Araştırma Makalesi
BibTex RIS Kaynak Göster

Impact of morphological measurements on symptoms in Chiari malformation type 1

Yıl 2019, Cilt: 3 Sayı: 6, 441 - 446, 28.06.2019
https://doi.org/10.28982/josam.572881

Öz

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.

Kaynakça

  • 1. Fernández AA, Guerrero AI, Martínez MI, Vázquez ME, Fernández JB, Chesa I Octavio E, et al. Malformations of the craniocervical junction (Chiari type I and syringomyelia:classification, diagnosis and treatment). BMC Musculoskelet Disord. 2009 Dec 17;10 Suppl 1:S1. doi: 10.1186/1471-2474-10-S1-S1.
  • 2. Godzik J, Kelly MP, Radmanesh A, Kim D, Holekamp TF, Smyth MD, et al. Relationship of syrinx size and tonsillar descent to spinal deformity in Chiari malformation type I with associated syringomyelia. J Neurosurg Pediatr. 2014;13(4):368–74. doi: 10.3171/2014.1.PEDS13105.
  • 3. Aiken AH, Hoots JA, Saindane AM, Hudgins PA. Incidence of cerebellar tonsillar ectopia in idiopathic intracranial hypertension: a mimic of the Chiari I malformation. AJNR Am J Neuroradiol. 2012;33(10):1901–6. doi: 10.3174/ajnr.A3068.
  • 4. Barkovich AJ, Wippold FJ, Sherman JL, Citrin CM. Significance of cerebellar tonsillar position on MR. AJNR Am J Neuroradiol 1986;7(5):795–9.
  • 5. Abbott D, Brockmeyer D, Neklason DW, Teerlink C, Cannon-Albright LA. Population-based description of familial clustering of Chiari malformation Type I. J Neurosurg. 2018; 128:460-5. doi: 10.3171/2016.9.JNS161274.
  • 6. Poretti A, Ashmawy R, Garzon-Muvdi T, Jallo GI, Huisman TA, Raybaud C: Chiari Type 1 Deformity in Children: Pathogenetic, Clinical, Neuroimaging, and Management Aspects. Neuropediatrics. 2016;47(5):293-307. doi: 10.1055/s-0036-1584563.
  • 7. Rogers JM, Savage G, Stoodley MA. A Systematic Review of Cognition in Chiari I Malformation. Neuropsychol Rev. 2018;28(2):176-87. doi: 10.1007/s11065-018-9368-6.
  • 8. Fischbein R, Saling JR, Marty P, Kropp D, Meeker J, Amerine J, et al. Patient-reported Chiari malformation type I symptoms and diagnostic experiences: a report from the national Conquer Chiari Patient Registry database. Neurological Sci. 2015;36(9):1617-24. doi: 10.1007/s10072-015-2219-9.
  • 9. Eppelheimer MS, Houston JR, Bapuraj JR, Labuda R, Loth DM, Braun AM, et al. A Retrospective 2D Morphometric Analysis of Adult Female Chiari Type I Patients with Commonly Reported and Related Conditions. Front Neuroanat 2018;12:2. doi: 10.3389/fnana.2018.00002.
  • 10. McVige JW, Leonardo J. Neuroimaging and the clinical manifestations of Chiari Malformation Type I (CMI). Curr Pain Headache Rep. 2015;19(16):18. doi: 10.1007/s11916-015-0491-2.
  • 11. Houston JR, Eppelheimer MS, Pahlavian SH, Biswas D, Urbizu A, Martin BA, et al. A morphometric assessment of type I Chiari malformation above the McRae line: A retrospective case-control study in 302 adult female subjects. J Neuroradiol. 2018;45(1):23-31. doi: 10.1016/j.neurad.2017.06.006.
  • 12. Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, et al. Chiari I malformation redefined:clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 1999;44(5):1005–17.
  • 13. Sekula RF, 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;18;2:11. doi: 10.1186/1743-8454-2-11.
  • 14. Taştemur Y, Sabanciogullari V, Salk I, Sönmez M, Cimen M. The Relationship of the posterior cranial fossa, the cerebrum, and cerebellum morphometry with Tonsiller Herniation. Iran J Radiol.1 2017; 4:236-44. doi: 10.5812/iranjradiol.24436.
  • 15. Arnautovic A, Splavski B, Boop FA, Arnautovic KI. Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr. 2015;15(2):161-77. doi: 10.3171/2014.10.PEDS14295.
  • 16. Lei ZW, Wu SQ, Zhang Z, Han Y, Wang JW, Li F, et al. Clinical Characteristics, Imaging Findings and Surgical Outcomes of Chiari Malformation Type I in Pediatric and Adult Patients. Curr Med Sci. 2018;38(2):289-95. doi: 10.1007/s11596-018-1877-2.
  • 17. Alperin N, Loftus JR, Oliu CJ, Bagci AM, Lee SH, Ertl-Wagner B, et al. Imaging-Based Features of Headaches in Chiari Malformation Type I. Neurosurgery. 2015;77(1):96-103. doi: 10.1227/NEU.0000000000000740.
  • 18. Yarbrough CK, Greenberg JK, Park TS. Clinical Outcome Measures in Chiari I Malformation. Neurosurgery clinics of North America. 2015;26(4):533-41. doi: 10.1016/j.nec.2015.06.008.
  • 19. Biswas D, Eppelheimer MS, Houston JR, Ibrahimy A, Bapuraj JR, Labuda R, et al. Quantification of Cerebellar Crowding in Type I Chiari Malformation. Ann Biomed Eng. 2019; 47(3):731-43. doi: 10.1007/s10439-018-02175-z.
  • 20. Gilmer HS, Xi M, Young SH. Surgical Decompression for Chiari Malformation Type I: An Age-Based Outcomes Study Based on the Chicago Chiari Outcome Scale. World Neurosurg. 2017;107:285-90. doi: 10.1016/j.wneu.2017.07.162.

