Significance of Modified Clivoaxial Angles in the Treatment of Adult Chiari Malformation Type I

He, Yunsen; Zheng, Tao; Wu, Bo; Wang, Ji‐Yang

doi:10.1016/j.wneu.2019.07.060

Cited by 10 publications

(11 citation statements)

References 29 publications

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“…However, the soft tissues in the retroodontidal space cause ventral compression depending on the anatomical position and angulation of the odontoid process ( 17 ). The modified clivoaxial angle, which assesses both the relationship of the odontoid process to the brainstem and the pressure created by the soft tissues (transverse ligament and tectorial membrane) in the retroodontoidal space, is very successful in predicting postoperative clinical improvement ( 18 ). In our study, we found that MCAA was very successful in predicting the postoperative CCOS score.…”

Section: Discussionmentioning

confidence: 99%

The role of ONSD in the assessment of headache associated with Chiari malformation type 1

Karadağ

Akyüz²,

Şahin³

2023

Front. Neurol.

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BackgroundCough associated headache is the most common symptom in Chiari malformation type 1 (CM1). However, its pathophysiology and treatment are not clear. The aim of this study was to investigate the relationship between optic nerve sheath diameter (ONSD), an indicator of intracranial pressure, and headache and to investigate its predictive value on postoperative outcome.MethodsIn symptomatic CM1 patients, craniovertebral junction morphometric measurements and ONSD measurements were made from preoperative MR images, and headache intensities and characteristics were evaluated. After different surgical procedures, the clinical characteristics of the patients were evaluated according to the Chicago Chiari Outcome Scale, the change in headache intensity was assessed and the relationship with ONSD was evaluated.ResultsPreoperative headache intensity was significantly correlated with ONSD measurement (p < 0.01). Modified clivoaxial angle and ONSD were independent predictors of postoperative clinical outcome (p < 0.01). The procedure that achieved the greatest surgical enlargement of the foramen Magnum stenosis provided the best clinical outcome. Postoperative reduction in headache intensity and ONS diameter were correlated (p < 0.01).ConclusionThe fact that ONSD is found to be wide in the preoperative period in CM1 patients indicates that the intracranial pressure is permanently high. This diameter increase is correlated with headache and is a valuable guide in the selection of the appropriate treatment method.

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Section: Discussionmentioning

confidence: 99%

The role of ONSD in the assessment of headache associated with Chiari malformation type 1

Karadağ

Akyüz²,

Şahin³

2023

Front. Neurol.

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“…The patient is assigned a score of 1–4 in each category for a total score of 4–16, with higher numbers representing better outcomes. Each patient with syringomyelia was divided into the postoperative clinically improved group (CCOS score: 13–16) or the clinically unimproved group (CCOS score: 4–12) based on the calculated total CCOS scores [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

Foramen Magnum Decompression with Outer Dura Matter Layer Resection for Chiari Type I Malformation: Factors Correlated with Syrinx Reduction

et al. 2023

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We aimed to investigate the surgical results of foramen magnum decompression (FMD) to identify the potential factors associated with syrinx reduction in Chiari malformation type I (CMI). Overview of Literature: The predictive value of preoperative factors for syrinx reduction in patients with CMI remains debatable. Methods: We enrolled patients who underwent microscopic FMD with outer dural layer resection for CMI. The distance from the tip of the cerebellar tonsil to the C2 vertebral endplate on sagittal magnetic resonance imaging (MRI) was defined as the tonsillar distance (TD). Patients who showed a >20% syrinx diameter reduction on the 1-year follow-up MRI were defined as the syrinx reduction group while the others were categorized in the syrinx nonreduction group. Patients with syringomyelia were categorized into the clinically improved and unimproved groups using the Chicago Chiari Outcome Scale. The imaging and clinical parameters were evaluated pre-and postoperatively. Results: This study included 25 patients of whom 19 (76.0%) had syringomyelia. At the 1-year follow-up, the syrinx diameter had decreased in 11 patients (57.8%). The increased TD significantly differed between the syrinx reduction and nonreduction groups. At the 1-year follow-up, 12 and seven patients with syringomyelia were categorized into the clinically improved and unimproved groups, respectively. The clinically improved and unimproved groups showed significant differences in the mean age and increased TD. Conclusions: Postoperative syrinx reduction was significantly correlated with the upward shifting of the cerebellar tonsil in patients with CMI. Our quantitative evaluation of the alterations in hindbrain position after FMD was easily performed and reflects the clinical outcomes.

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“…For example, a previous study of our research group has identified the modified clivoaxial angle (MCAA) = 138° as the threshold for ventral CVJ compression 10 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…In the PFDD group, the duraplasty was performed with synthetic dura mater and the arachnoid was preserved as much as possible. In the RT group, the cerebellar tonsils were coagulated or resected at their tips, followed by an arachnoid dissection and meticulous inspection of the foramen of Magendie to ensure its CSF drainage 10 . All operations were performed by the same senior professor (BW).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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A Novel Craniocervical Junction Compression Severity Index-Based Grading System for Multidirectional Quantification of the Biomechanics at Foramen Magnum of Chiari Malformation Type I

Liu

Zhang

et al. 2022

J Neurol Surg B Skull Base

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Objective This study aimed to establish a novel grading system, based on the craniovertebral junction compression severity index (CVJCSI) for multidirectional quantification at the foramen magnum plane for Chiari malformation type I (CMI). Methods The CVJCSI grading system was established to stratify patients based on the ventral (modified clivoaxial angle < 138°), dorsal (tonsil herniation), and central (brainstem herniation) CVJ compression, the CVJCSI grading system was established to stratify patients. The optimal surgical method for each grade was recommended by intragroup comparisons regarding the efficacy of the three operations. Finally, according to the CVJCSI grading system, a prospective validation trial was performed and surgically treated for internal validation. Results Based on the retrospective study (n = 310), the CVJCSI included six grades: I- syrinx alone without compression; II- dorsal compression; III- dorsal, and central compression; IV- ventral compression; V- dorsal, and ventral compression; and VI– ventral, dorsal, and central compression. Among all available variables, only the CVJCSI and surgical methods significantly affected the CCOS. The CCOS scores, overall and for each CVJCSI grade, in the prospective cohort (n = 42) than in the retrospective analysis. Conclusions The CVJCSI can be used to stratify CMI patients. The higher the CVJCSI grade, the more severer the CVJ compression and the worse posterior fossa deformity. Meanwhile, the CVJCSI was negatively correlated with the CCOS. The lower the CVJCSI grade, the better the response to surgery, and the less-invasive surgical procedure were warranted. Finally, the prospective cohort study validated the proposed CVJCSI-based surgical protocols.

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Significance of Modified Clivoaxial Angles in the Treatment of Adult Chiari Malformation Type I

Cited by 10 publications

References 29 publications

The role of ONSD in the assessment of headache associated with Chiari malformation type 1

The role of ONSD in the assessment of headache associated with Chiari malformation type 1

Foramen Magnum Decompression with Outer Dura Matter Layer Resection for Chiari Type I Malformation: Factors Correlated with Syrinx Reduction

A Novel Craniocervical Junction Compression Severity Index-Based Grading System for Multidirectional Quantification of the Biomechanics at Foramen Magnum of Chiari Malformation Type I

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