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Comparison of posterior cranial fossa morphometric measurements in Chiari type I patients with and without syrinx cavity on magnetic resonance imaging. Pol J Radiol 2022; 87:e694-e700. [PMID: 36643005 PMCID: PMC9834072 DOI: 10.5114/pjr.2022.123895] [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: 02/12/2022] [Accepted: 06/15/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To compare the posterior fossa measurements of Chiari type I malformation (CHM1) patients with and without syrinx and with a control group. Material and methods The patients with syrinx were divided into 2 groupd according to syrinx width/cord width (S/C) ratios: group 1 - S/C ratio < 50%; group 2 - S/C ratio > 50%. The length of the clivus, the AP length of the foramen magnum, the AP length of the posterior fossa, the perpendicular distance between the McRae line and (a) the splenium of corpus callosum, (b) the pons, and (c) the fastigium of the 160 patients and of the 160 control patients were statistically compared. In addition, the measurements of the patients with and without syrinx, according to the S/C ratio, were statistically compared. Results Syrinx was present in 59 (36.8 %) of the 160 patients. The S/C ratio was < 50% in 30 (50.9 %) of them, and S/C ratio > 50% in 29 (49.1%) of them. All the measurements in the patient group, except of the AP length of the foramen magnum, were statistically significantly lower than in the control group (p = 0.001). There was no significant difference in the measurements of the patients with syrinx group 1 and the patients without syrinx, but the AP length of posterior fossa was statistically significantly lower in the patients with syrinx group 2 than the patients without syrinx (p = 0.03). Conclusion The S/C ratio can be a guide to the underlying aetiology.
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The Small Posterior Cranial Fossa Syndrome and Chiari Malformation Type 0. J Clin Med 2022; 11:jcm11185472. [PMID: 36143119 PMCID: PMC9503629 DOI: 10.3390/jcm11185472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Patients showing typical Chiari malformation type 1 (CM1) signs and symptoms frequently undergo cranial and cervical MRI. In some patients, MRI documents >5 mm of cerebellar tonsillar herniation (TH) and the diagnosis of CM1. Patients with 3−5 mm TH have “borderline” CM1. Patients with less than 3 mm of TH and an associated cervical syrinx are diagnosed with Chiari “zero” malformation (CM0). However, patients reporting CM1 symptoms are usually not diagnosed with CM if MRI shows less than 3−5 mm of TH and no syrinx. Recent MRI morphometric analysis of the posterior fossa and upper cervical spine detected anatomical abnormalities in and around the foramen magnum (FM) that explain these patients’ symptoms. The abnormalities include a reduced size of the posterior fossa, FM, and upper cervical spinal canal and extension of the cerebellar tonsils around the medulla rather than inferior to the foramen magnum, as in CM1. These morphometric findings lead some neurologists and neurosurgeons to diagnose CM0 in patients with typical CM1 signs and symptoms, with or without cervical syringes. This article reviews recent findings and controversies about CM0 diagnosis and updates current thinking about the clinical and radiological relationship between CM0, borderline CM1, and CM1.
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Craniometric Analysis of Skullbase With Magnetic Resonance Imaging in Patients With Chiari Malformation. J Craniofac Surg 2019; 30:818-822. [PMID: 31048611 DOI: 10.1097/scs.0000000000005171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Basilar invagination, Platibasi, increased tentorium angle, and posterior fossa hypoplasia are the anomalies associated with Chiari malformation. When Chiari is symptomatic; tonsillary ectopenia appears to be a definitive criterion for diagnosis and treatment, the detection of additional anomaly may alter the surgical outcome. The aim of this study is to investigate the relationship between tonsillar ectopia and other anomalies.The authors retrospectively reviewed 31 cases which had Chiari Malformation at our Hospital. There were 8 men (25.8%) and 23 female (74.2%). Average age of the samples is 37.93 ± 12.93 years. Seventeen patients (54.8%) had tonsillar ectopia 0 to 5 mm, 14 patients had tonsillar ectopia over 5 mm. Seven patients had syrinx (22.6%), 2 patients had mild hydrocephalus (6.5%). Six patients had surgery for the treatment. The mean length of the clivus was 39.3 mm, supraoksiput length was 40.4 mm, cerebellar hemisphere length was 61.08 mm, Mc Rae line was 33.14 mm, Twinning Line was 79.4mm, and Tentorium-Twinning line angle was 40.35°. There was no significant difference between Tonsillar ectopia, syrinks, and hydrocephalus. Basilar invagination had relationship between platibasi (6 patients had platibasi according to 2 mm criteria, 2 patients had platibasi according to 5 mm criteria (P < 0.05). Patients with syrinx had relationship between Chamberlain line (P < 0.05).In the authors' study, although there was no statistically significant difference between the tonsillary ectopia and the criteria of these anomalies, the relationship between basilar invagination and platibasi was significant.
