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Ibrahimy A, Wu T, Mack J, Scott GC, Cortes MX, Cantor FK, Loth F, Heiss JD. Prospective, Longitudinal Study of Clinical Outcome and Morphometric Posterior Fossa Changes after Craniocervical Decompression for Symptomatic Chiari I Malformation. AJNR Am J Neuroradiol 2023; 44:1150-1156. [PMID: 37709353 PMCID: PMC10549945 DOI: 10.3174/ajnr.a7993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/16/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND PURPOSE The time course of changes in posterior fossa morphology, quality of life, and neurologic function of patients with Chiari I malformation after craniocervical decompression requires further elaboration. To better understand the pace of these changes, we longitudinally studied patients with Chiari I malformation, with or without syringomyelia, before and after the operation for up to 5 years. MATERIALS AND METHODS Thirty-eight symptomatic adult patients (35 women, 3 men) diagnosed with Chiari I malformation only (n = 15) or Chiari I malformation and syringomyelia (n = 23) and without previous Chiari I malformation surgery were enrolled in a clinical study. Patients underwent outpatient study visits and MR imaging at 7 time points (ie, initial [before the operation], 3 months, 1 year, 2 years, 3 years, 4 years, and 5 years) during 5 years. The surgical procedure for all patients was suboccipital craniectomy, C1 laminectomy, and autologous duraplasty. RESULTS Morphometric measurements demonstrated an enlargement of the CSF areas posterior to the cerebellar tonsils after the operation, which remained largely stable through the following years. There was a decrease in pain and improved quality of life after the operation, which remained steady during the following years. Reduction in pain and improved quality of life correlated with CSF area morphometrics. CONCLUSIONS Most changes in MR imaging morphometrics and quality of life measures occurred within the first year after the operation. A 1-year follow-up period after Chiari I malformation surgery is usually sufficient for evaluating surgical efficacy and postoperative MR imaging changes.
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Affiliation(s)
- Alaaddin Ibrahimy
- From the Surgical Neurology Branch (A.I., J.M., G.C.S., M.X.C., F.K.C., J.D.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
- Department of Biomedical Engineering (A.I.), Yale University, New Haven, Connecticut
| | - Tianxia Wu
- Clinical Trials Unit (T.W.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Jessica Mack
- From the Surgical Neurology Branch (A.I., J.M., G.C.S., M.X.C., F.K.C., J.D.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Gretchen C Scott
- From the Surgical Neurology Branch (A.I., J.M., G.C.S., M.X.C., F.K.C., J.D.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Michaela X Cortes
- From the Surgical Neurology Branch (A.I., J.M., G.C.S., M.X.C., F.K.C., J.D.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Fredric K Cantor
- From the Surgical Neurology Branch (A.I., J.M., G.C.S., M.X.C., F.K.C., J.D.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Francis Loth
- Departments of Mechanical and Industrial Engineering, and Bioengineering (F.L.), Northeastern University College of Engineering, Boston, Massachusetts
| | - John D Heiss
- From the Surgical Neurology Branch (A.I., J.M., G.C.S., M.X.C., F.K.C., J.D.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Karadag MK, Akyuz ME, Sahin MH. The role of ONSD in the assessment of headache associated with Chiari malformation type 1. Front Neurol 2023; 14:1127279. [PMID: 36824423 PMCID: PMC9941673 DOI: 10.3389/fneur.2023.1127279] [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: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Background Cough associated headache is the most common symptom in Chiari malformation type 1 (CM1). However, its pathophysiology and treatment are not clear. The aim of this study was to investigate the relationship between optic nerve sheath diameter (ONSD), an indicator of intracranial pressure, and headache and to investigate its predictive value on postoperative outcome. Methods In symptomatic CM1 patients, craniovertebral junction morphometric measurements and ONSD measurements were made from preoperative MR images, and headache intensities and characteristics were evaluated. After different surgical procedures, the clinical characteristics of the patients were evaluated according to the Chicago Chiari Outcome Scale, the change in headache intensity was assessed and the relationship with ONSD was evaluated. Results Preoperative headache intensity was significantly correlated with ONSD measurement (p < 0.01). Modified clivoaxial angle and ONSD were independent predictors of postoperative clinical outcome (p < 0.01). The procedure that achieved the greatest surgical enlargement of the foramen Magnum stenosis provided the best clinical outcome. Postoperative reduction in headache intensity and ONS diameter were correlated (p < 0.01). Conclusion The fact that ONSD is found to be wide in the preoperative period in CM1 patients indicates that the intracranial pressure is permanently high. This diameter increase is correlated with headache and is a valuable guide in the selection of the appropriate treatment method.
