and 31 (34.4%) patients, respectively. Eleven patients were presented with a syrinx. The mean aqueductal stroke volume (ASV) was 16.5 μl. The conservative treatment failed in treating five (5.6%) patients who underwent surgical intervention. The means of ASV in the benefited and non-benefited groups were 16.7 and 13.2 μl, respectively (p=0.004). CONCLUSION Conservative approaches (prescriptive medications, physical therapy, Pilates, and swimming) can improve the life quality of non-surgical candidate adult patients with CM1. Conservative treatment can be useful in selected patients with variably CM1 (ASV=16.7 μl). The presence of heavy sleep apnea or/and functional symptoms were prognostic factors that were affected the conservative treatment negatively.
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18
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Guo F, Turgut M. Precise Management of Chiari Malformation with Type I. Front Surg 2022; 9:850879. [PMID: 35558380 PMCID: PMC9088844 DOI: 10.3389/fsurg.2022.850879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/10/2022] [Indexed: 11/21/2022] Open
Abstract
Diagnosis of Chirai malformation type I (CM-I) is based on magnetic resonance imaging of the brain or cervical spinal cord. The main goal of surgery is to relieve the blockage to the free pulsatile flow of cerebrospinal fluid beyond the foramen magnum and to stop the progression of a syringomyelia. Despite recent advances in imaging and surgery, even today, there is no consensus on optimal management of CM-I. Ongoing focus is devoted to a better consideration of the pathophysiology of CM-I and the development of more effective medical and surgical treatments. It is hoped that proposed algorithm helps the neurosurgeon to provide a precise management for patients with CM-I in advance.
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Affiliation(s)
- Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Nervous System Malformation, Zhengzhou, China
- Correspondence: Fuyou Guo
| | - Mehmet Turgut
- Henan International Joint Laboratory of Nervous System Malformation, Zhengzhou, China
- Department of Neurosurgery, Aydın Adnan Menderes University Faculty of Medicine, Efeler, Aydın, Turkey
- Department of Histology and Embryology, Aydın Adnan Menderes University Health Sciences Institute, Efeler, Aydın, Turkey
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Clinicoradiographic data and management of children with Chiari malformation type 1 and 1.5: an Italian case series. Acta Neurol Belg 2021; 121:1547-1554. [PMID: 32524535 DOI: 10.1007/s13760-020-01398-z] [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: 04/01/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The widespread use of imaging has increased Chiari malformation (CM) diagnosis. CM shows clinical heterogeneity that makes management controversial. We aimed to evaluate the occurrence and clinical and radiographic presentation of children with CM-1 and CM-1.5, reporting possible differences according to age and management. METHODS We retrospectively reviewed 46 children diagnosed with CM-1 or CM-1.5, between 2006 and 2019 at our institute. We evaluated for each subject: reason for hospital admission, clinical presentation, age at diagnosis, extent of cerebellar tonsillar herniation (CTH) and type of treatment when carried out. Affected children were assigned to three age groups. In some patients, a clinical follow-up was carried out. RESULTS Mean age at diagnosis was 7.61 years. Mean CTH was 8.72 mm. Syringomyelia was found in 10.9%. Twenty-six individuals (56.5%) were symptomatic. The most frequent symptom was headache (34.8%). There were no statistically significant differences between the age groups with regard to the amount of CTH (p = 0.81). Thirteen children (28.3%) underwent surgical treatment. CTH was significantly higher in the surgical group (p < 0.01). Twenty-three patients (50%) performed a 3-year mean follow-up, 17 of whom had no surgery treatment. CTH was stable in 58.8%, reduced in three and increased in three, without any change in symptoms. Only one child showed a worsening in herniation and symptoms, then requiring surgery. CONCLUSION Frequency and type of symptoms were consistent with those reported in the literature. Conservative approach is a viable option for minimally symptomatic patients, most of whom did not show clinical worsening at follow-up.
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Abdallah A, Çınar İ, Güler Abdallah B. Long-term surgical outcome of Chiari type-I malformation-related syringomyelia: an experience of tertiary referral hospital. Neurol Res 2021; 44:299-310. [PMID: 34559033 DOI: 10.1080/01616412.2021.1981104] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Syringomyelia is a common condition seen in patients with Chiari type-I malformation (CM1). The purpose of this retrospective study was to evaluate the long-term clinical and radiological outcomes of posterior fossa decompression with duraplasty (PFDD) with coagulation of tonsillar ectopia in consecutive surgically treated adult patients with CM1-related syringomyelia (CRS). METHODS Over 9 years' duration (1993-2001), medical charts of diagnosed patient with CM1 at our neurosurgical center were reviewed retrospectively. This study included adult patients with CM1 who had syringomyelia and underwent PFDD with coagulation of tonsillar ectopia surgery. The differences between the pre- and postoperative syrinx/cord ratio (S/C), the syrinx length, and the regression of herniated cerebellar tonsils on coronal and midsagittal MRIs were evaluated. RESULTS A total of 87 surgical procedures (46 primary operations, 7 ventriculoperitoneal shunts, and 34 additional operations) for CRS were performed on 24 males and 22 females. The mean preoperative S/C was 0.59 ± 0.12. The means of regression in herniated cerebellar tonsils on mid-sagittal and coronal images were 11.8 ± 2.3 mm and 10.2 ± 2.2 mm (p < 0.0001), respectively. 35 (76.1%) patients were discharged after showing signs of recovery or improvement. Different complications occurred in 16 (34.8%) patients. Negative correlations were noticed between postoperative recovery/improvement and the long symptoms' duration, the herniated tonsils' extent, S/C, and the persistence of the herniated tonsils on the coronal images. CONCLUSION Early diagnosis of patients with CRS can improve surgical outcomes. Due to its efficacy in resolving clinical symptoms and syrinx cavities, PFDD is still an optimal surgical approach for CRS.