Chiari tip 1 malformasyonunda morfolojik ölçümlerin semptomlar üzerine etkisi

Yıl 2019, Cilt: 3 Sayı: 6, 441 - 446, 28.06.2019
https://doi.org/10.28982/josam.572881

Öz

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.

Kaynakça

  • 1. Fernández AA, Guerrero AI, Martínez MI, Vázquez ME, Fernández JB, Chesa I Octavio E, et al. Malformations of the craniocervical junction (Chiari type I and syringomyelia:classification, diagnosis and treatment). BMC Musculoskelet Disord. 2009 Dec 17;10 Suppl 1:S1. doi: 10.1186/1471-2474-10-S1-S1.
  • 2. Godzik J, Kelly MP, Radmanesh A, Kim D, Holekamp TF, Smyth MD, et al. Relationship of syrinx size and tonsillar descent to spinal deformity in Chiari malformation type I with associated syringomyelia. J Neurosurg Pediatr. 2014;13(4):368–74. doi: 10.3171/2014.1.PEDS13105.
  • 3. Aiken AH, Hoots JA, Saindane AM, Hudgins PA. Incidence of cerebellar tonsillar ectopia in idiopathic intracranial hypertension: a mimic of the Chiari I malformation. AJNR Am J Neuroradiol. 2012;33(10):1901–6. doi: 10.3174/ajnr.A3068.
  • 4. Barkovich AJ, Wippold FJ, Sherman JL, Citrin CM. Significance of cerebellar tonsillar position on MR. AJNR Am J Neuroradiol 1986;7(5):795–9.
  • 5. Abbott D, Brockmeyer D, Neklason DW, Teerlink C, Cannon-Albright LA. Population-based description of familial clustering of Chiari malformation Type I. J Neurosurg. 2018; 128:460-5. doi: 10.3171/2016.9.JNS161274.
  • 6. Poretti A, Ashmawy R, Garzon-Muvdi T, Jallo GI, Huisman TA, Raybaud C: Chiari Type 1 Deformity in Children: Pathogenetic, Clinical, Neuroimaging, and Management Aspects. Neuropediatrics. 2016;47(5):293-307. doi: 10.1055/s-0036-1584563.
  • 7. Rogers JM, Savage G, Stoodley MA. A Systematic Review of Cognition in Chiari I Malformation. Neuropsychol Rev. 2018;28(2):176-87. doi: 10.1007/s11065-018-9368-6.
  • 8. Fischbein R, Saling JR, Marty P, Kropp D, Meeker J, Amerine J, et al. Patient-reported Chiari malformation type I symptoms and diagnostic experiences: a report from the national Conquer Chiari Patient Registry database. Neurological Sci. 2015;36(9):1617-24. doi: 10.1007/s10072-015-2219-9.
  • 9. Eppelheimer MS, Houston JR, Bapuraj JR, Labuda R, Loth DM, Braun AM, et al. A Retrospective 2D Morphometric Analysis of Adult Female Chiari Type I Patients with Commonly Reported and Related Conditions. Front Neuroanat 2018;12:2. doi: 10.3389/fnana.2018.00002.
  • 10. McVige JW, Leonardo J. Neuroimaging and the clinical manifestations of Chiari Malformation Type I (CMI). Curr Pain Headache Rep. 2015;19(16):18. doi: 10.1007/s11916-015-0491-2.
  • 11. Houston JR, Eppelheimer MS, Pahlavian SH, Biswas D, Urbizu A, Martin BA, et al. A morphometric assessment of type I Chiari malformation above the McRae line: A retrospective case-control study in 302 adult female subjects. J Neuroradiol. 2018;45(1):23-31. doi: 10.1016/j.neurad.2017.06.006.
  • 12. Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, et al. Chiari I malformation redefined:clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 1999;44(5):1005–17.
  • 13. Sekula RF, 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;18;2:11. doi: 10.1186/1743-8454-2-11.
  • 14. Taştemur Y, Sabanciogullari V, Salk I, Sönmez M, Cimen M. The Relationship of the posterior cranial fossa, the cerebrum, and cerebellum morphometry with Tonsiller Herniation. Iran J Radiol.1 2017; 4:236-44. doi: 10.5812/iranjradiol.24436.
  • 15. Arnautovic A, Splavski B, Boop FA, Arnautovic KI. Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr. 2015;15(2):161-77. doi: 10.3171/2014.10.PEDS14295.
  • 16. Lei ZW, Wu SQ, Zhang Z, Han Y, Wang JW, Li F, et al. Clinical Characteristics, Imaging Findings and Surgical Outcomes of Chiari Malformation Type I in Pediatric and Adult Patients. Curr Med Sci. 2018;38(2):289-95. doi: 10.1007/s11596-018-1877-2.
  • 17. Alperin N, Loftus JR, Oliu CJ, Bagci AM, Lee SH, Ertl-Wagner B, et al. Imaging-Based Features of Headaches in Chiari Malformation Type I. Neurosurgery. 2015;77(1):96-103. doi: 10.1227/NEU.0000000000000740.
  • 18. Yarbrough CK, Greenberg JK, Park TS. Clinical Outcome Measures in Chiari I Malformation. Neurosurgery clinics of North America. 2015;26(4):533-41. doi: 10.1016/j.nec.2015.06.008.
  • 19. Biswas D, Eppelheimer MS, Houston JR, Ibrahimy A, Bapuraj JR, Labuda R, et al. Quantification of Cerebellar Crowding in Type I Chiari Malformation. Ann Biomed Eng. 2019; 47(3):731-43. doi: 10.1007/s10439-018-02175-z.
  • 20. Gilmer HS, Xi M, Young SH. Surgical Decompression for Chiari Malformation Type I: An Age-Based Outcomes Study Based on the Chicago Chiari Outcome Scale. World Neurosurg. 2017;107:285-90. doi: 10.1016/j.wneu.2017.07.162.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Radyoloji ve Organ Görüntüleme
Bölüm Araştırma makalesi
Yazarlar

