Posterior cranial fossa dimensions in the Chiari I malformation: Relation to pathogenesis and clinical presentation

Stovner, Lars Jacob; Bergan, Unni; Nilsen, G; Sjaastad, Ottar

doi:10.1007/bf00593966

Cited by 233 publications

(131 citation statements)

References 29 publications

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“…In recent times, however, several authors using x-ray, tomography and MRI examinations have also demonstrated that the posterior fossa volume, in the presence of BI and CM, is smaller than the observed in normal people [36][37][38][39] .…”

Section: Discussionmentioning

confidence: 96%

Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Silva¹,

Holanda

2003

Arq. Neuro-Psiquiatr.

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-The present study shows the results of 53 patients who have been treated surgically for basilar impression (BI), Chiari malformation (CM), and syringomyelia (SM). The patients were divided into two groups. Group I (24 patients) underwent osteodural decompression with large inferior occipital craniectomy, laminectomy from C 1 to C 3, dural opening in Y format, dissection of arachnoid adhesion between the cerebellar tonsils, medulla oblongata and spinal cord, large opening of the fourth ventricle and dural grafting with the use of bovine pericardium. Group II patients (29 patients) underwent osteodural-neural decompression with the same procedures described above plus dissection of the arachnoid adherences of the vessels of the region of the cerebellar tonsils, and tonsillectomy (amputation) in 10 cases, and as for the remainning 19 cases, intrapial aspiration of the cerebellar tonsils was performed. The residual pial sac was sutured to the dura in craniolateral position. After completion of the suture of the dural grafting, a thread was run through the graft at the level of the created cisterna magna and fixed to the cervical aponeurosis so as to move the dural graft on a posterior-caudal direction, avoiding, in this way, its adherence to the cerebellum. RESUMO -São analisados os resultados obtidos com o tratamento cirúrgico de 53 casos de impressão basilar (IB), malformação de Chiari (MC) e siringomielia (SM). Os pacientes foram divididos em dois grupos: no grupo I(24 casos) foi realizada a descompressão osteodural, caracterizada por craniectomia ampla occipital inferior, laminectomia variável de C 1 a C 3, abertura da dura-máter em forma de Y, dissecção das aderências aracnóideas das tonsilas cerebelares com o bulbo e medula cervical, abertura ampla do quarto ventrículo e enxerto dural; no grupo II (29 casos) foi utilizada a descompressão osteodural-neural, caracterizada pelos mesmos detalhes técnicos empregados no grupo I, acrescidos da tonsilectomia por amputação (10 casos) e por aspiração intrapial (19 casos). Nestes casos, o saco pial residual, resultante da aspiração intrapial das tonsilas cerebelares, foi suturado à dura-máter lateral e em posição cranial. Após o término do enxerto dural, foi passado um fio através do enxerto dural, à altura da cisterna criada, e fixado sobre a aponeurose cervical, com a finalidade de deslocar a plástica em direção caudal, evitando, desta forma, sua aderência ao cerebelo.PALAVRAS-CHAVE: impressão basilar, malformação de Chiari, siringomielia, tonsilectomia, enxerto da dura-máter.

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Section: Discussionmentioning

confidence: 96%

Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Silva¹,

Holanda

2003

Arq. Neuro-Psiquiatr.

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“…This reduced posterior fossa volume may in turn result in compression and herniation of the cerebellar tonsils. 6,13 Acquired CM-I has also been described in infants, particularly after lumbar puncture or placement of a lumboperitoneal shunt. 10 It should be noted that the first twin in the present study did undergo a lumbar puncture although only a small volume of cerebrospinal fluid was obtained for diagnostic purposes (< 1.5 ml); this .…”

Section: Discussionmentioning

confidence: 99%

Spontaneous resolution of Chiari malformation Type I in monozygotic twins

Miller

Limbrick²,

M³

et al. 2008

PED

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The spontaneous resolution of isolated tonsillar ectopia in Chiari malformation Type I (CM-I) is a known and reported entity in 2 previous single study case reports. However, it has not been previously described in monozygotic twins. Two children, ~ 1 year of age with CM-I and presumed episodes of pallid syncope or breath-holding spells presented for neurosurgical evaluation. Although Chiari decompression was considered, the authors decided to proceed with conservative management with close follow-up due to the uncertain nature of these episodes. Approximately 4 years later, both children's symptoms had resolved. Repeated MR imaging examinations also showed spontaneous resolution of the malformation in both girls. These cases emphasize that when patients with CM-I present with atypical symptoms, spontaneous resolution or improvement is possible, which may influence the decision to pursue a trial of nonsurgical management. The possible pathophysiological mechanisms and genetic influences of CM-I are also briefly discussed.

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“…1,8,10,12,28 It is likely that patients with CM-I have a reduced posterior fossa volume, which results in crowding at the foramen magnum. 6,21,25,27 Although cerebellar tonsil position is a convenient marker for crowding at the foramen magnum, the correlation is not exact. 26 In some cases, patients with < 5 mm of descent can have a clinical presentation of Chiari syndrome and even syringomyelia caused by crowding at the foramen magnum.…”

Section: Discussionmentioning

confidence: 99%

Impact of body mass index on cerebellar tonsil position in healthy subjects and patients with Chiari malformation

Smith¹,

Strahle²,

Kazarian³

et al. 2015

JNS

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OBJECT It is unclear if there is a relationship between Chiari malformation Type I (CM-I) and body mass index (BMI). The aim of this study was to identify the relationship between BMI and cerebellar tonsil position in a random sample of people. METHODS Cerebellar tonsil position in 2400 subjects from a cohort of patients undergoing MRI was measured. Three hundred patients were randomly selected from each of 8 age groups (from 0 to 80 years). A subject was then excluded if he or she had a posterior fossa mass or previous posterior fossa decompression or if height and weight information within 1 year of MRI was not recorded in the electronic medical record. RESULTS There were 1310 subjects (54.6%) with BMI records from within 1 year of the measured scan. Of these subjects, 534 (40.8%) were male and 776 (59.2%) were female. The average BMI of the group was 26.4 kg/m2, and the average tonsil position was 0.87 mm above the level of the foramen magnum. There were 46 subjects (3.5%) with a tonsil position ≥ 5 mm below the level of the foramen magnum. In the group as a whole, there was no correlation (R2 = 0.004) between BMI and cerebellar tonsil position. CONCLUSIONS In this examination of 1310 subjects undergoing MRI for any reason, there was no relationship between BMI and the level of the cerebellar tonsils or the diagnosis of CM-I on imaging.

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Posterior cranial fossa dimensions in the Chiari I malformation: Relation to pathogenesis and clinical presentation

Cited by 233 publications

References 29 publications

Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Spontaneous resolution of Chiari malformation Type I in monozygotic twins

Impact of body mass index on cerebellar tonsil position in healthy subjects and patients with Chiari malformation

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