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Affiliation(s)
- Anas Abdallah
- Department of Neurosurgery, Aile Hospital, Istanbul, Turkey
| | - İrfan Çınar
- Department of Neurosurgery, Aile Hospital, Istanbul, Turkey
| | - Betül Güler Abdallah
- Department of Psychiatry - AMATEM Unit, Bakırköy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry, University of Health Sciences, Istanbul, Turkey
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Han S, Gao J, Li Z, Wang X, Li Y. One-Year Outcomes of Chiari Type 1 Malformation and Syringomyelia Treated With Posterior Fossa Decompression. Clin Spine Surg 2021; 34:E248-E255. [PMID: 33605611 DOI: 10.1097/bsd.0000000000001136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to evaluate posterior fossa structural differences between Chiari type 1 malformation with and without syringomyelia, and assess data of the improvement of syringomyelia after different surgical options. SUMMARY OF BACKGROUND DATA Syringomyelia is among the most common concomitant complications of Chiari malformation (CM). However, posterior fossa decompression cannot definitely make the syringomyelia disappear even in the long term. Also, there are no universal criteria defining improvement in syrinx. MATERIALS AND METHODS All admitted CM patients at our institution from 2013 to 2018 with a 1-year follow-up were analyzed. Patients without syringomyelia were compared with those who had syringomyelia. Patients were divided into 3 groups according to the procedures performed: posterior fossa decompression versus posterior fossa decompression with duralplasty (PFDD) versus PFDD plus obex unblocking. Divergent prognosis of syringomyelia was defined as a 3-category ordinal variable. A multivariable ordinal regression model was used to estimate the relationship between patient variables and increased odds for better resolution of syringomyelia. RESULTS No significant linear difference in bony structure was found between syringomyelia and nonsyringomyelia patients. Among syringomyelia patients, the regression analysis demonstrated that patients with shorter posterior fossa height ( P =0.032), lower Pavlov ratio ( P =0.029), and obex unblocking (vs. PFDD, P <0.001; vs. posterior fossa decompression, P =0.037) were more likely to gain a better resolution of syringomyelia. CONCLUSIONS Syringomyelia of CM patients may not simply originate from single linear anatomic variation. Patients with shorter posterior fossa height and lower Pavlov ratio received better syringomyelia resolution. Also, unblocking the obex received better syringomyelia resolution compared with duraplasty alone and bony decompression alone with the avoidance of increased postoperative complications and worse clinical outcomes.
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Affiliation(s)
| | | | | | | | - Yongning Li
- Departments of Neurosurgery
- International Medical Service, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Rossettini G, Maselli F, de Filippis C, Mourad F, Lovato A. Acute Vertigo After CrossFit Workout in a Young Woman With Chiari I Malformation. Cureus 2021; 13:e13482. [PMID: 33633919 PMCID: PMC7899735 DOI: 10.7759/cureus.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
CrossFit workout is associated with injuries mostly located over the spine and upper limb. Chiari I malformation (CIM) is characterized by migration of the cerebellar tonsils below the foramen magnum and this clinical condition has never been described after high-intense training such as CrossFit. A 19-year-old woman presented to the ED with acute vertigo, nausea, vomiting, and horizontal spontaneous nystagmus; symptoms began after an intense workout session. During neuro-otological examination, spontaneous positional left-beating horizontal nystagmus, normal response to bi-thermal caloric stimulations, and unremarkable cervical vestibular evoked myogenic potentials in both ears were observed; pure tone audiometry showed normal hearing. Central vertigo was suspected; therefore, an MRI was done, which identified a CIM. The patient's symptoms spontaneously improved at short term. The six-month follow-up MRI confirmed no changes. The subject completely stopped any training and remained asymptomatic over a 12-month follow-up. Our case report is the first describing CIM presented with acute vertigo after a high-intensity training.
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Affiliation(s)
- Giacomo Rossettini
- Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova, Savona, ITA
| | - Filippo Maselli
- Sovrintendenza Sanitaria Regionale Puglia, Direzione Regionale Puglia INAIL, Bari, ITA.,Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova, Savona, ITA
| | - Cosimo de Filippis
- Neuroscience, University of Padova, Audiology unit at Treviso Hospital, University of Padova, Treviso, ITA
| | - Firas Mourad
- Faculty of Medicine and Surgery, Department of Clinical Science and Translation Medicine, University of Roma "Tor Vergata", Brescia, ITA
| | - Andrea Lovato
- Neuroscience, University of Padova, Audiology unit at Treviso Hospital, University of Padova, Treviso, ITA
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23
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Wang L, Zhao H, Zhu W, Yan P, Teng YD. A Combinatorial Approach with Cerebellar Tonsil Suspension to Treating Symptomatic Chiari Malformation Type I in Adults: A Retrospective Study. World Neurosurg 2020; 143:e19-e35. [DOI: 10.1016/j.wneu.2020.02.184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 02/06/2023]
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24
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Zhu K, Born DW, Dilli E. Secondary Headache: Current Update. Headache 2020; 60:2654-2664. [PMID: 33078413 DOI: 10.1111/head.13986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this paper is to review some of the causes of secondary headache particularly focusing on the subcategories of secondary headache in the International Classification of Headache Disorders, 3rd edition, the clinical features of these headaches, and their associated features and management. OVERVIEW Headache attributed to trauma or injury to the head and/or neck, headache attributed to cranial or cervical vascular disorder, headache attributed to non-vascular intracranial disorder, headache attributed to a substance or its withdrawal, headache attributed to infection, headache attributed to disorder of homeostasis, and headache or facial pain attributed to disorder of the cranium, neck, eye, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure are discussed in this paper. DISCUSSION Headache is a common symptom of multiple medical conditions. Although a minority of headache patients have a secondary basis for their headaches, it is important to identify clinical features of secondary headache disorders including both the headache and non-headache features of the condition, diagnose the secondary etiology correctly, and treat them appropriately.
