Ventral Tonsillar Herniation Predicts Headaches in Adults With Chiari Malformation

2021 ◽  
Author(s):  
John K. Chae ◽  
Arsalan Haghdel ◽  
Alexander Kelly ◽  
Amanda Cruz ◽  
Myles Wood ◽  
...  
Keyword(s):  
Chiari Malformation ◽  
Tonsillar Herniation

scholarly journals Impacted cisterna magna without syringomyelia associated or not with basilar impression and/or Chiari malformation

2013 ◽  
Vol 32 (01) ◽  
pp. 40-47
Author(s):  
José Alberto Gonçalves da Silva ◽  
Adailton Arcanjo dos Santos Júnior ◽  
José Demir Rodrigues
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Chiari Malformation ◽  
Sitting Position ◽  
Basilar Impression ◽  
Tonsillar Herniation ◽  
Upward Migration ◽  
Cisterna Magna ◽  
Large Opening ◽  
Magnetic Resonance Imaging Mri

Abstract Objective: The objective of this paper is to analyze the surgical treatment of impacted cisterna magna without syringomyelia (SM) associated or not with basilar impression (BI) and/or Chiari malformation (CM). Method: The authors present, in this work, the results of five cases with impacted cisterna magna without SM which were associated with BI in four cases, tonsillar herniation in three patients when they were in the sitting position and in the other two cases there was not herniation in the sitting position. Results: The surgical treatment was characterized by a large craniectomy with the patient in the sitting position, tonsillectomy, large opening of the fourth ventricle and duraplasty with creation of a large artificial cisterna magna. An upward migration of the posterior fossa structures was detected by postoperative magnetic resonance imaging (MRI). Conclusion: The surgical treatment of impacted cisterna magna without SM remains unclear, however, a large craniectomy associated with tonsillectomy and creation of a large cisterna magna showed good results and a tendency of upward migration of the posterior fossa structures.

scholarly journals Chiari Malformation-I with Syringomyelia: A Non-specific Presentation and Surgical Consideration

2016 ◽  
Vol 13 (2) ◽  
pp. 105-108
Author(s):  
Jemesh S Maharjan ◽  
Pranaya Shrestha ◽  
Avinash Chandra ◽  
Pravesh Rajbhandari ◽  
Samir Acharya ◽  
...  
Keyword(s):  
Case Report ◽  
Chiari Malformation ◽  
Foramen Magnum ◽  
Clinical Findings ◽  
Tonsillar Herniation ◽  
Diverse Range ◽  
Broad Perspective ◽  
Surgical Options ◽  
Chiari I ◽  
Selection Of

Chiari Malformation-I is a congenital disorder characterized by the anatomical defect of the base of skull with tonsillar herniation (≥5 mm) below the foramen magnum, which is detected on MRI. It has a diverse range of symptoms with non-specific presentation leading to the chances of misdiagnosis and untimely recognition of the disorder. Syringomyelia is the most common result of Chiari-I. The selection of surgical or non-surgical management depends upon the patient symptoms and the presence of absence of Syringomyelia. The objective of this case report is to give a broad perspective on Chiari Malformation-I from the symptoms and clinical findings obtained in a patient with Syringomyelia associated with Chiari Malformation-I and to discuss about the different surgical options as well as the psychological support required for the management of the condition.Nepal Journal of Neuroscience. Vol. 13, No. 2, 2016, Page: 105-108 

Symptomatic Outcome after Bone-only Suboccipital Decompression in Adult Patients with Chiari Type I Malformations in the Absence of Hydromyelia or Hydrocephalus

2017 ◽  
Vol 78 (04) ◽  
pp. 344-349 ◽  
Author(s):  
Hazem Abuhusain ◽  
Manuri Gunawardena ◽  
Tyler Auschwitz ◽  
Charles Teo ◽  
Nicolas Koechlin
Keyword(s):  
Chiari Malformation ◽  
Length Of Hospital Stay ◽  
Adult Patients ◽  
Common Symptom ◽  
Type I ◽  
Tonsillar Herniation ◽  
Adult Type ◽  
Duration Of Symptoms ◽  
Suboccipital Decompression ◽  
Pain Symptoms

