Atlantoaxial Fixation for Chiari 1 Formation in Pediatric Age-Group Patients: Report of Treatment in 33 Patients

Goel, Atul; Gore, Sandeep; Shah, Abhidha; Dharurkar, Pralhad; Vutha, Ravikiran; Patil, Abhinandan

doi:10.1016/j.wneu.2017.12.137

Cited by 35 publications

(36 citation statements)

References 32 publications

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“…Goel et al also described that atlantoaxial instability could cause ptosis of the brain stem and cerebellum. [12][13][14] They reported evidence showing that atlantoaxial fixation resolved the instability and ptosis of the brain stem and cerebellum. [12][13][14]…”

Section: Mechanisms: Pathogenesis Of Ptosis Of the Brain Stem And Cermentioning

confidence: 99%

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Pathogenesis and Classification of Chiari Malformation Type I Based on the Mechanism of Ptosis of the Brain Stem and Cerebellum: A Morphometric Study of the Posterior Cranial Fossa and Craniovertebral Junction

Nishikawa

Bolognese

Kula

et al. 2019

J Neurol Surg B Skull Base

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Introduction We investigated the mechanism of ptosis of the brain stem and cerebellum (hindbrain) in Chiari malformation type I (CM-I) and classified CM-I according to pathogenesis, based on a morphometric study of the posterior cranial fossa (PCF) and craniovertebral junction (CVJ). We discuss the appropriate surgical treatment for hindbrain ptosis. Materials and Methods We examined 500 patients with CM-I and 100 healthy control individuals. We calculated the volume of the PCF (VPCF) and measured the axial length of the enchondral parts of the occipital bone and hindbrain. As statistical analyses, for the multiple analyses, heavy palindromic tests were used. Using three independent objective parameters, we tried to classify CM-I. Results Three independent subtypes were confirmed (CM-I types A, B, and C). CM-I type A (167 cases): normal VPCF, normal volume of the area surrounding the foramen magnum (VSFM), and normal occipital bone size; CM-I type B (178 cases): normal VPCF, small VSFM, and small occipital bone size; and CM-I type C (155 cases): small VPCF, small VSFM, and small occipital bone size. Conclusions Morphometric analyses of PCF and CVJ were very useful for the investigation of the mechanism of hindbrain ptosis and classifying CM-I according to pathogenesis. CM-I type A included mechanisms other than hindbrain ptosis, for example, CVJ instability, tethered cord, and increased intracranial pressure. CM-I types B and C demonstrated underdevelopment of the occipital bone. For CM-I types B and C, posterior decompression should be performed. For CM-I type A, appropriate surgical management should be selected.

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Section: Mechanisms: Pathogenesis Of Ptosis Of the Brain Stem And Cermentioning

confidence: 99%

“…Craniocervical fixation should be selected for cases with craniovertebral instability causing functional cranial settling. [11][12][13][14] Untethering and/or sectioning of the filum terminale should be chosen for cases with a lesion of traction and/ or tethering, for example, tethered cord syndrome and thick filum terminale. 15…”

Section: Surgical Managementmentioning

confidence: 99%

Pathogenesis and Classification of Chiari Malformation Type I Based on the Mechanism of Ptosis of the Brain Stem and Cerebellum: A Morphometric Study of the Posterior Cranial Fossa and Craniovertebral Junction

Nishikawa

Bolognese

Kula

et al. 2019

J Neurol Surg B Skull Base

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“…Other mechanisms of ptosis of the brain stem and cerebellum, that is, hypermobility and instability of the craniovertebral junction (CVJ), traction by tethering, and pressure coning, have also been reported. [8][9][10][11][12][13] In those cases, FMD does not resolve the underlying mechanism. Misunderstandings of the mechanism of ptosis of the brain stem and cerebellum in Chiari malformation have resulted in confusion when choosing a surgical approach, and the use of inappropriate treatment has resulted in the recurrence of neurological symptoms.…”

Section: Background and Purposementioning

confidence: 99%

“…Diagnosis of instability at the CVJ was confirmed by a morphometric study and a craniocervical traction test, using morphometric analyses described by the authors and Goel et al [11][12][13] The first author (M.N. : neurosurgeon), second author (P.B.…”

Section: Hypermobility and Instability At The Craniovertebral Junctiomentioning

confidence: 99%

“…18 In the cases who received ESCP and FMD, CCF was performed on 52 subjects. [10][11][12] CCF was used in a total of 110 cases, of which CCF was performed on 64 cases and posterior atlantoaxial fixation was utilized in 46 cases. For tethered cord syndrome, untethering (lysis of the arachnoid adhesion and/or sectioning of the filum terminale [SFT]) was administered to 25 cases.…”

Section: Surgical Indications and Procedures (►Table 3)mentioning

confidence: 99%

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Surgical Management of Chiari Malformations: Preliminary Results of Surgery According to the Mechanisms of Ptosis of the Brain Stem and Cerebellum

Nishikawa

Bolognese

Kula

et al. 2019

J Neurol Surg B Skull Base

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Introduction We classified Chiari malformation type I (CM-I) according to the mechanism of ptosis of the brain stem and cerebellum, based on a morphometric study of the posterior cranial fossa (PCF) and craniovertebral junction (CVJ). Surgery was performed to manage the mechanism of the hindbrain ptosis. Materials and Methods We calculated the volume of the PCF (VPCF) and the area surrounding the foramen magnum (VSFM) and measured the axial length of the enchondral parts of the occipital bone (occipital bone size) and the hindbrain. According to these measures, we classified CM-I into type A (normal VPCF, normal VSFM, and normal occipital bone size), type B (normal VPCF, small VSFM, and small occipital bone size), and type C (small VPCF, small VSFM, and small occipital bone size). Foramen magnum decompression (FMD) (280 cases) was performed on CM-I types A and B. Expansive suboccipital cranioplasty (ESCP) was performed on CM-I type C. Posterior craniocervical fixation (CCF) was performed in cases with CVJ instability. Lysis of the adhesion and/or sectioning of the filum terminale were performed on cases with tethered cord syndrome. Results Both ESCP and FMD had a high rate of improvement of neurological symptoms (87%) and recovery rate. There was only small number of complications. CCF had a high rate of improvement of neurological symptoms (88%) and joint stabilization. Conclusion In the management of Chiari malformation, appropriate surgical methods that address ptosis of the hindbrain should be chosen. Each surgical approach resulted in a good improvement of neurological symptoms.

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Management of Chiari Malformation

Hersh

Jallo

Shimony

2023

Pediatric Neurosurgery Board Review

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Atlantoaxial Fixation for Chiari 1 Formation in Pediatric Age-Group Patients: Report of Treatment in 33 Patients

Cited by 35 publications

References 32 publications

Pathogenesis and Classification of Chiari Malformation Type I Based on the Mechanism of Ptosis of the Brain Stem and Cerebellum: A Morphometric Study of the Posterior Cranial Fossa and Craniovertebral Junction

Pathogenesis and Classification of Chiari Malformation Type I Based on the Mechanism of Ptosis of the Brain Stem and Cerebellum: A Morphometric Study of the Posterior Cranial Fossa and Craniovertebral Junction

Surgical Management of Chiari Malformations: Preliminary Results of Surgery According to the Mechanisms of Ptosis of the Brain Stem and Cerebellum

Management of Chiari Malformation

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