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Affiliation(s)
- Kai Zhu
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Dawson W Born
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Esma Dilli
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
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25
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Bragée B, Michos A, Drum B, Fahlgren M, Szulkin R, Bertilson BC. Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Front Neurol 2020; 11:828. [PMID: 32982905 PMCID: PMC7485557 DOI: 10.3389/fneur.2020.00828] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 07/02/2020] [Indexed: 12/24/2022] Open
Abstract
The pathophysiology of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is unknown. In this study, we test the hypothesis that hypermobility, signs of intracranial hypertension (IH), and craniocervical obstructions may be overrepresented in patients with ME/CFS and thereby explain many of the symptoms. Our study is a retrospective, cross-sectional study, performed at a specialist clinic for referred patients with severe ME/CFS as defined by the Canada Consensus Criteria. The first 272 patients with ME/CFS were invited to participate, and 229 who provided prompt informed consent were included. Hypermobility was assessed using the Beighton Score. IH was assessed indirectly by the quotient of the optic nerve sheet diameter (ONSD)/eyeball transverse diameter on both sides as measured on magnetic resonance imaging (MRI) of the brain. We also included assessment of cerebellar tonsil position in relation to the McRae line, indicating foramen magnum. Craniocervical obstructions were assessed on MRI of the cervical spine. Allodynia was assessed by quantitative sensory testing (QST) for pain in the 18 areas indicative of fibromyalgia syndrome (FMS). A total of 190 women, mean age 45 years, and 39 males, mean age 44 years, were included. Hypermobility was identified in 115 (50%) participants. MRI of the brain was performed on 205 participants of whom 112 (55%) had an increased ONSD and 171 (83%) had signs of possible IH, including 65 (32%) who had values indicating more severe states of IH. Cerebellar tonsils protruding under the McRae line into the foramen magnum were identified in 115 (56%) of the participants. MRI of the cervical spine was performed on 125 participants of whom 100 (80%) had craniocervical obstructions. Pain at harmless pressure, allodynia, was found in 96% of the participants, and FMS was present in 173 participants or 76%. Compared to a general population, we found a large overrepresentation of hypermobility, signs of IH, and craniocervical obstructions. Our hypothesis was strengthened for future studies on the possible relation between ME/CFS symptoms and hypermobility, IH, and craniocervical obstructions in a portion of patients with ME/CFS. If our findings are confirmed, new diagnostic and therapeutic approaches to this widespread neurological syndrome should be considered.
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Affiliation(s)
- Björn Bragée
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,ME-center, Bragée Clinics, Stockholm, Sweden
| | | | - Brandon Drum
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,ME-center, Bragée Clinics, Stockholm, Sweden
| | - Mikael Fahlgren
- ME-center, Bragée Clinics, Stockholm, Sweden.,Academic Primary Health Care Center, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Robert Szulkin
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Bo C Bertilson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,ME-center, Bragée Clinics, Stockholm, Sweden.,Academic Primary Health Care Center, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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26
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Giammattei L, Messerer M, Daniel RT, Aghakhani N, Parker F. Long-term outcome of surgical treatment of Chiari malformation without syringomyelia. J Neurosurg Sci 2020; 64:364-368. [DOI: 10.23736/s0390-5616.17.04063-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis. Acta Neurochir (Wien) 2020; 162:1553-1563. [PMID: 32504118 PMCID: PMC7295832 DOI: 10.1007/s00701-020-04429-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/22/2020] [Indexed: 12/27/2022]
Abstract
Introduction Recently, a novel hypothesis has been proposed concerning the origin of craniovertebral junction (CVJ) abnormalities. Commonly found in patients with these entities, atlantoaxial instability has been suspected to cause both Chiari malformation type I and basilar invagination, which renders the tried and tested surgical decompression strategy ineffective. In turn, C1-2 fusion is proposed as a single solution for all CVJ abnormalities, and a revised definition of atlantoaxial instability sees patients both with and without radiographic evidence of instability undergo fusion, instead relying on the intraoperative assessment of the atlantoaxial joints to confirm instability. Methods The authors conducted a comprehensive narrative review of literature and evidence covering this recently emerged hypothesis. The proposed pathomechanisms are discussed and contextualized with published literature. Conclusion The existing evidence is evaluated for supporting or opposing sole posterior C1-2 fusion in patients with CVJ abnormalities and compared with reported outcomes for conventional surgical strategies such as posterior fossa decompression, occipitocervical fusion, and anterior decompression. At present, there is insufficient evidence supporting the hypothesis of atlantoaxial instability being the common progenitor for CVJ abnormalities. Abolishing tried and tested surgical procedures in favor of a single universal approach would thus be unwarranted.
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28
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Janjua MB, Haynie AE, Bansal V, Bhattacharia S, Grant T, McQuillan D, Passias PG, Ozturk AK, Hwang SW. Determinants of Chiari I progression in pregnancy. J Clin Neurosci 2020; 77:1-7. [PMID: 32414621 DOI: 10.1016/j.jocn.2020.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
Chiari Malformation type 1 (CM-I) is congenital or an acquired anomaly of the hind brain; develops when the cerebellar tonsils recede downwards below the foramen magnum. Recurrent post tussive suboccipital headache is the common presentation in a pregnant woman and the diagnosis is usually missed or delayed due to lack of formal understanding of this neurological pathology. Much has been written regarding presentation, morphology and the treatment of CM-I; however, little is known when the etiology is acquired or an iatrogenic in its evolution. Similarly, unknown is the progression of CM-I (diagnosed or undiagnosed) in pregnancy. The objective of this study is to elucidate the causes of progression of CM-I in pregnancy, and how this can be avoided. A detailed literature review has been conducted to find the case reports or case studies on association of CM-I in pregnancy; therefore, the risk factors regarding the progression have been sought. There is a lack of literature on timing, mode of anesthesia, and the management of CM-I. Moreover, authors have sought a questionnaire to screen these patients at pre-conception, intrapartum visits if, the initial diagnosis is delayed. Crucial points of concern including but not limited to the diagnosis, pre-conception counseling, timing of intervention during pregnancy, and mode of anesthesia, have been discussed in detail. In summary, a formal management algorithm has been proposed to avoid the rapid progression of this complex neurological pathology especially, in women of child bearing age and/or during pregnancy.