Background Type I Chiari malformation presents without an associated hydromyelia in 30 to 70% of cases, yet there is no agreement regarding the optimal surgical treatment for these patients. We review our experience for treating symptomatic adult type I Chiari malformation without hydromyelia using a suboccipital bone decompression of the hindbrain and no duraplasty in 12 adult patients. Outcome was measured according to the Chicago Chiari Outcome Scale (CCOS). Results Nine of 12 patients were female; average age at surgery was 34.4 years (range: 17–67 years). Average duration of symptoms prior to surgery was 9.6 years (2 months–29 years). The most common symptom was head and/or neck pain (11/12 patients). All patients additionally presented with at least one non-pain symptom. Mean degree of tonsillar herniation on magnetic resonance imaging was 6.8 mm (range: 5–12 mm) below McRae's line. Operative time was on average 68 minutes (range: 47–120 minutes). No surgical complications were noted in any patient. Length of hospital stay was 2 days (1 overnight) for all patients. Mean follow-up was 167 weeks (range: 13–378 weeks). CCOS for all patients on average was 14.50 (range: 12–16). Pain symptoms underwent improvement (7/11 [63.6%]) or complete resolution (4/11 [36.4%]) in all affected patients. A shorter duration of preoperative symptoms significantly correlated with a better CCOS (p = 0.03). Degree of tonsillar herniation had no significant effect on CCOS (p = 0.67). Of non-pain symptoms, paresthesias/dysesthesias and visual symptoms improved or resolved completely in all affected patients. No patient experienced a worsening of either pain or non-pain symptoms. Conclusion In the subset of adult patients with a type I Chiari malformation and no associated hydromyelia, a craniectomy without an additional opening of the dura may achieve good overall results according to the CCOS.

scholarly journals Diffusion tensor imaging assessment of microstructural brainstem integrity in Chiari malformation Type I

2016 ◽  
Vol 125 (5) ◽  
pp. 1112-1119 ◽  
Author(s):  
Vibhor Krishna ◽  
Francesco Sammartino ◽  
Philip Yee ◽  
David Mikulis ◽  
Matthew Walker ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Posterior Fossa ◽  
Chiari Malformation ◽  
Diffusion Tensor ◽  
Structural Parameters ◽  
Ventricular Volume ◽  
Neurological Dysfunction ◽  
Type I ◽  
Tonsillar Herniation ◽  
Chiari Malformation Type I

OBJECTIVE The diagnosis of Chiari malformation Type I (CM-I) is primarily based on the degree of cerebellar tonsillar herniation even though it does not always correlate with symptoms. Neurological dysfunction in CM-I presumably results from brainstem compression. With the premise that conventional MRI does not reveal brain microstructural changes, this study examined both structural and microstructural neuroimaging metrics to distinguish patients with CM-I from age- and sex-matched healthy control subjects. METHODS Eight patients with CM-I and 16 controls were analyzed. Image postprocessing involved coregistration of anatomical T1-weighted with diffusion tensor images using 3D Slicer software. The structural parameters included volumes of the posterior fossa, fourth ventricle, and tentorial angle. Fractional anisotropy (FA) was calculated separately in the anterior and posterior compartments of the lower brainstem. RESULTS The mean age of patients in the CM-I cohort was 42.6 ± 10.4 years with mean tonsillar herniation of 12 mm (SD 0.7 mm). There were no significant differences in the posterior fossa volume (p = 0.06) or fourth ventricular volume between the 2 groups (p = 0.11). However, the FA in the anterior brainstem compartment was significantly higher in patients with CM-I preoperatively (p = 0.001). The FA values normalized after Chiari decompression except for persistently elevated FA in the posterior brainstem compartment in patients with CM-I and syrinx. CONCLUSIONS In this case-control study, microstructural alterations appear to be reliably associated with the diagnosis of CM-I, with a significantly elevated FA in the lower brainstem in patients with CM-I compared with controls. More importantly, the FA values normalized after decompressive surgery. These findings should be validated in future studies to determine the significance of diffusion tensor imaging–based assessment of brainstem microstructural integrity as an adjunct to the clinical assessment in patients with CM-I.

scholarly journals Outcomes after suboccipital decompression without dural opening in children with Chiari malformation Type I

