Impact of morphological measurements on symptoms in Chiari malformation type 1

Abstract

Aim: Chiari malformation Type 1 (CM1) is a pathology resulting from herniation of cerebellar tonsils or tonsils into the spinal canal. We aimed to examine the impact of the cranium’s morphological measurements on the symptoms with CM1 patients.

Methods: This research was designed as a retrospective case-control study in a single-center. 2309 patients aged between 18-70 who underwent brain magnetic resonance imaging (MRI) to confirm or exclude the diagnosis of CM1 as a result of clinical and examination findings were evaluated. Cranium’s morphological measurements, the amount of herniation, patient’s symptoms, and the modified Asgari score were retrospectively assessed. 

Results: Patients with a final diagnosis of CM1 after the MRI evaluation were classified as study group (n=212), and the others control group (n=2097). The maximum cranial length, maximum cranial height, supra occiput length, posterior cranial fossa (PCF) anteroposterior length, in the study group were shorter, whereas the sagittal diameter of the foramen magnum and the longest anteroposterior diameter of the cerebrum were longer (P<0.001 for all mentioned comparisons). Tentorium cerebelli slope was found to be significantly lower in the study group (P<0.001). The most prevalent symptoms were a headache (92%). The herniation amount had a negative correlation with maximum cranial length and maximum cranial height (r=-0.184, P=0.07; r=-0.158 and P=0.022, respectively) and a positive correlation with the modified Asgari score (r=0.598; P<0.001).

Conclusion: The cranium’s morphological measurements have an impact on the symptoms of patients with CM1.

Keywords

• Chiari I malformation,Magnetic resonance imaging,Posterior cranial fossa,Tonsillar herniation

Chiari tip 1 malformasyonunda morfolojik ölçümlerin semptomlar üzerine etkisi

Abstract

Amaç: Chiari Tip 1 malformasyonu (CM1) serebellar tonsil veya tonsillerin spinal kanala herniasyonu sonucu ortaya çıkan bir patolojidir. CM1 hastalarında kraniyumun morfolojik ölçümlerinin semptomlar üzerindeki etkisini incelemeyi amaçladık.

Yöntemler: Çalışmamız tek merkezde retrospektif vaka-kontrol çalışması olarak tasarlandı. Klinik ve muayene bulguları sonucunda CM1 olduğu düşünülen tanıyı kesinleştirmek veya dışlamak için beyin manyetik rezonans görüntüleme (MRG) yapılan, yaşları 18-70 arasında 2309 hasta değerlendirildi. Kranium, morfolojik ölçümleri, herniasyon miktarı, hastaların semptomları ve modifiye Asgari skoru retrospektif olarak incelendi.

Bulgular: MRG değerlendirilmesinden sonra kesin CM1 tanısı alanlar çalışma grubu (n=212) ve diğerleri kontrol grubu (n=2097) olarak hastalar sınıflandırıldı. Çalışma grubunda maksimum kranial uzunluk, maksimum kranial yükseklik, supraocciput uzunluğu, posterior cranial fossa anteroposterior (PCF) uzunluğu kısa iken, foramen magnumun sagital çapı ve serebrum’un en uzun ön arka çapı uzun idi. (hepsi için P<0,001). Çalışma grubunda tentorium serebelli eğimi belirgin olarak düşük saptandı (P<0,001). En sık görülen semptom baş ağrısıydı (%92). Herniasyon miktarı maksimum kranial uzunluk ve maksimum kranial yükseklik ile negatif korelasyon (sırası ile r=-0,184, P=0,07; r=-0,158, P=0,022) ve modifiye Asgari skoru ile pozitif korelasyon göstermekte idi (r=0,598; P<0,001).

Sonuç: Kraniyumun morfolojik ölçümleri CM1 hastalarının semptomlarını üzerinde etkilidir.

Keywords

• Chiari I malformasyonu,Manyetik rezonans görüntüleme,Posterior kranial fossa,Tonsiller herniasyon

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