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Affiliation(s)
- M Burhan Janjua
- Department of Neurological Surgery, Mercy Health Hospital, Rockford, IL, USA.
| | - Alexus E Haynie
- Department of Neurology, Mercy Health Hospital, Rockford, IL, USA
| | - Vibhav Bansal
- Department of Neurology, Mercy Health Hospital, Rockford, IL, USA.
| | | | - Tamila Grant
- Department of Anesthesiology, Mercy Health Hospital, Rockford, IL, USA
| | - Daniel McQuillan
- Department of Anesthesiology, Mercy Health Hospital, Rockford, IL, USA
| | - Peter G Passias
- Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Ali K Ozturk
- Department of Neurosurgery, University of Pennsylvania Hospital, PA, USA
| | - Steven W Hwang
- Department of Pediatric Neurosurgery, Shriners Hospital for Children Philadelphia, PA, USA
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29
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Mathkour M, Keen JR, Huang B, Werner C, Scullen T, Garces J, Skovgard M, Iwanaga J, Tubbs RS, Dumont A, Biro E, Bui CJ. “Two-Birds-One-Stone” Approach for Treating an Infant with Chiari I Malformation and Hydrocephalus: Is Cerebrospinal Fluid Diversion as Sole Treatment Enough? World Neurosurg 2020; 137:174-177. [DOI: 10.1016/j.wneu.2020.01.188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
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30
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Agrawal A, Moscote-Salazar LR, Gomez-Rhenals E, Garcia-Ballestas E. Letter: Obstetric Management and Maternal Outcomes of Childbirth Among Patients With Chiari Malformation Type I. Neurosurgery 2020; 86:E473. [PMID: 31885049 DOI: 10.1093/neuros/nyz560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amit Agrawal
- Department of Neurosurgery Narayana Medical College and Hospital Nellore, Andhra Pradesh, India
| | - Luis Rafael Moscote-Salazar
- Department of Neurosurgery Center for Biomedical Research (CIB) Faculty of Medicine - University of Cartagena Cartagena de Indias Bolivar, Colombia
| | - Edgar Gomez-Rhenals
- Department of Gynecology and Obstetrics University of Sinu Cartagena de Indias Bolivar, Colombia
| | - Ezequiel Garcia-Ballestas
- Center for Biomedical Research (CIB) Faculty of Medicine - University of Cartagena Cartagena de Indias Bolivar, Colombia
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31
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Elsamadicy AA, Koo AB, Lee M, David WB, Kundishora AJ, Freedman IG, Zogg CK, Hong CS, DeSpenza T, Sarkozy M, Kahle KT, DiLuna M. Risk Factors Portending Extended Length of Stay After Suboccipital Decompression for Adult Chiari I Malformation. World Neurosurg 2020; 138:e515-e522. [PMID: 32147550 DOI: 10.1016/j.wneu.2020.02.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE For adult patients undergoing surgical decompression for Chiari malformation type I (CM-I), the patient-level factors that influence extended length of stay (LOS) are relatively unknown. The aim of this study was to investigate the impact of patient-baseline comorbidities, demographics, and postoperative complications on extended LOS after intervention after adult CM-I decompression surgery. METHODS A retrospective cohort study using the National Inpatient Sample years 2010-2014 was performed. Adults (≥18 years) with a primary diagnosis of CM-I undergoing surgical decompression were identified. Weighted patient demographics, comorbidities, complications, LOS, disposition, and total cost were recorded. A multivariate logistic regression was used to determine the odds ratio for risk-adjusted LOS. RESULTS A total of 29,961 patients were identified, 6802 of whom (22.7%) had extended LOS. The extended LOS cohort had a significantly greater overall complication rate (normal LOS, 10.6% vs. extended LOS, 29.1%; P < 0.001) and total cost (normal LOS, $14,959 ± $6037 vs. extended LOS, $25,324 ± $21,629; P < 0.001) compared with the normal LOS cohort. On multivariate logistic regression, black race, income quartiles, private insurance, obstructive hydrocephalus, lack of coordination, fluid and electrolyte disorders, and paralysis were all independently associated with extended LOS. Additional duraplasty (P = 0.132) was not significantly associated with extended LOS after adjusting for other variables. The odds ratio for extended LOS was 2.07 (95% confidence interval, 1.59-2.71) for patients with 1 complication and 9.47 (95% confidence interval, 5.86-15.30) for patients with >1 complication. CONCLUSIONS Our study shows that extended LOS after adult CM-I decompression surgery may be influenced by multiple patient-level factors.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Megan Lee
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Wyatt B David
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Adam J Kundishora
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Isaac G Freedman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Cheryl K Zogg
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher S Hong
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Tyrone DeSpenza
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Margot Sarkozy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Kristopher T Kahle
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Michael DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut.
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Somatosensory and motor evoked potentials during correction surgery of scoliosis in neurologically asymptomatic Chiari malformation-associated scoliosis: A comparison with idiopathic scoliosis. Clin Neurol Neurosurg 2020; 191:105689. [PMID: 32006930 DOI: 10.1016/j.clineuro.2020.105689] [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: 10/26/2019] [Revised: 12/05/2019] [Accepted: 01/19/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To analyze the somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) in neurologically asymptomatic Chiari malformation-associated scoliosis (CMS) patients with and without syringomyelia as compared with those in idiopathic scoliosis (IS) ones, and to identify whether the deformities have impacts on the neurophysiological monitoring. PATIENTS AND METHODS This study included neurologically asymptomatic CMS patients undergoing posterior correction surgery between January 2010 and January 2016. IS patients were involved as control group and a subgroup of age- and height-matched IS patients were selected. The age, standing height and Cobb angles of main curve were measured. The SEPs latency and amplitude, MEPs amplitude, and the rate of abnormal SEPs pathologic change were compared between CMS and IS patients using independent-sample t-test and Chi-square test. RESULTS Sixty CMS patients and 210 IS patients were included. There was no difference between CMS patients and IS or matched IS patients in SEPs latency and amplitude, MEPs amplitude or rate of abnormal SEPs (p > 0.05). Forty-eight CMS patients concurrent with syringomyelia were associated with higher Cobb angle of main curve and lower SEPs amplitude than those without syringomyelia (p < 0.05). No significant difference was found between CMS patients with and without syringomyelia in age, height, SEPs latency, MEPs amplitude or rate of abnormal SEPs (p > 0.05). CONCLUSION Neurologically asymptomatic CMS patients showed similar absolute values of neurophysiological monitoring with IS patients. The syringomyelia in CMS indicated more severe curvature and lower SEPs amplitude even after posterior fossa decompression.