2015 ◽  
Vol 16 (2) ◽  
pp. 150-158 ◽  
Author(s):  
Benjamin C. Kennedy ◽  
Kathleen M. Kelly ◽  
Michelle Q. Phan ◽  
Samuel S. Bruce ◽  
Michael M. McDowell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chiari Malformation ◽  
Multivariate Regression ◽  
Type I ◽  
Tonsillar Herniation ◽  
Chiari Malformation Type I ◽  
Radiographic Findings ◽  
Major Complications ◽  
Risk Factors For Recurrence ◽  
Dural Opening

OBJECT Symptomatic pediatric Chiari malformation Type I (CM-I) is most often treated with posterior fossa decompression (PFD), but controversy exists over whether the dura needs to be opened during PFD. While dural opening as a part of PFD has been suggested to result in a higher rate of resolution of CM symptoms, it has also been shown to lead to more frequent complications. In this paper, the authors present the largest reported series of outcomes after PFD without dural opening surgery, as well as identify risk factors for recurrence. METHODS The authors performed a retrospective review of 156 consecutive pediatric patients in whom the senior authors performed PFD without dural opening from 2003 to 2013. Patient demographics, clinical symptoms and signs, radiographic findings, intraoperative ultrasound results, and neuromonitoring findings were reviewed. Univariate and multivariate regression analyses were performed to determine risk factors for recurrence of symptoms and the need for reoperation. RESULTS Over 90% of patients had a good clinical outcome, with improvement or resolution of their symptoms at last follow-up (mean 32 months). There were no major complications. The mean length of hospital stay was 2.0 days. In a multivariate regression model, partial C-2 laminectomy was an independent risk factor associated with reoperation (p = 0.037). Motor weakness on presentation was also associated with reoperation but only with trend-level significance (p = 0.075). No patient with < 8 mm of tonsillar herniation required reoperation. CONCLUSIONS The vast majority (> 90%) of children with symptomatic CM-I will have improvement or resolution of symptoms after a PFD without dural opening. A non–dural opening approach avoids major complications. While no patient with tonsillar herniation < 8 mm required reoperation, children with tonsillar herniation at or below C-2 have a higher risk for failure when this approach is used.

Chiari malformation Type I and syrinx in children undergoing magnetic resonance imaging

2011 ◽  
Vol 8 (2) ◽  
pp. 205-213 ◽  
Author(s):  
Jennifer Strahle ◽  
Karin M. Muraszko ◽  
Joseph Kapurch ◽  
J. Rajiv Bapuraj ◽  
Hugh J. L. Garton ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Mr Imaging ◽  
Chiari Malformation ◽  
Foramen Magnum ◽  
Type I ◽  
Csf Flow ◽  
Tonsillar Herniation ◽  
Chiari Malformation Type I ◽  
Age Related ◽  
Imaging Characteristics

Object Chiari malformation Type I (CM-I) with an associated spinal syrinx is a common pediatric diagnosis. A better understanding of the relative age-related prevalence and MR imaging characteristics of these associated conditions may lead to improved treatment decisions. Methods The authors performed a retrospective review of 14,116 consecutive individuals 18 years of age or younger who had undergone brain or cervical spine MR imaging at the University of Michigan between November 1997 and August 2008. In the patients with CM-I, demographic, clinical, and radiographic information was recorded. Results Five hundred nine children (3.6%) with CM-I were identified. Among these patients, 23% also had a spinal cord syrinx, and 86% of the syringes were found in the cervical spine. The MR imaging prevalence of CM-I with a syrinx was 1.2% in girls and 0.5% in boys (p < 0.0001). The severity of impaired CSF flow at the foramen magnum was associated with the amount of tonsillar herniation (p < 0.0001) and conformation of the tonsils (p < 0.0001). Patients with CM-I were treated surgically in 35% of cases; these patients exhibited more severe tonsillar herniation (p < 0.0001) and impaired CSF flow (p < 0.0001) as compared with those who did not undergo surgery. On imaging, 32% of all the patients with CM-I were considered symptomatic by the treating physician. Patients were more likely to be considered symptomatic if they were female, had a syrinx, displayed abnormal tonsillar pulsations, or had a greater amount of tonsillar herniation. Conclusions In this study the authors describe the age-related prevalence and MR imaging characteristics of CM-I and its association with a syrinx and other abnormalities in a large group of children who underwent MR imaging for any indication. Syringes are more common in older children, in girls, and in patients with a greater degree of tonsillar descent and CSF flow impairment.

