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Clinical significance of changes in pB-C2 distance in patients with Chiari Type I malformations following posterior fossa decompression: a single-institution experience.
J Neurosurg Pediatr. 2016 Mar; 17(3):336-42.JN

Abstract

OBJECT The coexistence of Chiari malformation Type I (CM-I) and ventral brainstem compression (VBSC) has been well documented, but the change in VBSC after posterior fossa decompression (PFD) has undergone little investigation. In this study the authors evaluated VBSC in patients with CM-I and determined the change in VBSC after PFD, correlating changes in VBSC with clinical status and the need for further intervention. METHODS Patients who underwent PFD for CM-I by the senior author from November 2005 to January 2013 with complete radiological records were included in the analysis. The following data were obtained: objective measure of VBSC (pB-C2 distance); relationship of odontoid to Chamberlain's, McGregor's, McRae's, and Wackenheim's lines; clival length; foramen magnum diameter; and basal angle. Statistical analyses were performed using paired t-tests and a mixed-effects ANOVA model. RESULTS Thirty-one patients were included in the analysis. The mean age of the cohort was 10.0 years. There was a small but statistically significant increase in pB-C2 postoperatively (0.5 mm, p < 0.0001, mixed-effects ANOVA). Eleven patients had postoperative pB-C2 values greater than 9 mm. The mean distance from the odontoid tip to Wackenheim's line did not change after PFD, signifying postoperative occipitocervical stability. No patients underwent transoral odontoidectomy or occipitocervical fusion. No patients experienced clinical deterioration after PFD. CONCLUSIONS The increase in pB-C2 in patients undergoing PFD may occur as a result of releasing the posterior vector on the ventral dura, allowing it to relax posteriorly. This increase appears to be well-tolerated, and a postoperative pB-C2 measurement of more than 9 mm in light of stable craniocervical metrics and a nonworsened clinical examination does not warrant further intervention.

Authors+Show Affiliations

Departments of 1 Neurosurgery and.Departments of 1 Neurosurgery and.Departments of 1 Neurosurgery and.Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.Departments of 1 Neurosurgery and.Departments of 1 Neurosurgery and.Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.Departments of 1 Neurosurgery and.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26613273

Citation

Bonney, Phillip A., et al. "Clinical Significance of Changes in pB-C2 Distance in Patients With Chiari Type I Malformations Following Posterior Fossa Decompression: a Single-institution Experience." Journal of Neurosurgery. Pediatrics, vol. 17, no. 3, 2016, pp. 336-42.
Bonney PA, Maurer AJ, Cheema AA, et al. Clinical significance of changes in pB-C2 distance in patients with Chiari Type I malformations following posterior fossa decompression: a single-institution experience. J Neurosurg Pediatr. 2016;17(3):336-42.
Bonney, P. A., Maurer, A. J., Cheema, A. A., Duong, Q., Glenn, C. A., Safavi-Abbasi, S., Stoner, J. A., & Mapstone, T. B. (2016). Clinical significance of changes in pB-C2 distance in patients with Chiari Type I malformations following posterior fossa decompression: a single-institution experience. Journal of Neurosurgery. Pediatrics, 17(3), 336-42. https://doi.org/10.3171/2015.7.PEDS15261
Bonney PA, et al. Clinical Significance of Changes in pB-C2 Distance in Patients With Chiari Type I Malformations Following Posterior Fossa Decompression: a Single-institution Experience. J Neurosurg Pediatr. 2016;17(3):336-42. PubMed PMID: 26613273.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical significance of changes in pB-C2 distance in patients with Chiari Type I malformations following posterior fossa decompression: a single-institution experience. AU - Bonney,Phillip A, AU - Maurer,Adrian J, AU - Cheema,Ahmed A, AU - Duong,Quyen, AU - Glenn,Chad A, AU - Safavi-Abbasi,Sam, AU - Stoner,Julie A, AU - Mapstone,Timothy B, Y1 - 2015/11/27/ PY - 2017/03/01/pmc-release PY - 2015/11/28/entrez PY - 2015/11/28/pubmed PY - 2016/7/9/medline KW - CM = Chiari malformation KW - Chiari malformation KW - PFD = posterior fossa decompression KW - VBSC = ventral brainstem compression KW - brainstem compression KW - posterior fossa decompression SP - 336 EP - 42 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 17 IS - 3 N2 - OBJECT The coexistence of Chiari malformation Type I (CM-I) and ventral brainstem compression (VBSC) has been well documented, but the change in VBSC after posterior fossa decompression (PFD) has undergone little investigation. In this study the authors evaluated VBSC in patients with CM-I and determined the change in VBSC after PFD, correlating changes in VBSC with clinical status and the need for further intervention. METHODS Patients who underwent PFD for CM-I by the senior author from November 2005 to January 2013 with complete radiological records were included in the analysis. The following data were obtained: objective measure of VBSC (pB-C2 distance); relationship of odontoid to Chamberlain's, McGregor's, McRae's, and Wackenheim's lines; clival length; foramen magnum diameter; and basal angle. Statistical analyses were performed using paired t-tests and a mixed-effects ANOVA model. RESULTS Thirty-one patients were included in the analysis. The mean age of the cohort was 10.0 years. There was a small but statistically significant increase in pB-C2 postoperatively (0.5 mm, p < 0.0001, mixed-effects ANOVA). Eleven patients had postoperative pB-C2 values greater than 9 mm. The mean distance from the odontoid tip to Wackenheim's line did not change after PFD, signifying postoperative occipitocervical stability. No patients underwent transoral odontoidectomy or occipitocervical fusion. No patients experienced clinical deterioration after PFD. CONCLUSIONS The increase in pB-C2 in patients undergoing PFD may occur as a result of releasing the posterior vector on the ventral dura, allowing it to relax posteriorly. This increase appears to be well-tolerated, and a postoperative pB-C2 measurement of more than 9 mm in light of stable craniocervical metrics and a nonworsened clinical examination does not warrant further intervention. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/26613273/Clinical_significance_of_changes_in_pB_C2_distance_in_patients_with_Chiari_Type_I_malformations_following_posterior_fossa_decompression:_a_single_institution_experience_ DB - PRIME DP - Unbound Medicine ER -