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Rutan E, Madan N, Zea R, Haughton V. Spinal subarachnoid space tapering in patients with syringomyelia. Neuroradiol J 2019; 32:382-385. [PMID: 31159654 DOI: 10.1177/1971400919854695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Cervical spine tapering affects cerebrospinal fluid dynamics. Cervical spine taper ratios derived from anteroposterior diameters reportedly differ between patients with syringomyelia and controls. We attempted to verify the differences in diameter and to show differences in cross-sectional area between syringomyelia and controls. METHODS Cervical spine magnetic resonance images in syringomyelia patients (idiopathic or Chiari I related) and control patients were examined. In each subject, the anteroposterior diameter of the spinal canal was measured at each cervical level, and C1-C4, C4-C7, and C1-C7 taper ratios were calculated. Differences in taper ratio between groups were tested for statistical significance with the t-test. Cross-sectional areas of the spinal canal were measured at each cervical spinal level, and tapering was calculated. RESULTS Eighteen patients with idiopathic syringomyelia, 28 with Chiari I, and 29 controls were studied. Chiari and syringomyelia patients had significantly steeper diameter-based taper ratios than controls. The dural sac areas tapered proportionally with the diameter-based taper ratio in all groups. CONCLUSIONS Cervical spine anteroposterior diameter tapering and dural sac cross-sectional areas tapering differ between syringomyelia patients and controls.
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Affiliation(s)
- Emily Rutan
- 2 Tufts University School of Medicine, Medstar Health, USA
| | - Neel Madan
- 3 Department of Radiology, Tufts Medical Center, USA
| | - Ryan Zea
- 1 Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, USA
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Abstract
Background Spinal canal tapering, which can be measured as taper ratios, affects cerebrospinal fluid flow dynamics. We calculated the tolerance interval for normal cervical spine taper ratios to facilitate the detection of abnormal taper ratios. Methods We collected a series of patients who had cervical spine magnetic resonance studies reported as normal. We measured anteroposterior diameters of the cervical spine and calculated C1-C4, C4-C7, and C1-C7 taper by standard methodology. We calculated the normal tolerance limits for taper ratios and compared results of this study with data in previous reports on taper ratios. Results We enrolled 78 patients aged 2-55 years. The 99% tolerance limits for the taper ratios for C1-C4, C4-C7, and C1-C7 were -0.31 to +0.09, -0.11 to +0.14, and -0.13 to +0.05 cm/level, respectively. Age and sex were not significant variables for taper ratios. Taper ratios in this study agreed with those reported for controls in previous studies. Patients with syringomyelia in previous reports tended to have taper ratios outside the normal tolerance limits. Conclusion Normal limits of the cervical taper ratios are reported.
