Investigation of The Improvement Rate Regarding The Herniation of Cerebellar Tonsils Following Shunting Procedures in Patients with Chiari Malformation and Associated Hydrocephalus

Yıl 2020, Cilt: 4 Sayı: 3, 276 - 279, 01.09.2020

Mehmet Onur Yuksel Salim Katar

https://doi.org/10.30621/jbachs.2020.1078

Öz

Introduction and Aim: Chiari malformation is a congenital anomaly formed as the result of the herniation of posterior fossa structures through the foramen magnum toward the spinal canal. In this study, we aimed to present the improvement rate regarding the herniation in cerebellar tonsils following shunting procedures in patients with Chiari malformation and associated hydrocephalus. Method: We measured in mm the improvement rate regarding the herniation in cerebellar tonsils in postoperative cervical MRI images obtained following ventriculoperitoneal shunting procedures for hydrocephalus in adult patients with symptoms of Chiari malformation such as balance disorder, dizziness, numbness and loss of muscular strength at the hands who were diagnosed with Chiari malformation and hydrocephalus following cranial and cervical magnetic resonance imaging MRI . Results: A total of fifteen adult patients in whom the cerebellar tonsillar herniation was over 5 mm and accompanied by hydrocephalus were included in our study. The measure of herniation in the patients involved in the study was between 1.11 cm and 8 mm. The amount of improvement in herniation following the shunting procedure was between 7.76 mm and 2.2 mm. Conclusion: In patients with Chiari malformation associated with hydrocephalus, cerebellar tonsillar herniation can regress to 5 mm, which is considered as physiological, and the symptoms related to Chiari malformation can disappear. When Chiari malformation is associated with hydrocephalus, the tonsillar herniation may improve, and symptoms may disappear following the ventriculoperitoneal shunting procedure for hydrocephalus without necessitating posterior decompression for Chiari-related herniation.