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Kouri I, Kolla BP, Morgenthaler TI, Mansukhani MP. Frequency and outcomes of primary central sleep apnea in a population-based study. Sleep Med 2019; 68:177-183. [PMID: 32044555 PMCID: PMC9272740 DOI: 10.1016/j.sleep.2019.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Primary central sleep apnea (PCSA) is believed to be rare and data regarding its prevalence and long-term outcomes are sparse. We used the Rochester Epidemiology Project (REP) resources to identify all Olmsted County, Minnesota, residents with an incident diagnosis of PCSA and their clinical outcomes. METHODS We searched the REP database for all residents with polysomnography (PSG)-confirmed diagnoses of central sleep apnea (CSA) between 2007 and 2015. From these, we reviewed the PSGs and medical records to find those who had PCSA based upon accepted diagnostic criteria. Data based on detailed review of the medical records, including all clinical notes and tests were recorded for analysis. RESULTS Of 650 patients identified with CSA, 25 (3.8%; 23 male) had PCSA, which was severe in most patients (n = 16, 64%). Of those, 23 (92%) patients were prescribed and 18/23 (78.2%) adherent to positive airway pressure therapy. Median duration of follow-up was 4.4 years (IQR:4.2). Four (16%) patients were subsequently diagnosed with cardiac arrhythmias, one (4%) with unstable angina, two (8%) with heart failure, five (20%) with mild cognitive impairment (MCI)/dementia and two (8%) with depression. Six (25%) patients died (median time to death = 5 years; IQR:4.8), three of whom had Lewy body dementia. CONCLUSIONS In this population-based study, PCSA was rare and when present, was severe in a majority of patients. The mortality rate was high. Most frequently observed disorders during follow-up were mild cognitive impairment (MCI)/dementia followed by cardiac arrhythmias; it is possible that these entities were present and not recognized prior to the diagnosis of PCSA.
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Affiliation(s)
- Ioanna Kouri
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bhanu Prakash Kolla
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Timothy I Morgenthaler
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Fiaschi P, Morana G, Anania P, Rossi A, Consales A, Piatelli G, Cama A, Pavanello M. Tonsillar herniation spectrum: more than just Chiari I. Update and controversies on classification and management. Neurosurg Rev 2019; 43:1473-1492. [DOI: 10.1007/s10143-019-01198-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/04/2019] [Accepted: 10/24/2019] [Indexed: 01/19/2023]
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35
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Capra V, Iacomino M, Accogli A, Pavanello M, Zara F, Cama A, De Marco P. Chiari malformation type I: what information from the genetics? Childs Nerv Syst 2019; 35:1665-1671. [PMID: 31385087 DOI: 10.1007/s00381-019-04322-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/28/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Chiari malformation type I (CMI), a rare disorder of the craniocerebral junction with an estimated incidence of 1 in 1280, is characterized by the downward herniation of the cerebellar tonsils of at least 5 mm through the foramen magnum, resulting in significant neurologic morbidity. Classical CMI is thought to be caused by an underdeveloped occipital bone, resulting in a posterior cranial fossa which is too small to accommodate the normal-sized cerebellum. In this review, we dissect the lines of evidence supporting a genetic contribution for this disorder. METHODS We present the results of two types of approaches: animal models and human studies encompassing different study designs such as whole genome linkage analysis, case-control association studies, and expression studies. The update of the literature also includes the most recent findings emerged by whole exome sequencing strategy. RESULTS Despite evidence for a genetic component, no major genes have been identified and the genetics of CMI is still very much unknown. One major challenge is the variability of clinical presentation within CMI patient population that reflects an underlying genetic heterogeneity. CONCLUSIONS The identification of the genes that contribute to the etiology of CMI will provide an important step to the understanding of the underlying pathology. The finding of a predisposing gene may lead to the development of simple and accurate diagnostic tests for better prognosis, counseling, and clinical management of patients and their relatives.
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Affiliation(s)
- Valeria Capra
- UOC Neurochirurgia, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy
| | - Michele Iacomino
- UOC Neurochirurgia, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy.,UOSD Laboratorio Neurogenetica e Neuroscienze, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy
| | - Andrea Accogli
- UOC Neurochirurgia, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy
| | - Marco Pavanello
- UOC Neurochirurgia, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy
| | - Federico Zara
- UOSD Laboratorio Neurogenetica e Neuroscienze, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy
| | - Armando Cama
- UOC Neurochirurgia, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy
| | - Patrizia De Marco
- UOSD Laboratorio Neurogenetica e Neuroscienze, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy.
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Abstract
BACKGROUND The pathophysiology of Chiari 1 malformation (CM1) is inextricably related to intracranial pressure (ICP). The characteristic cerebellar tonsil herniation at the foramen magnum may either cause raised ICP by disturbing CSF flow (as observed in idiopathic CM1) or may itself be the effect of raised ICP (as observed in acquired CM1). Distinguishing between these two phenomena, therefore, is of paramount importance in successfully alleviating the symptoms of the condition and preventing serious complications. OBJECTIVES In this article, we discuss the pathophysiology of raised ICP in CM1 and review the current evidence for its investigation and treatment. We also share our own clinical experience which investigates the utility of ICP monitoring in a series of 26 children with CM1.
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37
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Gilemkhanova IM, Safin S, Derevyanko K, Gilemkhanov A, Buzaev I. «A case of a pharmacoresistant tachyarrhythmia associated with Arnold-Chiari malformation». Br J Neurosurg 2019; 33:671-672. [PMID: 31556758 DOI: 10.1080/02688697.2019.1668540] [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: 10/25/2022]
Abstract
Introduction: Arnold-Chiari malformation is a group of congenital malformations of the hindbrain. Common symptoms include cephalgia, vestibular, cerebral and cochlear disorders We present a case of pharmacoresistant tachyarrhythmia associated with Arnold-Chiari malformation.Case Description: A 49-year-old female patient had an Arnold-Chiari malformation (ACM), syringomyelia, a retrocerebellar cyst and a 6 year history of tachyarrhythmia. Heart rhythm normalized after Chiari decompression.Conclusion: ACM can lead to heart rhythm disorders.
