Imaging characteristics associated with surgery in Chiari malformation type I

被引:5
作者
Alford, Elizabeth N. [1 ]
Atchley, Travis J. [1 ]
Leon, Tofey J. [2 ]
Laskay, Nicholas M. B. [1 ]
Arynchyna, Anastasia A. [1 ]
Smith, Burkely P. [3 ]
Aban, Inmaculada [4 ]
Johnston, James M. [1 ]
Blount, Jeffrey P. [1 ]
Rozzelle, Curtis J. [1 ]
Oakes, W. Jerry [1 ]
Rocque, Brandon G. [1 ]
机构
[1] Univ Alabama Birmingham, Dept Neurosurg, Div Pediat Neurosurg, Birmingham, AL USA
[2] Univ Alabama Birmingham, Dept Internal Med, Birmingham, AL USA
[3] Univ Alabama Birmingham, Dept Surg, Birmingham, AL 35294 USA
[4] Univ Alabama Birmingham, Dept Stat, Birmingham, AL USA
关键词
Chiari malformation type I; magnetic resonance imaging; syrinx; posterior fossa decompression; NATURAL-HISTORY; EXTERNAL VALIDATION; ODONTOID PROCESS; MANAGEMENT; CHILDREN; FEATURES; FOSSA; INDEX;
D O I
10.3171/2020.9.PEDS20347
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE In Chiari malformation type I (CM-I), a variety of imaging findings have been purported to be important; however, results have been inconclusive, inconsistent, or not replicated in independent studies. The purpose of this study was to report imaging characteristics for a large cohort of patients with CM-I and identify the imaging findings associated with surgical decompression. METHODS Patients were identified using ICD-9 codes for CM-I for the period from 1996 to 2017. After review of the medical records, patients were excluded if they 1) did not have a diagnosis of CM-I, 2) were not evaluated by a neurosurgeon, or 3) did not have available preoperative MRI. Retrospective chart review was performed to collect demographic and clinical data. Imaging parameters were measured according to the Chiari I Malformation Common Data Elements. RESULTS A total of 731 patients were included for analysis, having a mean follow-up duration of 25.5 months. The mean age at presentation was 8.5 years. The mean tonsil position was 11.4 mm below the foramen magnum, and 62.8% of patients had a pegged tonsil shape. Two hundred patients (27.4%) underwent surgery for life-dominating tussive headache, lower cranial nerve dysfunction, syrinx, and/or brainstem dysfunction. Surgical treatment was associated with a syrinx (OR 20.4, 95% CI 12.3-33.3, p < 0.0001), CM-1.5 (OR 1.797, 95% CI 1.08-2.98, p = 0.023), lower tonsil position (OR 1.130, 95% CI 1.08-1.18, p < 0.0001), and congenital fusion of cervical vertebrae (OR 5.473, 95% CI 1.08-27.8, p = 0.040). Among patients with benign CM-I, tonsil position was statistically significantly associated with future surgery. CONCLUSIONS Comprehensive imaging characteristics for a large cohort of patients with CM-I are reported. Analysis showed that a lower tonsillar position, a syrinx, and CM-1.5 were associated with undergoing posterior fossa decompression. This study demonstrates the importance of considering imaging findings in the context of patient symptomatology.
引用
收藏
页码:620 / 628
页数:9
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