Anahtar Kelimeler

chiari malformation, tonsillary herniation, ventriculoperitoneal shunt

Kaynakça

• 1. Carmel PW, Markesbery WR. Early descriptions of the ArnoldChiari malformation. The contribution of John Cleland. J Neurosurg 1972;37:543–547. [CrossRef]
• 2. Chiari H. Über Veränderungen des kleinhirns infolge von hydrocephalie des grosshirns. Dtsch Med Wochenschr 1891;17:1172– 1175. [CrossRef]
• 3. Chiari H. Über Veranderungen des kleinhirns, des Pons und der Medulla oblongota in Folge von congenitaler Hydrocephalie Grosshirns Denkschr Grosshirns. Denkschr Akad Wiss. Wien: 1895; p.63. https: // bildsuche. digitale-sammlungen. de / index. html?c=viewer & bandnummer= bsb00081264 & pimage=00063& lv=1&l=de
• 4. Brockmeyer DL. The complex Chiari: issues and management strategies. Neurol Sci 2011;32:S345–S347. [CrossRef]
• 5. Haines SJ, Berger M. Current treatment of Chiari malformations types I and II. A survey of the Pediatric Section of the American Association of Neurological Surgeons. Neurosurgery 1991;28:353–357. [CrossRef] https://doi.org/10.1227/00006123-199103000-00003
• 6. Tubbs RS, Iskandar BJ, Bartolucci AA, Oakes WJ. A critical analysis of the Chiari 1.5 malformation. J Neurosurg 2004;101:179–183. [CrossRef]
• 7. Tubbs RS, Muhleman M, Loukas M, Oakes WJ. A new form of herniation: the Chiari V malformation. Childs Nerv Syst 2012;28:305– 307. [CrossRef]
• 8. Işık N. Chiari malformasyonları ve syringomyeli. Türk Nöroşirürji Derg 2013;23:185–194. http://norosirurji.dergisi.org/pdf/pdf_TND_855.pdf
• 9. Castillo M, Dominguez R. Imaging of common congenital anomalies of the brain and spine. Clin Imaging 1992;16:73–88. [CrossRef]
• 10. Milhorat TH, Bolognese PA, Nishikawa M, McDonnell NB, Francomano CA. Syndrome of occipitoatlantoaxial hypermobility, cranial settling, and chiari malformation type I in patients with hereditary disorders of connective tissue. J Neurosurg Spine 2007;7:601–609. [CrossRef]
• 11. Barry A, Patten BM, Stewart BH. Possible factors in the development of the Arnold-Chiari malformation. J Neurosurg 1957;14:285–301. [CrossRef]
• 12. Daniel PM, Strich SJ. Some observations on the congenital deformity of the central nervous system known as the Arnold-Chiari malformation. J Neuropathol Exp Neurol 1958;17:255–266. [CrossRef]
• 13. Gardner WJ, Goodall RJ. The surgical treatment of ArnoldChiari malformation in adults; an explanation of its mechanism and importance of encephalography in diagnosis. J Neurosurg 1950;7:199–206. [CrossRef]
• 14. Klekamp J, Batzdorf U, Samii M, Bothe HW. The surgical treatment of Chiari I malformation. Acta Neurochir (Wien) 1996;138:788–801. [CrossRef]
• 15. McLone DG, Knepper PA. The cause of Chiari II malformation: a unified theory. Pediatr Neurosci 1989;15:1–12. [CrossRef]
• 16. Nishikawa M, Sakamoto H, Hakuba A, Nakanishi N, Inoue Y. Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa. J Neurosurg 1997;86:40–47. [CrossRef]
• 17. Oldfield EH, Muraszko K, Shawker TH, Patronas NJ. Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg 1994;80:3–15. [CrossRef]
• 18. Sekula RF Jr, Jannetta PJ, Casey KF, Marchan EM, Sekula LK, McCrady CS. Dimensions of the posterior fossa in patients symptomatic for Chiari I malformation but without cerebellar tonsillar descent. Cerebrospinal Fluid Res 2005;2:11. [CrossRef]
• 19. Batzdorf U. Chiari I malformation with syringomyelia. Evaluation of surgical therapy by magnetic resonance imaging. J Neurosurg 1988;68:726–730. [CrossRef]
• 20. Elster AD, Chen MY. Chiari I malformations: clinical and radiologic reappraisal. Radiology 1992;183:347–353. [CrossRef]
• 21. Sahuquillo J, Rubio E, Poca MA, Rovira A, Rodriguez-Baeza A, Cervera C. Posterior fossa reconstruction: a surgical technique for the treatment of Chiari I malformation and Chiari I/syringomyelia complex--preliminary results and magnetic resonance imaging quantitative assessment of hindbrain migration. Neurosurgery 1994;35:874–884;discussion 884–885. [CrossRef]
• 22. Wen L, Ma C, Wang H, Hu Z. The role of hydrocephalus in the development of Chiari I malformation and syringomyelia. J Neurol Sci 2014;344:240–242. [CrossRef]
• 23. Di Rocco C, Frassanito P, Massimi L, Peraio S. Hydrocephalus and Chiari type I malformation. Childs Nerv Syst 2011;27:1653–1664. [CrossRef]
• 24. Metellus P, Dufour H, Levrier O, François Grisoli. Endoscopic third ventriculostomy for treatment of noncommunicating syringomyelia associated with a Chiari I malformation and hydrocephalus: case report and pathophysiological considerations. Neurosurgery 2002;51:500–503;discussion 503–504. [CrossRef]
• 25. Massimi L, Pennisi G, Frassanito P, Tamburrini G, Rocco CD, Caldarelli M. Chiari type I and hydrocephalus. Childs Nerv Syst 2019;35:1701– 1709. [CrossRef]
• 26. Strayer A. Chiari I Malformation: clinical presentation and management. J Neurosci Nurs 2001;33:90–96, 104. [CrossRef]
• 27. Wu Y, Li C, Zong X, et al. Application of endoscopic third ventriculostomy for treating hydrocephalus-correlated Chiari type I malformation in a single Chinese neurosurgery centre. Neurosurg Rev 2018;41:249–254. [CrossRef]
• 28. Massimi L, Pravatà E, Tamburrini G, et al. Endoscopic third ventriculostomy for the management of Chiari I and related hydrocephalus: outcome and pathogenetic implications. Neurosurgery 2011;68:950–956. [CrossRef]