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Magnetic resonance imaging measures of posterior cranial fossa morphology and cerebrospinal fluid physiology in Chiari malformation type I.
Neurosurgery. 2014 Nov; 75(5):515-22; discussion 522.N

Abstract

BACKGROUND

It has been well documented that, along with tonsillar herniation, Chiari Malformation Type I (CMI) is associated with smaller posterior cranial fossa (PCF) and altered cerebrospinal fluid (CSF) flow and tissue motion in the craniocervical junction.

OBJECTIVE

This study assesses the relationship between PCF volumetry and CSF and tissue dynamics toward a combined imaging-based morphological-physiological characterization of CMI. Multivariate analysis is used to identify the subset of parameters that best discriminates CMI from a healthy cohort.

METHODS

Eleven length and volumetric measures of PCF, including crowdedness and 4th ventricle volume, 4 measures of CSF and cord motion in the craniocervical junction, and 5 global intracranial measures, including intracranial compliance and pressure, were measured by magnetic resonance imaging (MRI) in 36 symptomatic CMI subjects (28 female, 37 ± 11 years) and 37 control subjects (24 female, 36 ± 12 years). The CMI group was further divided based on symptomatology into "typical" and "atypical" subgroups.

RESULTS

Ten of the 20 morphologic and physiologic measures were significantly different between the CMI and the control cohorts. These parameters also had less variability and stronger significance in the typical CMI compared with the atypical. The measures with the most significance were clival and supraocciput lengths, PCF crowdedness, normalized PCF volume, 4th ventricle volume, maximal cord displacement (P < .001), and MR measure of intracranial pressure (P = .007). Multivariate testing identified cord displacement, PCF crowdedness, and normalized PCF as the strongest discriminator subset between CMI and controls. MR measure of intracranial pressure was higher in the typical CMI cohort compared with the atypical.

CONCLUSION

The identified 10 complementing morphological and physiological measures provide a more complete and symptomatology-relevant characterization of CMI than tonsillar herniation alone.

Authors+Show Affiliations

*Department of Radiology, University of Miami, Miami, Florida; ‡Department of Radiology, University of Munich, Munich, Germany; §Department of Neurological Surgery, University of Miami, Miami, Florida; and ¶Neurological Surgery, University of Pittsburgh, Pennsylvania.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25328981

Citation

Alperin, Noam, et al. "Magnetic Resonance Imaging Measures of Posterior Cranial Fossa Morphology and Cerebrospinal Fluid Physiology in Chiari Malformation Type I." Neurosurgery, vol. 75, no. 5, 2014, pp. 515-22; discussion 522.
Alperin N, Loftus JR, Oliu CJ, et al. Magnetic resonance imaging measures of posterior cranial fossa morphology and cerebrospinal fluid physiology in Chiari malformation type I. Neurosurgery. 2014;75(5):515-22; discussion 522.
Alperin, N., Loftus, J. R., Oliu, C. J., Bagci, A. M., Lee, S. H., Ertl-Wagner, B., Green, B., & Sekula, R. (2014). Magnetic resonance imaging measures of posterior cranial fossa morphology and cerebrospinal fluid physiology in Chiari malformation type I. Neurosurgery, 75(5), 515-22; discussion 522. https://doi.org/10.1227/NEU.0000000000000507
Alperin N, et al. Magnetic Resonance Imaging Measures of Posterior Cranial Fossa Morphology and Cerebrospinal Fluid Physiology in Chiari Malformation Type I. Neurosurgery. 2014;75(5):515-22; discussion 522. PubMed PMID: 25328981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Magnetic resonance imaging measures of posterior cranial fossa morphology and cerebrospinal fluid physiology in Chiari malformation type I. AU - Alperin,Noam, AU - Loftus,James R, AU - Oliu,Carlos J, AU - Bagci,Ahmet M, AU - Lee,Sang H, AU - Ertl-Wagner,Birgit, AU - Green,Barth, AU - Sekula,Raymond, PY - 2014/10/21/entrez PY - 2014/10/21/pubmed PY - 2015/7/15/medline SP - 515-22; discussion 522 JF - Neurosurgery JO - Neurosurgery VL - 75 IS - 5 N2 - BACKGROUND: It has been well documented that, along with tonsillar herniation, Chiari Malformation Type I (CMI) is associated with smaller posterior cranial fossa (PCF) and altered cerebrospinal fluid (CSF) flow and tissue motion in the craniocervical junction. OBJECTIVE: This study assesses the relationship between PCF volumetry and CSF and tissue dynamics toward a combined imaging-based morphological-physiological characterization of CMI. Multivariate analysis is used to identify the subset of parameters that best discriminates CMI from a healthy cohort. METHODS: Eleven length and volumetric measures of PCF, including crowdedness and 4th ventricle volume, 4 measures of CSF and cord motion in the craniocervical junction, and 5 global intracranial measures, including intracranial compliance and pressure, were measured by magnetic resonance imaging (MRI) in 36 symptomatic CMI subjects (28 female, 37 ± 11 years) and 37 control subjects (24 female, 36 ± 12 years). The CMI group was further divided based on symptomatology into "typical" and "atypical" subgroups. RESULTS: Ten of the 20 morphologic and physiologic measures were significantly different between the CMI and the control cohorts. These parameters also had less variability and stronger significance in the typical CMI compared with the atypical. The measures with the most significance were clival and supraocciput lengths, PCF crowdedness, normalized PCF volume, 4th ventricle volume, maximal cord displacement (P < .001), and MR measure of intracranial pressure (P = .007). Multivariate testing identified cord displacement, PCF crowdedness, and normalized PCF as the strongest discriminator subset between CMI and controls. MR measure of intracranial pressure was higher in the typical CMI cohort compared with the atypical. CONCLUSION: The identified 10 complementing morphological and physiological measures provide a more complete and symptomatology-relevant characterization of CMI than tonsillar herniation alone. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/25328981/Magnetic_resonance_imaging_measures_of_posterior_cranial_fossa_morphology_and_cerebrospinal_fluid_physiology_in_Chiari_malformation_type_I_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/NEU.0000000000000507 DB - PRIME DP - Unbound Medicine ER -