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Affiliation(s)
- I M Gilemkhanova
- Department of neurosurgery with courses of medical rehabilitation of idpo, Bashkir State Medical University, Ufa, Russian
| | - Shamil Safin
- Department of neurosurgery with courses of medical rehabilitation of idpo, Bashkir State Medical University, Ufa, Russian
| | - Khristina Derevyanko
- Department of neurosurgery with courses of medical rehabilitation of idpo, Bashkir State Medical University, Ufa, Russian.,Clinic of Bashkir State Medical University, Ufa, Russian
| | - Albert Gilemkhanov
- Department of neurosurgery with courses of medical rehabilitation of idpo, Bashkir State Medical University, Ufa, Russian.,Clinic of Bashkir State Medical University, Ufa, Russian
| | - Igor Buzaev
- Republican Cardiology Center Ufa, Ufa, Russian
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Eppelheimer MS, Biswas D, Braun AM, Houston JR, Allen PA, Bapuraj JR, Labuda R, Loth DM, Frim D, Loth F. Quantification of changes in brain morphology following posterior fossa decompression surgery in women treated for Chiari malformation type 1. Neuroradiology 2019; 61:1011-1022. [PMID: 31119343 DOI: 10.1007/s00234-019-02206-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/01/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE While 84% of patients surgically treated for Chiari malformation type 1 (CM1) demonstrate improved quality of life after posterior fossa decompression surgery, there are many risks associated with this surgery. Surgical planning to identify candidates likely to improve postoperatively may benefit from an improved understanding of morphological changes after decompression surgery. To evaluate these changes, we quantified 59 morphological parameters on 42 CM1 adult female patients before and after CM1 decompression surgery. METHODS Fifty-nine morphological parameters in the posterior cranial fossa, cranio-cervical, and intracranial regions in the midsagittal plane were evaluated using 42 T1-weighted magnetic resonance images of female CM1 patients before and after surgery, and 42 healthy female controls. Morphological differences before and after surgery were compared through the development of a technique to establish the opisthion location, a key reference point not present after surgery. RESULTS In addition to the expected reduction of the cranio-caudal dimension of the cerebellum, objective analyses showed a significant increase in the area of the cerebrospinal fluid spaces, posterior (6×) and inferior (2.6×) to the cerebellum (+ 112 ± 102 and + 140 ± 127 mm2, respectively). This increased area was primarily impacted by an average reduction in the occipital bone length of 24.5 ± 7.3 mm following surgery. Based on multiple angles, results demonstrated a 2°-4° anterior rotation of the cerebellum after surgery. CONCLUSION Our results show that decompression surgery results in significant changes in the cerebellum and cerebrospinal fluid spaces. Further investigation should determine how these morphological changes impact clinical outcomes.
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Affiliation(s)
- Maggie S Eppelheimer
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, USA.
| | - Dipankar Biswas
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
| | - Audrey M Braun
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
| | - James R Houston
- Department of Psychology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Philip A Allen
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, OH, USA
| | | | | | - Dorothy M Loth
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, OH, USA
| | - David Frim
- Department of Neurosurgery, University of Chicago, Chicago, IL, USA
| | - Francis Loth
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, USA
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
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Impact of morphological measurements on symptoms in Chiari malformation type 1. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.572881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Salehpour F, Shakeri M, Mirzaei F, Shokouhi B, Kazemzadeh M, Moghadasian N, Naseri Alavi SA. Cystic Degeneration of Cerebellar Tonsil 1 Year After Chiari I Malformation Surgery: A Case Report and Review of the Literature. World Neurosurg 2019; 128:501-505. [PMID: 31077896 DOI: 10.1016/j.wneu.2019.04.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/27/2019] [Accepted: 04/29/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chiari malformation results from a bony structural anomaly of the skull base. The structural defect causes downward displacement of the cerebellar tonsils through the foramen magnum. The herniated tonsils block the normal flow of cerebrospinal fluid, which causes a wide spectrum of clinical symptoms. CASE REPORT In May 2015, a 16-year-old girl was referred to our center because of a 1-year history of occipital headache, most often triggered by exercise and physical activity at school. She had experienced new-onset numbness in both hands, more severe on the right side, associated with some degrees of weakness. Eventually, an evaluation of her condition included magnetic resonance imaging in T1 and T2 sequences, which revealed a 20-mm downward migration of the cerebellar tonsils, associated with a cervical cord syrinx at the level of the fourth and fifth cervical vertebrae. The patient underwent posterior fossa decompression and C1 and partial C2 laminectomies. Postoperatively there were no complications, and the patient was discharged on day 3. Postoperatively, she experienced some improvement in her symptoms. After 2 months of routine outpatient follow-up, she was better, the headaches had subsided, she could resume some activities, and there was no paresis in her limbs. CONCLUSIONS In cases of progressive symptoms of Chiari malformation, surgical decompression is important and should be considered after shunt insertion to the hindbrain.
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Affiliation(s)
- Firooz Salehpour
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Moslem Shakeri
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Mirzaei
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behrooz Shokouhi
- Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Kazemzadeh
- Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nava Moghadasian
- Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ahmad Naseri Alavi
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Affiliation(s)
- Rory J Piper
- Department of Paediatric Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Michael Pike
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Harrington
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Shailendra A Magdum
- Department of Paediatric Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
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Brito JNPDO, dos Santos BA, Nascimento IF, Martins LA, Tavares CB. Basilar invagination associated with chiari malformation type I: A literature review. Clinics (Sao Paulo) 2019; 74:e653. [PMID: 30970117 PMCID: PMC6448527 DOI: 10.6061/clinics/2019/e653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/23/2018] [Indexed: 11/27/2022] Open
Abstract
Basilar invagination (BI) and Chiari malformation type I (CM-I) are very important anomalies that introduce instability and compression in the occipitocervical transition region and have complex clinical characteristics. These anomalies vary according to the affected structures. The present study revises current knowledge regarding the anatomy, anatomo-physiology, clinical manifestations, and radiological findings of these entities and the associated surgical treatment approaches. A bibliographic survey was performed through a search in the Medline, PubMed, SciELO, Science and LILACS databases. When associated, these craniovertebral malformations result in neurological deficits due to neural parenchyma compression; however, the presence of microtraumas due to repetitive lesions caused by the bulb and cervical marrow instability has been highlighted as a determinant dysfunction. Surgical treatment is controversial and has many technical variations. Surgery is also challenging due to the complex anatomical characteristics and biomechanics of this region. Nevertheless, advances have been achieved in our understanding of related mechanisms, and compression and atlantoaxial instability are considered key elements when selecting the surgical approach.
