Morphometric analysis of foramen magnum dimensions and intracranial volume in pediatric Chiari I malformation

Furtado, Sunil V.; Thakre, Darpan J.; Venkatesh, Prasanna K.; Reddy, Kalyan; Hegde, Alangar S.

doi:10.1007/s00701-009-0480-5

Cited by 41 publications

(41 citation statements)

References 22 publications

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“…Foramen magnum size appeared to be however evenly distributed between both groups; therefore, only the size of the Chiari I malformation had an influence on syrinx formation. This finding is in agreement with another study, which has not found a relationship between foramen magnum diameter and the incidence of Chiari I either [23]. Dufton et al [24] came to the conclusion that a wider foramen magnum diameter in Chiari I patients is associated with a greater tonsillar descent, which may explain why a larger foramen magnum diameter does not protect against cervical syrinx formation.…”

Section: Discussionsupporting

confidence: 81%

Morphometric Analysis of Predictors of Cervical Syrinx Formation in the Setting of Chiari I Malformation

et al. 2016

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Background/Aims: We performed a morphometric analysis of Chiari I malformations to look for predictors of cervical syrinx formation. Methods: Eighteen patients with Chiari I malformation and associated cervical syrinx and 16 patients with Chiari I malformation without associated cervical syrinx were included in the study. Chiari I size was obtained from the radiology report; foramen magnum diameter, cerebellar volume, posterior fossa volume and intracranial volume were calculated using OsiriX software, and average measurements were compared between the two groups. Results and Conclusion: Patients with Chiari I with syrinx had an average tonsillar descent of 13.03 ± 5.31 mm compared to 9.25 ± 3.31 mm in the Chiari I without syrinx group (p < 0.05). Patients with Chiari I and syrinx also showed increased cerebellar crowding with a higher cerebellar volume to posterior fossa volume ratio; however, this difference was not significant (0.83 vs. 0.81; p = 0.1872). No difference between groups was found in posterior fossa volume, intracranial volume and foramen magnum diameter. Therefore, only Chiari I size based on the extent of tonsillar herniation was found to be a determinant of cervical syrinx formation.

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Section: Discussionsupporting

confidence: 81%

Morphometric Analysis of Predictors of Cervical Syrinx Formation in the Setting of Chiari I Malformation

et al. 2016

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“…The view generally accepted of CM pathogenesis is that the hindbrain develops normally after birth but later herniates into the spinal canal due to overcrowding of the posterior cranial fossa and dysplasia of the occipital somites of the mesodermal at the embryonic stage or the developmental lag of occipital somites (Schijman, 2004;Park et al, 2009;Furtado et al, 2010). SM is secondarily derived from the abnormal anatomy of the foramen magnum.…”

Section: Discussionmentioning

confidence: 99%

Craniocervical decompression with duraplasty and cerebellar tonsillectomy as treatment for Chiari malformation-I complicated with syringomyelia

et al. 2015

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ABSTRACT. This study aimed to investigate the therapeutic effects of craniocervical decompression with duraplasty and cerebellar tonsillectomy for the treatment of Chiari malformation-I with syringomyelia (CM I-SM). From January 2005 to December 2011, 127 patients with CM I-SM underwent craniocervical decompression with duraplasty and cerebellar tonsillectomy and the therapeutic effects of these surgeries were evaluated using Tator scores. No patient in this study died or showed disease deterioration after the surgery. Reexamination by magnetic resonance imaging (MRI) showed that the cisterna magna was obviously larger after the operation in all but one patient. Moreover, syringomyelia (SM) was reduced in 76 patients. CM I-SM symptoms disappeared or decreased in 112 patients after following discharge. Follow-up was conducted in 84 of the patients and 79 of these patients exhibited improved symptoms. A second MRI re-examination showed that the cisterna magna was successfully constructed in 44 Treatment of Chiari malformations patients; 42 of these patients showed further eliminated or obviously reduced SM. Craniocervical decompression with duraplasty and cerebellar tonsillectomy achieved favorable therapeutic effects. Thus, craniocervical decompression with duraplasty and cerebellar tonsillectomy is a rational surgical approach with beneficial clinical effects. The proposed approach may have useful applications in the treatment of CM I-SM.

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“…1,[17][18][19]33,34,47,50,52,54 Surgical treatment with posterior fossa decompression (PFD) is not universally successful, with failure of symptomatic resolution reported in up to a third of cases. 17,42,43,61 The pathogenesis of syringomyelia in CM-I (and other etiologies) remains unclear, which makes it difficult to develop improved treatments.…”

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confidence: 99%

Cerebellar and hindbrain motion in Chiari malformation with and without syringomyelia

Leung

Magnussen

Stoodley

et al. 2016

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OBJECTIVE The pathogenesis of syringomyelia associated with Chiari malformation type I (CM-I) is unclear. Theories of pathogenesis suggest the cerebellar tonsils may obstruct CSF flow or alter pressure gradients, or their motion might act as a piston to increase CSF pressure in the spinal subarachnoid space. This study was performed to measure cerebellar tonsillar and hindbrain motion in CM-I and assess the potential contributions to syrinx formation. METHODS Sixty-four CM-I patients and 25 controls were retrospectively selected from a clinical database, and all subjects had undergone cardiac-gated cine balanced fast-field echo MRI. There were a total of 36 preoperative CM-I scans, which consisted of 15 patients with and 21 patients without syringomyelia. Nineteen patients underwent paired pre- and postoperative imaging. Anteroposterior (AP) and superoinferior (SI) movements of the tip of the cerebellar tonsils, obex, fastigium of the fourth ventricle, pontomedullary junction, and cervicomedullary junction were measured. The distance between the fastigium and tip of the tonsils was used to calculate tonsillar tissue strain (Δi/i0). RESULTS CM-I patients had significantly greater cerebellar tonsillar motion in both the AP and SI directions than controls (AP +0.34 mm [+136%], p < 0.001; SI +0.49 mm [+163%], p < 0.001). This motion decreased after posterior fossa decompression (AP −0.20 mm [−33%], p = 0.001; SI −0.29 mm [−36%]; p < 0.001), but remained elevated above control levels (AP +56%, p = 0.021; SI +67%, p = 0.015). Similar trends were seen for all other tracked landmarks. There were no significant differences in the magnitude or timing of motion throughout the hindbrain between CM-I patients with and without syringomyelia. Increased tonsillar tissue strain correlated with Valsalva headaches (p = 0.03). CONCLUSIONS Cerebellar tonsillar motion may be a potential marker of CM-I and may have use in tailoring surgical procedures. The lack of association with syringomyelia suggests that tonsillar motion alone is not the driver of syrinx formation. Tonsillar tissue strain may play a part in the pathophysiology of Valsalva headaches.

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Morphometric analysis of foramen magnum dimensions and intracranial volume in pediatric Chiari I malformation

Cited by 41 publications

References 22 publications

Morphometric Analysis of Predictors of Cervical Syrinx Formation in the Setting of Chiari I Malformation

Morphometric Analysis of Predictors of Cervical Syrinx Formation in the Setting of Chiari I Malformation

Craniocervical decompression with duraplasty and cerebellar tonsillectomy as treatment for Chiari malformation-I complicated with syringomyelia

Cerebellar and hindbrain motion in Chiari malformation with and without syringomyelia

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