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Zisakis A, Sun R, Pepper J, Tsermoulas G. Chiari Malformation Type 1 in Adults. Adv Tech Stand Neurosurg 2023; 46:149-173. [PMID: 37318574 DOI: 10.1007/978-3-031-28202-7_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The term Chiari malformation refers to a heterogeneous group of anatomical abnormalities at the craniovertebral junction. Chiari malformation type 1 (CM1) refers to the abnormal protrusion of cerebellar tonsils through the foramen magnum and is by far the commonest type. Its prevalence is estimated approximately 1%; it is more common in women and is associated with syringomyelia in 25-70% of cases. The prevalent pathophysiological theory proposes a morphological mismatch between a small posterior cranial fossa and a normally developed hindbrain that results in ectopia of the tonsils.In most people, CM1 is asymptomatic and diagnosed incidentally. In symptomatic cases, headache is the cardinal symptom. The typical headache is induced by Valsalva-like maneuvers. Many of the other symptoms are nonspecific, and in the absence of syringomyelia, the natural history is benign. Syringomyelia manifests with spinal cord dysfunction of varying severity. The approach to patients with CM1 should be multidisciplinary, and the first step in the management is phenotyping the symptoms, because they may be due to other pathologies, like a primary headache syndrome. Magnetic resonance imaging, which shows cerebellar tonsillar decent 5 mm or more below the foramen magnum, is the gold standard investigative modality. The diagnostic workup may include dynamic imaging of the craniocervical junction and intracranial pressure monitoring.The management of CM1 is variable and sometimes controversial. Surgery is usually reserved for patients with disabling headaches or neurological deficits from the syrinx. Surgical decompression of the craniocervical junction is the most widely used procedure. Several surgical techniques have been proposed, but there is no consensus on the best treatment strategy, mainly due to lack of high-quality evidence. The management of the condition during pregnancy, restriction to lifestyle related to athletic activities, and the coexistence of hypermobility require special considerations.
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Affiliation(s)
- Athanasios Zisakis
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham, Birmingham, UK
| | - Rosa Sun
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham, Birmingham, UK
| | - Joshua Pepper
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham, Birmingham, UK
| | - Georgios Tsermoulas
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham, Birmingham, UK.
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
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Lin WW, Liu TJ, Dai WL, Wang QW, Hu XB, Gu ZW, Zhu YJ. Diagnostic performance evaluation of adult Chiari malformation type I based on convolutional neural networks. Eur J Radiol 2022; 151:110287. [DOI: 10.1016/j.ejrad.2022.110287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 03/02/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
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Abstract
BACKGROUND: Post-traumatic headache is the most common sequela of brain injury and can last months or years after the damaging event. Many headache types are associated with visual concerns also known to stem from concussion. OBJECTIVES: To describe the various headache types seen after head injury and demonstrate how they impact or are impacted by the visual system. METHODS: We will mirror the International Classification of Headache Disorders (ICHD) format to demonstrate the variety of headaches following brain injury and relate correlates to the visual pathways. The PubMed database was searched using terms such as headache, head pain, vision, concussion, traumatic brain injury, glare, visuomotor pathways. RESULTS: Every type of headache described in the International Classification of Headache Disorders Edition III can be initiated or worsened after head trauma. Furthermore, there is very often a direct or indirect impact upon the visual system for each of these headaches. CONCLUSION: Headaches of every described type in the ICHD can be caused by brain injury and all are related in some way to the afferent, efferent or association areas of the visual system.
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Affiliation(s)
- Patrick T. Quaid
- Head of Optometry, VUE Cubed Vision Therapy Clinics, ON, Canada
- College of Optometrists of Ontario (Regulatory Body), ON, Canada
| | - Eric L. Singman
- Ophthalmology & Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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Evaluation Of Cervical Sagittal Parameters On Supine Magnetic Resonance Imaging In Patients With Chiari I Malformation Without Syringomyelia. Neurochirurgie 2022; 68:504-509. [PMID: 35525315 DOI: 10.1016/j.neuchi.2022.04.007] [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: 02/04/2022] [Revised: 03/27/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE . The current study aimed to assess the effects of tonsillar herniation on cervical alignment in Chiari I patients without syringomyelia using new cervical sagittal alignment parameters, such as C0-2 Cobb angle, C2-7 cobb angle, T1 slope, and C2-7 sagittal vertical axis (SVA). METHODS Two spinal surgeons independently evaluated midline T2-weighted sagittal magnetic resonance imaging findings of 28 Chiari I patients without syringomyelia and 40 patients without tonsillar herniation but with similar complaints. Thereafter, the measured C0-2 Cobb angle, C2-7 Cobb angle T1 slope, and C2-7 SVA were compared using the t-test. RESULTS Differences in the mean values for C2-7 Cobb angle, T1 slope, and C2-7 SVA were found between Chiari I patients and those without tonsillar herniation Conclusion: The current study showed that Chiari I patients were less lordotic (kyphotic) compared to subjects without tonsillar herniation.