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Affiliation(s)
- José Nazareno Pearce de Oliveira Brito
- Departamento de Neurologia e Neurocirurgia, Faculdade de Ciencias Medicas (FACIME), Universidade Estadual do Piaui, Teresina, PI, BR
- Centro Universitário UNINOVAFAPI, Teresina. PI, BR
- Hospital Sao Marcos, Teresina, PI, BR
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Wang X, Gao J, Wang T, Li Z, Li Y. Clinical Significance of Variable Clivus Gradients in Patients with Chiari Malformation Type I After Surgical Decompression: A Retrospective Analysis. World Neurosurg 2019; 122:e443-e448. [DOI: 10.1016/j.wneu.2018.10.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/25/2022]
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Villa A, Imperato A, Maugeri R, Visocchi M, Iacopino DG, Francaviglia N. Surgical Treatment in Symptomatic Chiari Malformation Type I: A Series of 25 Adult Patients Treated with Cerebellar Tonsil Shrinkage. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:125-131. [PMID: 30610312 DOI: 10.1007/978-3-319-62515-7_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The variety of symptoms and radiological findings in patients with Chiari malformation type I makes both the indication for surgery and the technical modality controversial. We report our 5-year experience, describing our technique and critically evaluating the clinical results. METHODS Between 2012 and 2016, 25 patients (15 female and 10 male; mean age 39.2 years) underwent posterior fossa decompression for Chiari malformation type I. Their clinical complaints included headache, nuchalgia, upper limb weakness or numbness, instability, dizziness and diplopia. Syringomyelia was present in 12 patients (48%). Suboccipital craniectomy was completed in all cases with C1 laminectomy and shrinkage of the cerebellar tonsils by bipolar coagulation; duraplasty was performed with a suturable dura substitute. RESULTS Gratifying results were observed in our series. Symptoms and signs were resolved in 52% of patients, and 20% of patients had an improvement in their preoperative deficits. The symptoms of six patients (24%) were essentially unchanged, and one patient (4%) deteriorated despite undergoing surgery. Generally, patients with syringomyelia on magnetic resonance imaging (MRI) showed less symptomatic improvement after surgery. The syrinx disappeared in seven of 12 patients, and complications occurred in three patients (12%). CONCLUSION Cerebellar tonsil reduction and restoration of cerebrospinal fluid (CSF) circulation provided clinical improvement and a stable reduction in the syrinx size in the vast majority of treated patients, with a low rate of complications.
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Affiliation(s)
- Alessandro Villa
- Division of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy.
| | | | - Rosario Maugeri
- Neurosurgical Clinic, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
| | | | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
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45
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Wang X, Li Y, Gao J, Wang T, Li Z. Charcot arthropathy of the shoulder joint as a presenting feature of basilar impression with syringomyelia: A case report and literature review. Medicine (Baltimore) 2018; 97:e11391. [PMID: 29995782 PMCID: PMC6076164 DOI: 10.1097/md.0000000000011391] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Charcot arthropathy, also known as Neuropathic arthropathy (NA), is an unusual chronic degenerative disease. To date, there exists a paucity of research on NA caused by syringomyelia. PATIENTS CONCERNS A 52-year-old non-diabetic female presented with progressive swelling, pain and limited movement in her left shoulder joint combined with asthenia of her left upper extremity for three months. DIAGNOSES Neuropathic arthropathy of the shoulder associated with the cervicothoracic syrinx and basilar impressions was diagnosed. INTERVENTIONS The treatment is directed to its potential cause to cease its progression. A posterior fossa decompression (PFD) was conducted for this patient. OUTCOMES Postoperatively, the patient's symptoms were relieved and the size of syrinx was reduced at the 6-month follow-up. LESSONS Taken together with 34 previous reports identified from a PubMed search, an analysis of 35 cases of Charcot arthropathy was conducted. Surgical decompression is an effective treatment, but the optimal treatment remains controversial. Thus, the aim of this literature review was to remind us to diagnose the potential cause as early as possible and we should spare no efforts on the exploration of etiology and adjuvant therapy for this disease.
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Díaz Sanhueza C, Pardo Vargas R, Bustos P. Manifestaciones neurológicas asociadas a espina bífida en adultos. Semergen 2018; 44:276-280. [DOI: 10.1016/j.semerg.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/17/2017] [Accepted: 09/22/2017] [Indexed: 11/26/2022]
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de Arruda JA, Figueiredo E, Monteiro JL, Barbosa LM, Rodrigues C, Vasconcelos B. Orofacial clinical features in Arnold Chiari type I malformation: A case series. J Clin Exp Dent 2018; 10:e378-e382. [PMID: 29750100 PMCID: PMC5937955 DOI: 10.4317/jced.54419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/14/2018] [Indexed: 11/05/2022] Open
Abstract
Background Arnold Chiari malformation (ACM) is characterized by an anatomical defect at the base of the skull where the cerebellum and the spinal cord herniate through the foramen magnum into the cervical spinal canal. Among the subtypes of the condition, ACM type I (ACM-I) is particularly outstanding because of the severity of symptoms. This study aimed to analyze the orofacial clinical manifestations of patients with ACM-I, and discuss their demographic distribution and clinical features in light of the literature. Material and Methods A case series with patients with ACM-I treated between 2012 and 2015 was described. The sample consisted of patients who were referred by the Department of Neurosurgery to the Oral and Maxillofacial Surgery Service of Hospital da Restauração in Brazil for the assessment of facial symptomatology. A questionnaire was applied to evaluate the presence of painful orofacial findings. Data are reported using descriptive statistical methods. Results Mean patient age was 39.3 years and the sample consisted mostly of male patients. A high prevalence of headache (50%) and pain in the neck (66.7%) and masticatory muscles (50%) was found. Only one patient reported difficulty in performing mandibular movements and two reported jaw clicking sounds. Mean mouth opening was 40.83 mm. Conclusions ACM-I patients may exhibit orofacial symptoms which may mimic temporomandibular joint disorders. This study brings interesting information that could help clinicians and oral and maxillofacial surgeons to understand this uncommon condition and also help with the diagnosis of patients with similar physical characteristics by referring them to a neurosurgeon. Key words:Arnold-Chiari malformation, facial pain, diagnosis, orofacial.
