Ventral Brain Stem Compression in Pediatric and Young Adult Patients with Chiari I Malformations

Grabb, Paul A.; Mapstone, Timothy B.; Oakes, W. Jerry

doi:10.1097/00006123-199903000-00050

Cited by 179 publications

(135 citation statements)

References 14 publications

Supporting

Mentioning

129

Contrasting

Order By: Relevance

“…The clinical outcomes in this series are consistent with observation in experimental models that axons subjected to strain recover rapidly, both anatomically and functionally [30][31][32], and with neurosurgical series where anatomical alignment has been restored, and which show that even profound clinical deficits are recoverable [5,12,14,17,[33][34][35][36][37][38][39][40]. Improvement in pain, bulbar symptoms, ASIA index, Karnofsky index and quality of life assessment support the concept that restoration of the neutral position of the cervical spine and craniospinal junction with a neck brace decreases the deleterious effects of flexion in the setting of erstwhile abnormal movement and anatomical abnormality.…”

Section: Neurological Outcomes After Whiplash Injurysupporting

confidence: 86%

“…The Karnofsky Index was designed as a functional index for cancer patients, but has also been used in other areas as a reliable means of assessing function [9]. The Brainstem Disability Index [5] used in this report is not validated, but is used by the authors to measure improvement in the panoply of symptoms generally attributed to neurological dysfunction of the brainstem based upon the encyclopedic descriptions of others [10][11][12][13][14][15][16][17][18][19][20][21]. A score of 100 represents the presence of all 20 symptoms and significant disability ( Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…The deformative stress imposed upon the neuraxis by flexion of the neck and craniocervical junction, such as occurs in whiplash injury, is manifest radiologically by the measurement of increased length of the medulla and spinal cord [5,12,14,17,18,22,46,49,51,52,61,64,68,[70][71][72][73][74][75][76][77][78][79] (Figs. 4A-C).…”

Section: Pathophysiology Of Whiplash Injury Associated With Neurologimentioning

confidence: 99%

See 2 more Smart Citations

Clinical and Finite Element Analysis of Acute Whiplash

Tannoury¹,

Rihn²,

Wilson³

et al. 2011

TOSPINEJ

View full text Add to dashboard Cite

Study Design:A prospective 1-year follow-up study of whiplash patients presenting with neurological signs/or symptoms (WADIII), and whiplash patients with neck pain but no neurologic findings (WADI/II). Objective:We hypothesize that WADI/II and WADIII are distinct entities, with regards to clinical presentation, pathoanatomy, and prognosis.Summary of Background Data: symptoms associated with whiplash injury range from mild neck pain (WADI/II), to injuries associated with neurologic sequellae (WADIII). To date, literature considers whiplash associated disorders (WAD) a single clinical and pathologic entity, with different grades of severity (WADI-IV).Methods: Thirty one subjects were divided into a WADIII study group and a WADI/II comparison group. All subjects underwent H&P, radiographic evaluations, and clinical outcome measures (collected at 3, 6, and 12 months). Statistical analysis was performed (Student T-test, Wilcoxon Signed-Rank test) with significance set at p=0.05. A finite element analysis (FEA) technology (SCOSIA©) was used to predict stresses within the neuraxis.Results: At day 0: Better neurologic assessments, functional performances, and higher quality-of-life measurements were noted in WADI/II compared to WADIII. VAS scores were comparable.At 12 months: Both groups reported improvements in neurologic status and disability symptoms. However functional recovery and quality-of-life measures significantly improved in WADIII, and conversely deteriorated in WADI/II along with notable worsening of pain symptoms. Litigation claims were comparable. FEA predicted higher stress within the neuraxis of WADIII, notably in subjects with preexisting stenosis and odontoid retroflexion. Conclusion:WADI/II and WADIII are distinct entities. Musculoskeletal injury precipitates WADI/II pain symptoms while neuronal stretching leads to WADIII neurologic injuries, which are mostly recoverable.

show abstract

Section: Neurological Outcomes After Whiplash Injurysupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Section: Pathophysiology Of Whiplash Injury Associated With Neurologimentioning

confidence: 99%

See 1 more Smart Citation

Clinical and Finite Element Analysis of Acute Whiplash

Tannoury¹,

Rihn²,

Wilson³

et al. 2011

TOSPINEJ

View full text Add to dashboard Cite

show abstract

“…9 In the pediatric population, Grabb et al have suggested that patients with a significantly lengthened pB-C2 distance (> 9 mm) may benefit from traction or transoral odontoidectomy prior to standard CM decompression. 4 Given the differences between the adult and the pediatric populations and the differences between male and female patients, the decision of whether to perform odontoidectomy or traction with posterior fusion may be not only agebut also sex-specific. Nine of our patients with CM-I had pB-C2 values greater than 9 mm and did not demonstrate a difference from those patients with a pB-C2 value less than 9 mm, with respect to success of standard suboccipital decompression.…”