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Labuda R, Nwotchouang BST, Ibrahimy A, Allen PA, Oshinski JN, Klinge P, Loth F. A new hypothesis for the pathophysiology of symptomatic adult Chiari malformation Type I. Med Hypotheses 2022; 158. [PMID: 34992329 PMCID: PMC8730378 DOI: 10.1016/j.mehy.2021.110740] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chiari malformation Type I (CMI) is characterized by herniation of the cerebellar tonsils through the foramen magnum. The pathophysiology of CMI is not well elucidated; however, the prevailing theory focuses on the underdevelopment of the posterior cranial fossa which results in tonsillar herniation. Symptoms are believed to be due to the herniation causing resistance to the natural flow of cerebrospinal fluid (CSF) and exerting a mass effect on nearby neural tissue. However, asymptomatic cases vastly outnumber symptomatic ones and it is not known why some people become symptomatic. Recently, it has been proposed that CMI symptoms are primarily due to instability of either the atlanto-axial (AA) or the atlanto-occipital (AO) joint and the cerebellar tonsils herniate to prevent mechanical pinching. However, only a small percentage of patients exhibit clinical instability and these theories do not account for asymptomatic herniations. We propose that the pathophysiology of adult CMI involves a combination of craniocervical abnormalities which leads to tonsillar herniation and reduced compliance of the cervical spinal canal. Specifically, abnormal AO and/or AA joint morphology leads to chronic cervical instability, often subclinical, in a large portion of CMI patients. This in turn causes overwork of the suboccipital muscles as they try to compensate for the instability. Over time, the repeated, involuntary activation of these muscles leads to mechanical overload of the myodural bridge complex, altering the mechanical properties of the dura it merges with. As a result, the dura becomes stiffer, reducing the overall compliance of the cervical region. This lower compliance, combined with CSF resistance at the same level, leads to intracranial pressure peaks during the cardiac cycle (pulse pressure) that are amplified during activities such as coughing, sneezing, and physical exertion. This increase in pulse pressure reduces the compliance of the cervical subarachnoid space which increases the CSF wave speed in the spinal canal, and further increases pulse pressure in a feedback loop. Finally, the abnormal pressure environment induces greater neural tissue motion and strain, causing microstructural damage to the cerebellum, brainstem, and cervical spinal cord, and leading to symptoms. This hypothesis explains how the combination of craniocervical bony abnormalities, anatomic CSF restriction, and reduced compliance leads to symptoms in adult CMI.
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Affiliation(s)
- Rick Labuda
- Conquer Chiari, 320 Osprey Ct., Wexford, PA 15090, United States
| | - Blaise Simplice Talla Nwotchouang
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, 264 Wolf Ledges Pkwy Rm 211b, Akron, OH 44325, United States
| | - Alaaddin Ibrahimy
- Department of Biomedical Engineering, Yale University, 17 Hillhouse Avenue, New Haven, CT 06520, United States
| | - Philip A Allen
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, 302 Buchtel Hall, Akron, OH 44325, United States
| | - John N Oshinski
- Department of Radiology & Imaging Sciences, Emory University School of Medcinece, Atlanta, GA 30322, United States
| | - Petra Klinge
- The Warren Alpert Medical School of Brown University, United States
| | - Francis Loth
- Department of Mechanical & Industrial Engineering, Department of Bioengineering, Northeastern University, 334 Snell Engineering, 360 Huntington Ave, Boston, MA 02115, United States
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Pepper J, Elhabal A, Tsermoulas G, Flint G. Symptom outcome after craniovertebral decompression for Chiari type 1 malformation without syringomyelia. Acta Neurochir (Wien) 2021; 163:239-244. [PMID: 33130986 DOI: 10.1007/s00701-020-04631-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Specific symptom outcomes after craniovertebral decompression for patients with Chiari type 1 malformation, without accompanying syringomyelia, are not well characterised and poorly reported. METHODS We performed a retrospective review of all patients diagnosed with Chiari type 1, without syringomyelia, who underwent craniovertebral decompression in our unit. RESULTS We identified 129 individuals with a minimum of 2 years' follow-up. The most common pre-operative symptoms were pressure dissociation headaches (78%), visual disturbances (33%), dizziness/balance disturbances (24%) and blackouts (17%). The symptoms most likely to respond to surgery included Valsalva-induced headache (74% response, p < 0.0001) and blackouts (86% response, p < 0.001). CONCLUSIONS After successful craniovertebral decompression, most patients presenting with pressure dissociation headaches and blackouts will improve. However, the large variety of other symptoms patients often present with may not improve after surgery.