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Affiliation(s)
- José-Alcides de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - João-Luiz Monteiro
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade de Pernambuco, Camaragibe, PE, Brazil
| | - Livia-Mirelle Barbosa
- Department of Maxillofacial Prosthesis and Surgery, School of Dentistry, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Cleomar Rodrigues
- Department of Oral Imaging, School of Dentistry, Faculdades Integradas da União Educacional do Planalto Central, Brasília, DF, Brazil
| | - Belmiro Vasconcelos
- Hospital da Restauração, Universidade de Pernambuco, Recife, PE, Brazil.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade de Pernambuco, Camaragibe, PE, Brazil
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48
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Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O’Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. SCOLIOSIS AND SPINAL DISORDERS 2018; 13:3. [PMID: 29435499 PMCID: PMC5795289 DOI: 10.1186/s13013-017-0145-8] [Citation(s) in RCA: 412] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines' version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS). METHODS Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016. RESULTS The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing (n = 25), PSSE to prevent scoliosis progression during growth (n = 12), PSSE during brace treatment and surgical therapy (n = 6), other conservative treatments (n = 2), respiratory function and exercises (n = 3), general sport activities (n = 6); and assessment (n = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation "I" and level of evidence "II". Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8. CONCLUSION The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee.
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Affiliation(s)
- Stefano Negrini
- Clinical and Experimental Sciences Department, University of Brescia Viale Europa 11, Brescia, Italy
- IRCCS Fondazione Don Gnocchi, Milan, Italy
| | - Sabrina Donzelli
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
| | - Angelo Gabriele Aulisa
- U.O.C. of Orthopedics and Traumatology, Children’s Hospital Bambino Gesù, Institute of Scientific Research, 00165 Rome, Italy
| | - Dariusz Czaprowski
- Center of Body Posture, Olsztyn, Poland
- Department of Physiotherapy, Józef Rusiecki University College, Olsztyn, Poland
| | - Sanja Schreiber
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Alberta Health Services, Department of Surgery, Edmonton, Canada
| | | | - Helmut Diers
- Department of Orthopedics and Trauma Surgery, University Medical Center, Mainz, Germany
| | - Theodoros B. Grivas
- Department of Orthopaedics and Traumatology, “Tzaneio” General Hospital of Piraeus, Piraeus, Greece
| | - Patrick Knott
- Rosalind Franklin University of Medicine and Science, North Chicago, IL USA
| | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland
| | - Andrea Lebel
- Scoliosis Physiotherapy & Posture Centre, 231 McLeod Street, Ottawa, Ontario K2P0Z8 Canada
| | - Cindy Marti
- Schroth-Barcelona Institute, LLC, Spinal Dynamics of Wisconsin, SC., Barcelona, Spain
| | - Toru Maruyama
- Saitama Prefectural Rehabilitation Center, Saitama, Japan
| | - Joe O’Brien
- National Scoliosis Foundation, Stoughton, MA USA
| | - Nigel Price
- Section of Spine Surgery, Children’s Mercy Hospitals and Clinics, UMKC Orthopedics, Kansas City, MO USA
| | - Eric Parent
- Department of Physical Therapy, 2-50 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Manuel Rigo
- Salvá SLP (E. Salvá Institute), Vía Augusta 185, 08021 Barcelona, Spain
| | - Michele Romano
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
| | - Luke Stikeleather
- National Scoliosis Center, 3023 Hamaker Court, Suite LL-50, Fairfax, VA 22124 USA
| | - James Wynne
- Boston Orthotics & Prosthetics, Boston, MA USA
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
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Low SYY, Lian DWQ, Tang PH, Loh E, Seow WT, Low DCY. Concurrent paediatric medulloblastoma and Chiari I malformation with syringomyelia. Childs Nerv Syst 2017; 33:881-883. [PMID: 28432427 DOI: 10.1007/s00381-017-3413-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. .,Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Derrick W Q Lian
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Phua Hwee Tang
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Eva Loh
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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Patra KC, Kirtane AP. Not all cases of nyctalopia are benign: Unusual and serendipitous presentation of Arnold-Chiari Type 1 malformation at a Pediatric Tertiary Care Center. J Pediatr Neurosci 2016; 11:244-248. [PMID: 27857798 PMCID: PMC5108132 DOI: 10.4103/1817-1745.193358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The Arnold-Chiari Type 1 malformation (CM1) is a rare congenital abnormality characterized by ectopia or caudal herniation of the cerebellar tonsils through the foramen magnum into the cervical spine, resulting in crowding at the craniocervical junction. It seldom presents in childhood with symptoms and a normal neurological examination. More typically, CM1 presents in young adult women with neurological symptoms including a headache, cervical pain, cranial nerve palsies, neurosensory deficit, and ataxia. Ocular manifestations associated with Chiari I include third and sixth cranial nerve paresis and convergence/divergence abnormalities. Papilledema is a rare manifestation of Chiari I with a clinical presentation often similar to that of idiopathic intracranial hypertension. To underscore this noteworthy complication, the authors report a case of an 8-year-old boy who presented with nyctalopia and suboccipital headaches, but was diagnosed serendipitously as a case of papilledema due to Chiari I malformation.
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Affiliation(s)
- Kailash Chandra Patra
- Department of Pediatrics, ESI PGIMSR, ESIC Model Hospital, Mumbai, Maharashtra, India
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