scholarly journals Management of parturients in active labor with Arnold Chiari malformation, tonsillar herniation, and syringomyelia

2017 ◽  
Vol 8 (1) ◽  
pp. 10 ◽  
Author(s):  
RamsisF Ghaly ◽  
Tatiana Tverdohleb ◽  
KennethD Candido ◽  
NebojsaNick Knezevic
Keyword(s):  
Chiari Malformation ◽  
Tonsillar Herniation ◽  
Arnold Chiari Malformation ◽  
Active Labor

scholarly journals Definition of the adult Chiari malformation: a brief historical overview

2001 ◽  
Vol 11 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Ghassan K. Bejjani
Keyword(s):  
Chiari Malformation ◽  
Historical Review ◽  
Historical Overview ◽  
Tonsillar Herniation ◽  
Definition Of ◽  
Radiology And Pathology ◽  
Neuroimaging Techniques

With the widespread use of newer neuroimaging techniques and modalities, significant tonsillar herniation is being diagnosed in more than 0.5% of patients, some of whom are asymptomatic. This puts the definition of the adult Chiari malformation to the test. The author provides a historical review of the evolution of the definition of the adult Chiari malformation in the neurosurgery, radiology, and pathology literature.

scholarly journals Multimodal evaluation of CSF dynamics following extradural decompression for Chiari malformation Type I

2015 ◽  
Vol 22 (6) ◽  
pp. 622-630 ◽  
Author(s):  
Jennifer L. Quon ◽  
Ryan A. Grant ◽  
Michael L. DiLuna
Keyword(s):  
Chiari Malformation ◽  
Phase Contrast ◽  
Clinical Symptoms ◽  
Type I ◽  
Csf Flow ◽  
Tonsillar Herniation ◽  
Csf Dynamics ◽  
Chiari Malformation Type I ◽  
Cisterna Magna ◽  
Flow Mri

OBJECT Extradural decompression is a minimally invasive technique for treating Chiari malformation Type I (CM-I) that avoids the complications of dural opening. While there is no agreement on which surgical method is optimal, mounting evidence demonstrates that extradural decompression effectively treats clinical symptoms, with a minimal reoperation rate. Neurological symptoms such as headache may be related to obstructed flow of CSF, and one aspect of successful extradural decompression is improved CSF dynamics. In this series, the authors report on their use of phase-contrast cine flow MRI to assess CSF flow as well as satisfactory decompression. METHODS The authors describe their first surgical series of 18 patients with CM-I undergoing extradural decompression and correlate clinical improvement with radiological changes. Patients were categorized as having complete, partial, or no resolution of their symptoms. Posterior fossa area, cisterna magna area, and tonsillar herniation were assessed on T2-weighted MRI, whereas improvement of CSF flow was evaluated with phase-contrast cine flow MRI. All patients received standard pre- and postoperative MRI studies; 8 (44.4%) patients had pre- and postoperative phase-contrast cine, while the rest underwent cine studies only postoperatively. RESULTS All 18 patients presented with symptomatic CM-I, with imaging studies demonstrating tonsillar herniation ≥ 5 mm, and 2 patients had associated syringomelia. All patients underwent suboccipital decompression and C-1 laminectomy with splitting of the dura. Patients with complete resolution of their symptoms had a greater relative increase in cisterna magna area compared with those with only partial improvement (p = 0.022). In addition, in those with complete improvement the preoperative cisterna magna area was smaller than in those who had either partial (0.020) or no (0.025) improvement. Ten (91%) of the 11 patients with improved flow also had improvement in their symptoms. There was 1 postoperative complication of dysphagia and dysphonia. None of the patients have required a second operation. CONCLUSIONS Extradural decompression has the potential to be the first-line treatment for CM-I but has been lacking an objective measure by which to assess surgical success as well as the need for reoperation. An increase in the CSF spaces and improved CSF dynamics may be associated with resolution of clinical symptoms. Including cine imaging as part of routine pre- and postoperative evaluation can help identify which patients are most likely to benefit from surgery.

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