Rasime Pelin Kavak

Meltem Özdemir 0000-0002-7388-2871

Mehmet Sorar 0000-0002-6933-7627

Yayımlanma Tarihi 28 Haziran 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 3 Sayı: 6

Kaynak Göster

APA Kavak, R. P., Özdemir, M., & Sorar, M. (2019). Impact of morphological measurements on symptoms in Chiari malformation type 1. Journal of Surgery and Medicine, 3(6), 441-446. https://doi.org/10.28982/josam.572881
AMA Kavak RP, Özdemir M, Sorar M. Impact of morphological measurements on symptoms in Chiari malformation type 1. J Surg Med. Haziran 2019;3(6):441-446. doi:10.28982/josam.572881
Chicago Kavak, Rasime Pelin, Meltem Özdemir, ve Mehmet Sorar. “Impact of Morphological Measurements on Symptoms in Chiari Malformation Type 1”. Journal of Surgery and Medicine 3, sy. 6 (Haziran 2019): 441-46. https://doi.org/10.28982/josam.572881.
EndNote Kavak RP, Özdemir M, Sorar M (01 Haziran 2019) Impact of morphological measurements on symptoms in Chiari malformation type 1. Journal of Surgery and Medicine 3 6 441–446.
IEEE R. P. Kavak, M. Özdemir, ve M. Sorar, “Impact of morphological measurements on symptoms in Chiari malformation type 1”, J Surg Med, c. 3, sy. 6, ss. 441–446, 2019, doi: 10.28982/josam.572881.
ISNAD Kavak, Rasime Pelin vd. “Impact of Morphological Measurements on Symptoms in Chiari Malformation Type 1”. Journal of Surgery and Medicine 3/6 (Haziran 2019), 441-446. https://doi.org/10.28982/josam.572881.
JAMA Kavak RP, Özdemir M, Sorar M. Impact of morphological measurements on symptoms in Chiari malformation type 1. J Surg Med. 2019;3:441–446.
MLA Kavak, Rasime Pelin vd. “Impact of Morphological Measurements on Symptoms in Chiari Malformation Type 1”. Journal of Surgery and Medicine, c. 3, sy. 6, 2019, ss. 441-6, doi:10.28982/josam.572881.
Vancouver Kavak RP, Özdemir M, Sorar M. Impact of morphological measurements on symptoms in Chiari malformation type 1. J Surg Med. 2019;3(6):441-6.