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Evaluating the relationship of the pB-C2 line to clinical outcomes in a 15-year single-center cohort of pediatric Chiari I malformation.
J Neurosurg Pediatr. 2015 Feb; 15(2):178-88.JN

Abstract

OBJECT

The clinical significance of radiological measurements of the craniocervical junction in pediatric Chiari I malformation (CM-I) is yet to be fully established across the field. The authors examined their institutional experience with the pB-C2 line (drawn perpendicular to a line drawn between the basion and the posterior aspect of the C-2 vertebral body, at the most posterior extent of the odontoid process at the dural interface). The pB-C2 line is a measure of ventral canal encroachment, and its relationship with symptomatology and syringomyelia in pediatric CM-I was assessed.

METHODS

The authors performed a retrospective review of 119 patients at the Monroe Carell Jr. Children's Hospital at Vanderbilt University who underwent posterior fossa decompression with duraplasty, 78 of whom had imaging for review. A neuroradiologist retrospectively evaluated preoperative and postoperative MRI examinations performed in these 78 patients, measuring the pB-C2 line length and documenting syringomyelia. The pB-C2 line length was divided into Grade 0 (<3 mm) and Grade I (≥3 mm). Statistical analysis was performed using the t-test for continuous variables and Fisher's exact test analysis for categorical variables. Multivariate logistic and linear regression analyses were performed to assess the relationship between pB-C2 line grade and clinical variables found significant on univariate analysis, controlling for age and sex.

RESULTS

The mean patient age was 8.5 years, and the mean follow-up duration was 2.4 years. The mean pB-C2 line length was 3.5 mm (SD 2 mm), ranging from 0 to 10 mm. Overall, 65.4% of patients had a Grade I pB-C2 line. Patients with Grade I pB-C2 lines were 51% more likely to have a syrinx than those with Grade 0 pB-C2 lines (RR 1.513 [95% CI 1.024-2.90], p=0.021) and, when present, had greater syrinx reduction (3.6 mm vs 0.2 mm, p=0.002). Although there was no preoperative difference in headache incidence, postoperatively patients with Grade I pB-C2 lines were 69% more likely to have headache reduction than those with Grade 0 pB-C2 lines (RR 1.686 [95% CI 1.035-2.747], p=0.009). After controlling for age and sex, pB-C2 line grade remained an independent correlate of headache improvement and syrinx reduction.

CONCLUSIONS

Ventral canal encroachment may explain the symptomatology of select patients with CM-I. The clinical findings presented suggest that patients with Grade I pB-C lines2, with increased ventral canal obstruction, may experience a higher likelihood of syrinx reduction and headache resolution from decompressive surgery with duraplasty than those with Grade 0 pB-C2 lines.

Authors+Show Affiliations

Departments of 1 Neurological Surgery and.No 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, Non-U.S. Gov't

Language

eng

PubMed ID

25479579

Citation

Ladner, Travis R., et al. "Evaluating the Relationship of the pB-C2 Line to Clinical Outcomes in a 15-year Single-center Cohort of Pediatric Chiari I Malformation." Journal of Neurosurgery. Pediatrics, vol. 15, no. 2, 2015, pp. 178-88.
Ladner TR, Dewan MC, Day MA, et al. Evaluating the relationship of the pB-C2 line to clinical outcomes in a 15-year single-center cohort of pediatric Chiari I malformation. J Neurosurg Pediatr. 2015;15(2):178-88.
Ladner, T. R., Dewan, M. C., Day, M. A., Shannon, C. N., Tomycz, L., Tulipan, N., & Wellons, J. C. (2015). Evaluating the relationship of the pB-C2 line to clinical outcomes in a 15-year single-center cohort of pediatric Chiari I malformation. Journal of Neurosurgery. Pediatrics, 15(2), 178-88. https://doi.org/10.3171/2014.9.PEDS14176
Ladner TR, et al. Evaluating the Relationship of the pB-C2 Line to Clinical Outcomes in a 15-year Single-center Cohort of Pediatric Chiari I Malformation. J Neurosurg Pediatr. 2015;15(2):178-88. PubMed PMID: 25479579.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluating the relationship of the pB-C2 line to clinical outcomes in a 15-year single-center cohort of pediatric Chiari I malformation. AU - Ladner,Travis R, AU - Dewan,Michael C, AU - Day,Matthew A, AU - Shannon,Chevis N, AU - Tomycz,Luke, AU - Tulipan,Noel, AU - Wellons,John C,3rd Y1 - 2014/12/05/ PY - 2014/12/6/entrez PY - 2014/12/6/pubmed PY - 2015/4/14/medline KW - CD = cord diameter KW - CM-I = Chiari I malformation KW - Chiari I malformation KW - MSD = maximum syrinx diameter KW - PFDD = posterior fossa decompression with duraplasty KW - ROC = receiver operating characteristic KW - craniocervical junction KW - posterior fossa decompression KW - syringomyelia SP - 178 EP - 88 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 15 IS - 2 N2 - OBJECT: The clinical significance of radiological measurements of the craniocervical junction in pediatric Chiari I malformation (CM-I) is yet to be fully established across the field. The authors examined their institutional experience with the pB-C2 line (drawn perpendicular to a line drawn between the basion and the posterior aspect of the C-2 vertebral body, at the most posterior extent of the odontoid process at the dural interface). The pB-C2 line is a measure of ventral canal encroachment, and its relationship with symptomatology and syringomyelia in pediatric CM-I was assessed. METHODS: The authors performed a retrospective review of 119 patients at the Monroe Carell Jr. Children's Hospital at Vanderbilt University who underwent posterior fossa decompression with duraplasty, 78 of whom had imaging for review. A neuroradiologist retrospectively evaluated preoperative and postoperative MRI examinations performed in these 78 patients, measuring the pB-C2 line length and documenting syringomyelia. The pB-C2 line length was divided into Grade 0 (<3 mm) and Grade I (≥3 mm). Statistical analysis was performed using the t-test for continuous variables and Fisher's exact test analysis for categorical variables. Multivariate logistic and linear regression analyses were performed to assess the relationship between pB-C2 line grade and clinical variables found significant on univariate analysis, controlling for age and sex. RESULTS: The mean patient age was 8.5 years, and the mean follow-up duration was 2.4 years. The mean pB-C2 line length was 3.5 mm (SD 2 mm), ranging from 0 to 10 mm. Overall, 65.4% of patients had a Grade I pB-C2 line. Patients with Grade I pB-C2 lines were 51% more likely to have a syrinx than those with Grade 0 pB-C2 lines (RR 1.513 [95% CI 1.024-2.90], p=0.021) and, when present, had greater syrinx reduction (3.6 mm vs 0.2 mm, p=0.002). Although there was no preoperative difference in headache incidence, postoperatively patients with Grade I pB-C2 lines were 69% more likely to have headache reduction than those with Grade 0 pB-C2 lines (RR 1.686 [95% CI 1.035-2.747], p=0.009). After controlling for age and sex, pB-C2 line grade remained an independent correlate of headache improvement and syrinx reduction. CONCLUSIONS: Ventral canal encroachment may explain the symptomatology of select patients with CM-I. The clinical findings presented suggest that patients with Grade I pB-C lines2, with increased ventral canal obstruction, may experience a higher likelihood of syrinx reduction and headache resolution from decompressive surgery with duraplasty than those with Grade 0 pB-C2 lines. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/25479579/Evaluating_the_relationship_of_the_pB_C2_line_to_clinical_outcomes_in_a_15_year_single_center_cohort_of_pediatric_Chiari_I_malformation_ DB - PRIME DP - Unbound Medicine ER -