Clinical and radiological evaluation of treated Chiari I adult patients: retrospective study from two neurosurgical centers

Papaker, Meliha Gündağ; Abdallah, Anas; Çeşme, Dilek Hacer; Gönen, Güven; Asiltürk, Murad; Avyasov, Rashid; Sofuoğlu, Özden Erhan; Abdallah, Betül Güler; Emel, Erhan

doi:10.1007/s10143-020-01414-z

Cited by 18 publications

(31 citation statements)

References 21 publications

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“…In the first evaluation, an acceptable interobserver agreement was seen in 22 of 25 (88.0%) patients with Cohen's Kappa of 0.80.5. The measurements were compared between pre-and postoperative MRIs: syrinx/cord ratio (S/C) based on the maximal anteroposterior diameters on axial images, maximal syrinx length on sagittal images (Figure 1), and regression of the herniated ectopic cerebellar tonsils measured by the descent from the estimated McRae's line to the lowest level of tonsils into the upper spinal canal on the sagittal images and the descent between the horizontal plane from the foramen magnum and the lowest level of tonsils on the coronal images [1] (Figure 2).…”

Section: Radiological Investigationsmentioning

confidence: 99%

“…Chiari malformation type I (CM1) can be diagnosed incidentally with magnetic resonance imaging (MRI). CM1 is a congenital deformity characterized by a herniation of the cerebellar tonsillar below the foramen magnum level through the spinal column [1]. Due to the posterior fossa congestion, the clinical symptoms range from asymptomatic presentation to severe symptoms such as cognitive impairment and sleep apnea [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…In the literature, several mechanisms were suggested to explain the pathogenesis of a CM1 as follows: 1) excess tissue in the posterior fossa by a tumor; 2) hemodynamic disturbances that increase intracranial pressure; 3) overcrowding caused by underdevelopment of the posterior fossa bony structures; and 4) downward movement of the central nervous system by events that lower intrathecal pressure [4]. While there is no consensus regarding the mechanism to identify the association between syrinx cavity and CM1, it is commonly assumed that this can be attributed to the obstruction at the level below the fourth ventricle in the subarachnoid space can impair the flow of the cerebrospinal fluid (CSF) in the central canal and the compression at the foramen magnum level that prevents it at the craniocervical junction [1,[4][5][6]. However, the syrinx cavity does not appear in all patients with CM1.…”

Section: Introductionmentioning

confidence: 99%

“…Some neurosurgeons argued that PFD without duraplasty is adequate to regress the syrinx and improve most clinical symptoms [6]. Conversely, several studies recommended PFD with duraplasty (PFDD) for patients with CM1 to normalize the CSF flow at the craniovertebral junction [1,7].…”

Section: Introductionmentioning

confidence: 99%

“…Aliaga and colleagues presented in 2012 Chicago Chiari Outcome Scale (CCOS), a scoring system to evaluate the surgical outcomes in patients with CM1 [1,8,9]. In the present study, we used the CCOS to analyze the outcomes of 25 consecutive patients with CM1 who underwent PFDD in a tertiary institution.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Outcomes of Adult Chiari Malformation Type 1: Experience at a Tertiary Institute

Papaker¹,

Abdallah²,

Çınar³

2021

Cureus

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BackgroundChiari type I malformation (CM1) is a herniation of the caudal cerebellum and/or medulla oblongata into the upper spinal canal, occurring in pediatric and adult populations. We aimed to analyze the surgical outcomes of adult patients with CM1 consecutively treated with a posterior fossa decompression and duraplasty (PFDD) in a tertiary institution. Patients and methodsWe retrospectively reviewed the medical charts of 45 adult patients with CM1 who underwent PFDD at the Neurosurgery Department of our institution between January 2012 and December 2017. Radiological evaluation was based on pre-and postoperative syrinx/cord ratio, syrinx length, and regression of the ectopic cerebellar tonsils on coronal and sagittal magnetic resonance imaging (MRI) images, and clinical assessment of the patients was performed with the Chicago Chiari Outcome Scale (CCOS). ResultsOf the 45 patients included in the study, 25 (four men, 21 women) were diagnosed with symptomatic CM1 with an age average of 36.6±11.4 (18-66) years. Headache was the most common symptom (72.0%), while pinprick losses were prevalent in 13 (52.0%) patients. The mean postoperative CCOS score was 14.7±2.0 (8-16). Symptoms improved in 20 patients (80.0%) at the last follow-up. The mean regression in ectopic tonsils on midsagittal and coronal images were 9.1±1.8 (range: 0-16.5) mm and 8.3±1.2 (0-12.0) mm, respectively (p<0.05). The syrinxes had regressed completely or significantly in 7 (87.5%) of eight patients with syrinx. ConclusionOur findings showed that PFDD is sufficient to relieve most of the major symptoms and resolve the syrinx cavity without additional surgical interventions. The CCOS keeps its measurability of assessment of the clinical outcomes. A reliable radiological evaluation should be performed on midsagittal and coronal MRI images.

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Section: Radiological Investigationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Surgical Outcomes of Adult Chiari Malformation Type 1: Experience at a Tertiary Institute

Papaker¹,

Abdallah²,

Çınar³

2021

Cureus

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Cerebrospinal Fluid Flow and Brain Motion in Chiari I Malformation: Past, Present, and Future

Bhadelia

Chang

Oshinski

et al. 2023

Magnetic Resonance Imaging

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Cranio-spinal volume and pressure changes associated with the cardiac-cycle and respiration are altered in Chiari I malformation (CMI) due to obstruction of cerebrospinal fluid (CSF) flow at the foramen magnum. With the introduction of motion-sensitive MRI sequences, it was envisioned that these could provide noninvasive information about volumepressure dynamics at the cranio-cervical junction in CMI hitherto available only through invasive pressure measurements. Since the early 1990s, multiple studies have assessed CSF flow and brain motion in CMI. However, differences in design and varied approaches in the presentation of results and conclusions makes it difficult to fully comprehend the role of MR imaging of CSF flow and brain motion in CMI. In this review, a cohesive summary of the current status of MRI assessment of CSF flow and brain motion in CMI is presented. Simplified versions of the results and conclusions of previous studies are presented by dividing the studies in distinct topics: 1) comparing CSF flow and brain motion between healthy subjects (HS) and CMI patients (before and after surgery), 2) comparing CSF flow and brain motion to CMI severity and symptoms, and 3) comparing CSF flow and brain motion in CMI with and without syringomyelia. Finally, we will discuss our vision of the future directions of MR imaging in CMI patients. Evidence Level: 2. Technical Efficacy: 5.

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Pediatric Chiari I malformation: novel and traditional measurements associated with syrinx and surgery

et al. 2022

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Clinical and radiological evaluation of treated Chiari I adult patients: retrospective study from two neurosurgical centers

Cited by 18 publications

References 21 publications

Surgical Outcomes of Adult Chiari Malformation Type 1: Experience at a Tertiary Institute

Surgical Outcomes of Adult Chiari Malformation Type 1: Experience at a Tertiary Institute

Cerebrospinal Fluid Flow and Brain Motion in Chiari I Malformation: Past, Present, and Future

Pediatric Chiari I malformation: novel and traditional measurements associated with syrinx and surgery

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