A new entity: chiari zero malformation, and its surgical method

Elmacı, İlhan; Kaksi, Mustafa; Gökben, Bekir; Işık, Nihal; Çelik, Melek Güra

doi:10.5137/1019-5149.jtn.2705-09.1

Cited by 12 publications

(16 citation statements)

References 12 publications

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“…Successful surgical treatment requires appropriate patient selection and identification of the optimal procedure for the individual patient. PCF decompression with or without dura reconstruction is the most common procedure performed in these pa-tients, improving the clinical symptoms in most (around 80%-90%) CM-I, 11,49 CM-0, 21,22 and CM-1.5 cases, 48 but additional procedures are often needed, 16,56 and some complications can occur (9%-42% of cases). 11,49 Furthermore, some patients do not report any significant improvement.…”

Section: Impactmentioning

confidence: 99%

“…These studies have indicated that individuals with CM-0 or CM-1.5 display an overcrowded PCF and symptoms similar to CM-I patients. However, since TH is generally absent in CM-0 21,22,41,47 and the position of the brainstem in CM-1.5 is between that seen in CM-I and that seen in CM-II, 26,48 there is a debate over the relevance and even the existence of these newer categories. 35 The radiographic measurement of TH may not be the best anatomical feature to use for CM diagnosis.…”

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confidence: 99%

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Machine learning applied to neuroimaging for diagnosis of adult classic Chiari malformation: role of the basion as a key morphometric indicator

Urbizu¹,

Martin

Moncho

et al. 2018

Journal of Neurosurgery

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OBJECTIVE The current diagnostic criterion for Chiari malformation Type I (CM-I), based on tonsillar herniation (TH), includes a diversity of patients with amygdalar descent that may be caused by a variety of factors. In contrast, patients presenting with an overcrowded posterior cranial fossa, a key characteristic of the disease, may remain misdiagnosed if they have little or no TH. The objective of the present study was to use machine-learning classification methods to identify morphometric measures that help discern patients with classic CM-I to improve diagnosis and treatment and provide insight into the etiology of the disease. METHODS Fifteen morphometric measurements of the posterior cranial fossa were performed on midsagittal T1-weighted MR images obtained in 195 adult patients diagnosed with CM. Seven different machine-learning classification methods were applied to images from 117 patients with classic CM-I and 50 controls matched by age and sex to identify the best classifiers discriminating the 2 cohorts with the minimum number of parameters. These classifiers were then tested using independent CM cohorts representing different entities of the disease. RESULTS Machine learning identified combinations of 2 and 3 morphometric measurements that were able to discern not only classic CM-I (with more than 5 mm TH) but also other entities such as classic CM-I with moderate TH and CM Type 1.5 (CM-1.5), with high accuracy (> 87%) and independent of the TH criterion. In contrast, lower accuracy was obtained in patients with CM Type 0. The distances from the lower aspect of the corpus callosum, pons, and fastigium to the foramen magnum and the basal and Wackenheim angles were identified as the most relevant morphometric traits to differentiate these patients. The stronger significance (p < 0.01) of the correlations with the clivus length, compared with the supraoccipital length, suggests that these 5 relevant traits would be affected more by the relative position of the basion than the opisthion. CONCLUSIONS Tonsillar herniation as a unique criterion is insufficient for radiographic diagnosis of CM-I, which can be improved by considering the basion position. The position of the basion was altered in different entities of CM, including classic CM-I, classic CM-I with moderate TH, and CM-1.5. The authors propose a predictive model based on 3 parameters, all related to the basion location, to discern classic CM-I with 90% accuracy and suggest considering the anterior alterations in the evaluation of surgical procedures and outcomes.

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Section: Impactmentioning

confidence: 99%

mentioning

confidence: 99%

Machine learning applied to neuroimaging for diagnosis of adult classic Chiari malformation: role of the basion as a key morphometric indicator

Urbizu¹,

Martin

Moncho

et al. 2018

Journal of Neurosurgery

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“…The definition of CM-I based on TP has come under scrutiny since several studies employing quantitative measurements have shown that TP does not correlate with the severity of symptoms and the degree of cerebellar TP below the foramen magnum is not heritable in multiplex families with CM-I patients [14–17]. Patients with pronounced TP may present clinically asymptomatic, while patients with minimal or no TP may present with marked symptomatology.…”

Section: Introductionmentioning

confidence: 99%

Cerebellar tonsil ectopia measurement in type I Chiari malformation patients show poor inter-operator reliability

Lawrence

Urbizu

Allen

et al. 2018

Fluids Barriers CNS

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BackgroundType 1 Chiari malformation (CM-I) has been historically defined by cerebellar tonsillar position (TP) greater than 3–5 mm below the foramen magnum (FM). Often, the radiographic findings are highly variable, which may influence the clinical course and patient outcome. In this study, we evaluate the inter-operator reliability (reproducibility) of MRI-based measurement of TP in CM-I patients and healthy controls.MethodsThirty-three T2-weighted MRI sets were obtained for 23 CM-I patients (11 symptomatic and 12 asymptomatic) and 10 healthy controls. TP inferior to the FM was measured in the mid-sagittal plane by seven expert operators with reference to McRae’s line. Overall agreement between the operators was quantified by intraclass correlation coefficient (ICC).ResultsThe mean and standard deviation of cerebellar TP measurements for asymptomatic (CM-Ia) and symptomatic (CM-Is) patients in mid-sagittal plane was 6.38 ± 2.19 and 9.57 ± 2.63 mm, respectively. TP measurements for healthy controls was 0.48 ± 2.88 mm. The average range of TP measurements for all data sets analyzed was 7.7 mm. Overall operator agreement for TP measurements was relatively high with an ICC of 0.83.ConclusionThe results demonstrated a large average range (7.7 mm) of measurements among the seven expert operators and support that, if economically feasible, two radiologists should make independent measurements before radiologic diagnosis of CM-I and surgery is contemplated. In the future, an objective diagnostic parameter for CM-I that utilizes automated algorithms and results in smaller inter-operator variation may improve patient selection.

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“…in the recent years, several studies have showed that extracts of cigarette smoke inhibited the activity of Pon1 (2,9,21).…”

Section: Introductionmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease and Paraoxonase-1 192 and 55 Gene Polymorphisms

Tekes

Işık

Yıldız

et al. 2010

Biotechnology & Biotechnological Equipment

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A new entity: chiari zero malformation, and its surgical method

Cited by 12 publications

References 12 publications

Machine learning applied to neuroimaging for diagnosis of adult classic Chiari malformation: role of the basion as a key morphometric indicator

Machine learning applied to neuroimaging for diagnosis of adult classic Chiari malformation: role of the basion as a key morphometric indicator

Cerebellar tonsil ectopia measurement in type I Chiari malformation patients show poor inter-operator reliability

Chronic Obstructive Pulmonary Disease and Paraoxonase-1 192 and 55 Gene Polymorphisms

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