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Affiliation(s)
- Adrienne Thompson
- 1 University of Alberta, Edmonton, Canada.,2 Walter C. Mackenzie Health Sciences Centre, Edmonton, Canada
| | - Ryan Zea
- 3 Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, USA
| | - Victor Haughton
- 4 School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
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Thakar S, Kurudi Siddappa A, Aryan S, Mohan D, Sai Kiran NA, Hegde AS. Does the mesodermal derangement in Chiari Type I malformation extend to the cervical spine? Evidence from an analytical morphometric study on cervical paraspinal muscles. J Neurosurg Spine 2017; 27:421-427. [DOI: 10.3171/2016.12.spine16914] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe mesodermal derangement in Chiari Type I malformation (CMI) has been postulated to encompass the cervical spine. The objectives of this study were to assess the cross-sectional areas (CSAs) of cervical paraspinal muscles (PSMs) in patients with CMI without syringomyelia, compare them with those in non-CMI subjects, and evaluate their correlations with various factors.METHODSIn this retrospective study, the CSAs of cervical PSMs in 25 patients were calculated on T2-weighted axial MR images and computed as ratios with respect to the corresponding vertebral body areas. These values and the cervical taper ratios were then compared with those of age- and sex-matched non-CMI subjects and analyzed with respect to demographic data and clinicoradiological factors.RESULTSCompared with the non-CMI group, the mean CSA values for the rectus capitis minor and all of the subaxial PSMs were lower in the study group, and those of the deep extensors were significantly lower (p = 0.004). The cervical taper ratio was found to be significantly higher in the study cohort (p = 0.0003). A longer duration of symptoms and a steeper cervical taper ratio were independently associated with lower CSA values for the deep extensors (p = 0.04 and p = 0.03, respectively). The presence of neck pain was associated with a lower CSA value for the deep flexors (p = 0.03).CONCLUSIONSPatients with CMI demonstrate alterations in their cervical paraspinal musculature even in the absence of coexistent syringomyelia. Their deep extensor muscles undergo significant atrophic changes that worsen with the duration of their symptoms. This could be related to a significantly steeper cervical taper ratio that their cervical cords are exposed to. Neck pain in these patients is related to atrophy of their deep flexor muscles. A steeper cervical taper ratio and alterations in the PSMs could be additional indicators for surgery in patients with CMI without syringomyelia.
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Gadde JA, Shah V, Liebo GB, Ringstad GA, Pomeraniec IJ, Bakke SJ, Fric R, Ksendzovsky A, Jane JA, Schwartz ES, Haughton V. Anatomical features of the cervical spinal canal in Chiari I deformity with presyrinx: A case-control study. Neuroradiol J 2017; 30:405-409. [PMID: 28691569 DOI: 10.1177/1971400917718842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The relationship between syringomyelia and presyrinx, characterized by edema in the spinal cord, has not been firmly established. Patients with syringomyelia have abnormal spinal canal tapering that alters cerebrospinal fluid flow dynamics, but taper ratios in presyrinx have never been reported. We tested the hypothesis that presyrinx patients have abnormal spinal canal tapering. Materials and methods At six medical institutions, investigators searched the PACS system for patients with Chiari I and spinal cord edema unassociated with tumor, trauma, or other evident cause. In each case taper ratios were calculated for C1 to C4 and C4 to C7. In two age- and gender-matched control groups, Chiari I patients with no syringomyelia and patients with normal MR scans, the same measurements were made. Differences between groups were tested for statistical significance with t tests. Results The study enrolled 21 presyrinx patients and equal numbers of matched Chiari I and normal controls. C4 to C7 taper ratios were positive and steeper in presyrinx patients than in the normal controls ( p = 0.04). The upper cervical spine, C1 to C4, tapered negatively in cases and controls without significant differences between the groups. The difference in degree of tonsillar herniation was statistically significant between presyrinx patients and Chiari I controls ( p = 0.01). Conclusions Presyrinx patients have greater than normal positive tapering in the lower cervical spine and greater degree of tonsillar herniation than the controls.
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Affiliation(s)
- Judith A Gadde
- 1 Department of Radiology, The Children's Hospital of Philadelphia, USA
| | - Vinil Shah
- 2 Department of Radiology, University of California San Francisco, USA
| | | | - Geir A Ringstad
- 4 Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - I Jonathan Pomeraniec
- 5 Department of Neurological Surgery, University of Virginia Health System, USA.,6 Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, USA
| | - Soren J Bakke
- 7 Department of Neuroradiology, Oslo University Hospital, Norway
| | - Radek Fric
- 8 Department of Neurosurgery, Oslo University Hospital, Norway
| | - Alexander Ksendzovsky
- 5 Department of Neurological Surgery, University of Virginia Health System, USA.,6 Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, USA
| | - John A Jane
- 5 Department of Neurological Surgery, University of Virginia Health System, USA
| | - Erin S Schwartz
- 1 Department of Radiology, The Children's Hospital of Philadelphia, USA
