Chiari 1.5 Malformation : An Advanced Form of Chiari I Malformation

Kim, In Kyeong; Wang, Kyu Chang; Cho, Byung Kyu

doi:10.3340/jkns.2010.48.4.375

Cited by 50 publications

(41 citation statements)

References 14 publications

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“…16 The 8-mm mean distance of the obex from the FM in our patient cohort was less than the 10-to 12-mm distance observed in healthy populations. 24,29 This suggests that, along with the classic tonsillar descent in CMI, the cervicomedullary junction also tends to be caudally displaced toward the FM.…”

Section: Correlations Of Preoperative Radiological Variables With CMImentioning

confidence: 89%

A points-based algorithm for prognosticating clinical outcome of Chiari malformation Type I with syringomyelia: results from a predictive model analysis of 82 surgically managed adult patients

Thakar

Sivaraju

Jacob

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEAlthough various predictors of postoperative outcome have been previously identified in patients with Chiari malformation Type I (CMI) with syringomyelia, there is no known algorithm for predicting a multifactorial outcome measure in this widely studied disorder. Using one of the largest preoperative variable arrays used so far in CMI research, the authors attempted to generate a formula for predicting postoperative outcome.METHODSData from the clinical records of 82 symptomatic adult patients with CMI and altered hindbrain CSF flow who were managed with foramen magnum decompression, C-1 laminectomy, and duraplasty over an 8-year period were collected and analyzed. Various preoperative clinical and radiological variables in the 57 patients who formed the study cohort were assessed in a bivariate analysis to determine their ability to predict clinical outcome (as measured on the Chicago Chiari Outcome Scale [CCOS]) and the resolution of syrinx at the last follow-up. The variables that were significant in the bivariate analysis were further analyzed in a multiple linear regression analysis. Different regression models were tested, and the model with the best prediction of CCOS was identified and internally validated in a subcohort of 25 patients.RESULTSThere was no correlation between CCOS score and syrinx resolution (p = 0.24) at a mean ± SD follow-up of 40.29 ± 10.36 months. Multiple linear regression analysis revealed that the presence of gait instability, obex position, and the M-line–fourth ventricle vertex (FVV) distance correlated with CCOS score, while the presence of motor deficits was associated with poor syrinx resolution (p ≤ 0.05). The algorithm generated from the regression model demonstrated good diagnostic accuracy (area under curve 0.81), with a score of more than 128 points demonstrating 100% specificity for clinical improvement (CCOS score of 11 or greater). The model had excellent reliability (κ = 0.85) and was validated with fair accuracy in the validation cohort (area under the curve 0.75).CONCLUSIONSThe presence of gait imbalance and motor deficits independently predict worse clinical and radiological outcomes, respectively, after decompressive surgery for CMI with altered hindbrain CSF flow. Caudal displacement of the obex and a shorter M-line–FVV distance correlated with good CCOS scores, indicating that patients with a greater degree of hindbrain pathology respond better to surgery. The proposed points-based algorithm has good predictive value for postoperative multifactorial outcome in these patients.

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Section: Correlations Of Preoperative Radiological Variables With CMImentioning

confidence: 89%

A points-based algorithm for prognosticating clinical outcome of Chiari malformation Type I with syringomyelia: results from a predictive model analysis of 82 surgically managed adult patients

Thakar

Sivaraju

Jacob

et al. 2018

Journal of Neurosurgery: Spine

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“…CMI along with brainstem herniation is also referred to Chiari malformation type 1.5 (CM 1.5) (14,30). It is reported that there is no specific sign or symptom peculiar to CM 1.5, but the incidence of unresolved SM after SPFD is nearly two-fold higher in CM 1.5 than CMI.…”

Section: Risk Factors On Prognosismentioning

confidence: 98%

Long-Term Outcomes After Small-Bone-Window Posterior Fossa Decompression and Duraplasty in Adults with Chiari Malformation Type I

et al. 2015

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“…In 1998, Iskandar et al (12) described 'Chiari Zero malformation' to characterize a type of syringomyelia that exhibits classical CM-1 symptoms with little to no herniation. In 2010, Kim et al described 'Chiari 1.5 malformation' as an advanced form of CM-1 (14).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the surgical results for foramen magnum decompression with and without duraplasty in chiari malformation type 1

Gürbüz¹,

Karaaslan²,

Çalışkan³

et al. 2014

Turkish Neurosurgery

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AIM:The surgical results for foramen magnum decompression (FMD) with and without duraplasty in Chiari Malformation type 1 (CM-1) were compared retrospectively. MATErIAL and METHods:Thirty-nine cases of CM-1 with and without syringomyelia (SM) were included. There were 18 patients in the nonduraplasty and 21 in the duraplasty group. Syringomyelia, tonsillar herniation (TH), preoperative symptom duration, and postoperative SM size were compared. rEsuLTs: No significant difference was found between improvement in the duraplasty group (81%) and the non-duraplasty group (61.1%). In cases whose symptom duration was 0-36 months, improvement in the duraplasty group (93%) was significantly better than in the nonduraplasty group (50%) (p<0.01). The rate of syrinx regression was 92.3% in the duraplasty group and 12.5% in the non-duraplasty group (p<0.05). In cases with SM, the improvement was 21.4% in the non-duraplasty group compared to 78.6% in the duraplasty group (p=0.056). In cases with TH greater than 10 mm, the improvement was 66.7% in the non-duraplasty group, whereas all six cases (100%) in the duraplasty group had improved. CoNCLusIoN:In SM associated cases, cases with TH greater than 10 mm, and whose symptom duration is less than 36 months, duraplasty is a more reliable choice despite a slightly higher rate of complications. BuLGuLAr: Duraplastili (%81) ve duraplastisiz grubun (%61,1) iyileşme oranları arasında anlamlı fark bulunmadı. Preoperatif semptom süresi 0-36 ay arasında olan olgularda; duraplastili grubun iyileşme oranı (%93) duraplastisiz gruba göre (%50) anlamlı oranda yüksekti (p<0.05). Sirenks boyutunda küçülme oranı duraplastili grupta % 92,3 iken duraplastisiz grupta % 12.5 idi (p<0.05). SM bulunan olgularda; duraplastili grubun iyileşme oranı % 78,6, duraplastisiz grubun iyileşme oranı ise % 21,4 idi (p=0.056). TH'un 10 mm'den fazla olduğu olgularda; duraplastisiz grubun iyileşme oranı % 66,7 iken, duraplastili 6 olgunun tamamı iyileşmişti (%100).soNuÇ: SM'li olgularda, TH'un 10 mm'den fazla olduğu olgularda ve semptom süresi 36 aydan kısa olan olgularda duraplasti hafif yüksek komplikasyon oranı olmakla birlikte daha iyi bir seçenek olarak düşünülmüştür.

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Chiari 1.5 Malformation : An Advanced Form of Chiari I Malformation

Cited by 50 publications

References 14 publications

A points-based algorithm for prognosticating clinical outcome of Chiari malformation Type I with syringomyelia: results from a predictive model analysis of 82 surgically managed adult patients

A points-based algorithm for prognosticating clinical outcome of Chiari malformation Type I with syringomyelia: results from a predictive model analysis of 82 surgically managed adult patients

Long-Term Outcomes After Small-Bone-Window Posterior Fossa Decompression and Duraplasty in Adults with Chiari Malformation Type I

Comparison of the surgical results for foramen magnum decompression with and without duraplasty in chiari malformation type 1

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