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Affiliation(s)
- Joshua Pepper
- Department of Neurosurgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, B29 4AB, UK.
| | - Ahmed Elhabal
- Department of Neurosurgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, B29 4AB, UK
| | - Georgios Tsermoulas
- Department of Neurosurgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, B29 4AB, UK
| | - Graham Flint
- Department of Neurosurgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, B29 4AB, UK
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Naessig S, Kapadia BH, Para A, Ahmad W, Pierce K, Janjua B, Vira S, Diebo B, Sciubba D, Passias PG. Timing to surgery of Chiari malformation type 1 affects complication types: An analysis of 13,812 patients. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:232-236. [PMID: 33100774 PMCID: PMC7546060 DOI: 10.4103/jcvjs.jcvjs_67_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Chiari malformations (CM) are congenital defects due to hypoplasia of the posterior fossa with cerebellar herniation into the foramen magnum and upper spinal canal. Despite the vast research done on this neurological and structural syndrome, clinical features and management options have not yet conclusively evolved. Quantification of proper treatment planning, can lead to potential perioperative benefits based on diagnoses and days to procedure. This study aims to identify if early operation produces better perioperative outcomes or if there are benefits to delaying CM surgery. Aims and Objective: Assess outcomes for Chiari type I. Methods: The KID database was queried for diagnoses of Chiari Malformation from 2003-2012 by icd9 codes (348.4, 741.0, 742.0, 742.2). Included patients: had complete time to procedure (TTP) data. Patients were stratified into 7 groups by TTP: Same-day as admission (SD), 1-day delay (1D), 2-day delay (2D), 3-day delay (3D), 4-7 days delay (4-7D), 8-14 days delay (8-14D), >14 days delay (>14D). Differences in pre-operative demographics (age/BMI) and perioperative complication rates between patient cohorts were assessed using Pearson's chi-squared tests and T-tests. Surgical details, perioperative complications, length of stay (LOS), total charges, and discharge disposition was compared. Binary logistic regressions determined independent predictors of varying complications (reference: same-day). Results: 13,812 Chiari type I patients were isolated from KID (10.12 ± 6.3, 49.2F%, .063 ± 1.3CCI). CM-1 pts were older (10.12 yrs vs 3.62 yrs) and had a higher Charlson Comorbidity Score (0.62 vs 0.53; all P < 0.05). Procedure rates: 27.8% laminectomy, 28.3% decompression, and 2.2% spinal fusion. CM-1 experienced more complications (61.2% vs 37.9%) with the most common being related to the nervous system (2.8%), anemia (2.4%), acute respiratory distress disorder (2.1%), and dysphagia (1.2%). SD was associated with the low length of stay (5.3 days vs 9.5-25.2 days, P < 0.001), total hospital charges ($70,265.44 vs $90, 945.33-$269, 193.26, P < 0.001) when compared to other TTP groups. Relative to SD, all delay groups had significantly increased odds of developing postoperative complications (1D-OR: 1.29 [1.1- 1.6] → 8-14D-OR: 4.77[3.4-6.6]; all P < 0.05), more specifically, nervous system (1D-OR: 1.8 [1.2-2.5] → 8-14D-OR: 3.3 [1.8-6.2]; all P < 0.05).Sepsis complications were associated with a delay of at least 3D(2.5[1.4-4.6]) while respiratory complications (6.2 [3.1-12.3]) and anemia (2 [1.1-3.5]) were associated with a delay of at least 8-14D (all P < 0.05).
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Affiliation(s)
- Sara Naessig
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, USA
| | - Bhaveen H Kapadia
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, USA
| | - Ashok Para
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, USA
| | - Waleed Ahmad
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, USA
| | - Katherine Pierce
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, USA
| | - Burhan Janjua
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, USA
| | - Shaleen Vira
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, USA
| | - Bassel Diebo
- Department of Orthopedics, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Gust Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, USA
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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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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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Chiari I malformation: surgical technique, indications and limits. Acta Neurochir (Wien) 2018; 160:213-217. [PMID: 29130121 DOI: 10.1007/s00701-017-3380-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chiari malformation type I (CM-I) is a rare disease characterised by herniation of cerebellar tonsils below the foramen magnum with associated anomalies of posterior fossa. We describe here the surgical technique, indications and limits of surgical treatment. METHOD The authors describe the surgical technique, including: posterior fossa decompression, opening of the foramen of Magendie and duraplasty in case of CM-I. CONCLUSIONS Posterior fossa decompression plus duraplasty is a safe and effective procedure for patients with CM-I malformation.
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