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Yan H, Han X, Jin M, Liu Z, Xie D, Sha S, Qiu Y, Zhu Z. Morphometric features of posterior cranial fossa are different between Chiari I malformation with and without syringomyelia. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2202-9. [PMID: 26821142 DOI: 10.1007/s00586-016-4410-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate whether the posterior cranial fossa (PCF) morphology in Chiari I malformation without syringomyelia (also called syrinx) (CMI-only) is different from that in Chiari I malformation with syrinx (CMI-S). METHODS Nineteen CMI patients without syrinx constituted the CMI-only group, whereas 48 CMI patients with syrinx were assigned to the CMI-S group. Another cohort of 40 age-matched asymptomatic adolescents was enrolled to serve as the control group. Six measurements were evaluated and compared between these three groups from T1-weighted magnetic resonance (MR) imaging, including the length of the clivus (AB), the anteroposterior diameter of the foramen magnum (BC), the length of the supraocciput (CD), the anteroposterior diameter of the posterior fossa (DA), the posterior fossa height (BE) and the clivus gradient ([Formula: see text]). The posterior cranial fossa morphology in relation to syrinx severity was also investigated. RESULTS Compared to the normal controls, the AB, CD, DA, BE and [Formula: see text] were significantly larger in the CMI-S group. Similar changes in AB, CD, DA and BE were also demonstrated in the CMI-only group, while the clivus gradient ([Formula: see text]) was found to be normal when compared with the control group. A significantly decreased clivus gradient was observed in the CMI-S group as compared to CMI-only group. In addition, the clivus was significantly flattened in patients with a distended-syrinx in comparison to those with a non-distended syrinx. CONCLUSIONS Small size of the posterior fossa was detected both in CMI cases with and without syrinx. The clivus gradient served as the only morphologic difference in the PCF between CMI-S and CMI-only patients and was correlated with the severity of the syrinx, may support the theory that the restricted circulation of cerebrospinal fluid at the anterior paramedial subarachnoid space contributes to the formation of a syrinx.
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Affiliation(s)
- Huang Yan
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Xiao Han
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Mengran Jin
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Zhen Liu
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Dingding Xie
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Shifu Sha
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Yong Qiu
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Zezhang Zhu
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China.
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Thompson A, Madan N, Hesselink JR, Weinstein G, Munoz del Rio A, Haughton V. The Cervical Spinal Canal Tapers Differently in Patients with Chiari I with and without Syringomyelia. AJNR Am J Neuroradiol 2015; 37:755-8. [PMID: 26585256 DOI: 10.3174/ajnr.a4597] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 09/15/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The cause of syringomyelia in patients with Chiari I remains uncertain. Cervical spine anatomy modifies CSF velocities, flow patterns, and pressure gradients, which may affect the spinal cord. We tested the hypothesis that cervical spinal anatomy differs between Chiari I patients with and without syringomyelia. MATERIALS AND METHODS We identified consecutive patients with Chiari I at 3 institutions and divided them into groups with and without syringomyelia. Five readers measured anteroposterior cervical spinal diameters, tonsillar herniation, and syrinx dimensions on cervical MR images. Taper ratios for C1-C7, C1-C4, and C4-C7 spinal segments were calculated by linear least squares fitting to the appropriate spinal canal diameters. Mean taper ratios and tonsillar herniation for groups were compared and tested for statistical significance with a Kruskal-Wallis test. Inter- and intrareader agreement and correlations in the data were measured. RESULTS One hundred fifty patients were included, of which 49 had syringomyelia. C1-C7 taper ratios were smaller and C4-C7 taper ratios greater for patients with syringomyelia than for those without it. C1-C4 taper ratios did not differ significantly between groups. Patients with syringomyelia had, on average, greater tonsillar herniation than those without a syrinx. However, C4-C7 taper ratios were steeper, for all degrees of tonsil herniation, in patients with syringomyelia. Differences among readers did not exceed differences among patient groups. CONCLUSIONS The tapering of the lower cervical spine may contribute to the development of syringomyelia in patients with Chiari I.
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Affiliation(s)
- A Thompson
- From the Departments of Radiology (A.T., A.M.d.R., V.H.)
| | - N Madan
- Department of Radiology (N.M., G.W.), Tufts University School of Medicine, Boston, Massachusetts
| | - J R Hesselink
- Department of Radiology (J.R.H.), University of California San Diego, San Diego, California
| | - G Weinstein
- Department of Radiology (N.M., G.W.), Tufts University School of Medicine, Boston, Massachusetts
| | - A Munoz del Rio
- From the Departments of Radiology (A.T., A.M.d.R., V.H.) Medical Physics (A.M.d.R.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - V Haughton
- From the Departments of Radiology (A.T., A.M.d.R., V.H.)
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