mentioning

confidence: 99%

“…Ventral brainstem compression associated with congenital CM-I from basilar invagination has a reported incidence of 4%-31%, predominantly in the pediatric population. 2,4,5,13 Posterior decompression with CM-I patients with coexisting basilar invagination involves a higher late complication rate even if the anterior component is not initially symptomatic if there is postdecompression cranial settling. 4 In rare cases of symptomatic postdecompression cranial settling, some have advised initial preservation of the C-2 lamina or occipital-C1-2 fusion with subsequent transoral resection of the odontoid if cervicomedullary indentation persists.…”

mentioning

confidence: 99%

Odontoid process inclination in normal adults and in an adult population with Chiari malformation Type I

Besachio

Khaleel

Shah

2015

SPI

View full text Add to dashboard Cite

OBJECT Posterior odontoid process inclination has been demonstrated as a factor associated with Chiari malformation Type I (CM-I) in the pediatric population; however, no studies to date have examined this measurement in the adult CM-I population. The purpose of this study was to evaluate craniocervical junction (CCJ) measurements in adult CM-I versus a control group. METHODS The odontoid retroflexion, odontoid retroversion, odontoid height, posterior basion to C-2 line measured to the dural margin (pB-C2 line), posterior basion to C-2 line measured to the dorsal odontoid cortical margin (pB-C2* line), and clivus-canal angle measurements were retrospectively analyzed in adult patients with CM-I using MRI. These measurements were compared with normative values established from CT scans of the cervical spine in adults without CM-I. RESULTS A statistically significant difference was found between 55 adults with CM-I and 150 sex-matched controls (125 used for analysis) in the mean clivus-canal angle and the mean pB-C2 line. CONCLUSIONS These data suggest that there are sex-specific differences with respect to measurements at the CCJ between men and women, with women showing a more posteriorly inclined odontoid process. There were also differences between the CM-I and control groups: a more acute clivus-canal angle was associated with CM-I in the adult population. These CCJ findings could have an influence on presurgical planning.

show abstract

Neurological and spinal manifestations of the Ehlers–Danlos syndromes

Henderson¹,

Austin²,

Benzel³

et al. 2017

American J of Med Genetics Pt C

182

174

View full text Add to dashboard Cite

The Ehlers–Danlos syndromes (EDS) are a heterogeneous group of heritable connective tissue disorders characterized by joint hypermobility, skin extensibility, and tissue fragility. This communication briefly reports upon the neurological manifestations that arise including the weakness of the ligaments of the craniocervical junction and spine, early disc degeneration, and the weakness of the epineurium and perineurium surrounding peripheral nerves. Entrapment, deformation, and biophysical deformative stresses exerted upon the nervous system may alter gene expression, neuronal function and phenotypic expression. This report also discusses increased prevalence of migraine, idiopathic intracranial hypertension, Tarlov cysts, tethered cord syndrome, and dystonia, where associations with EDS have been anecdotally reported, but where epidemiological evidence is not yet available. Chiari Malformation Type I (CMI) has been reported to be a comorbid condition to EDS, and may be complicated by craniocervical instability or basilar invagination. Motor delay, headache, and quadriparesis have been attributed to ligamentous laxity and instability at the atlanto‐occipital and atlantoaxial joints, which may complicate all forms of EDS. Discopathy and early degenerative spondylotic disease manifest by spinal segmental instability and kyphosis, rendering EDS patients prone to mechanical pain, and myelopathy. Musculoskeletal pain starts early, is chronic and debilitating, and the neuromuscular disease of EDS manifests symptomatically with weakness, myalgia, easy fatigability, limited walking, reduction of vibration sense, and mild impairment of mobility and daily activities. Consensus criteria and clinical practice guidelines, based upon stronger epidemiological and pathophysiological evidence, are needed to refine diagnosis and treatment of the various neurological and spinal manifestations of EDS. © 2017 Wiley Periodicals, Inc.

show abstract

Ventral Brain Stem Compression in Pediatric and Young Adult Patients with Chiari I Malformations

Abstract: Patients with a pB-C2 measurement of less than 9 mm do not require treatment directed at VBSC. In select patients with pB-C2 measurements of 9 mm or greater, reduction of VBSC may be prudent before posterior fossa decompression.

Cited by 179 publications

References 14 publications

Clinical and Finite Element Analysis of Acute Whiplash

Clinical and Finite Element Analysis of Acute Whiplash

Odontoid process inclination in normal adults and in an adult population with Chiari malformation Type I

Neurological and spinal manifestations of the Ehlers–Danlos syndromes

Contact Info

Product

Resources

About