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Cerebellar and hindbrain motion in Chiari malformation with and without syringomyelia.
J Neurosurg Spine. 2016 Apr; 24(4):546-55.JN

Abstract

OBJECTIVE

The pathogenesis of syringomyelia associated with Chiari malformation type I (CM-I) is unclear. Theories of pathogenesis suggest the cerebellar tonsils may obstruct CSF flow or alter pressure gradients, or their motion might act as a piston to increase CSF pressure in the spinal subarachnoid space. This study was performed to measure cerebellar tonsillar and hindbrain motion in CM-I and assess the potential contributions to syrinx formation.

METHODS

Sixty-four CM-I patients and 25 controls were retrospectively selected from a clinical database, and all subjects had undergone cardiac-gated cine balanced fast-field echo MRI. There were a total of 36 preoperative CM-I scans, which consisted of 15 patients with and 21 patients without syringomyelia. Nineteen patients underwent paired pre- and postoperative imaging. Anteroposterior (AP) and superoinferior (SI) movements of the tip of the cerebellar tonsils, obex, fastigium of the fourth ventricle, pontomedullary junction, and cervicomedullary junction were measured. The distance between the fastigium and tip of the tonsils was used to calculate tonsillar tissue strain (Δi/i0).

RESULTS

CM-I patients had significantly greater cerebellar tonsillar motion in both the AP and SI directions than controls (AP +0.34 mm [+136%], p < 0.001; SI +0.49 mm [+163%], p < 0.001). This motion decreased after posterior fossa decompression (AP -0.20 mm [-33%], p = 0.001; SI -0.29 mm [-36%]; p < 0.001), but remained elevated above control levels (AP +56%, p = 0.021; SI +67%, p = 0.015). Similar trends were seen for all other tracked landmarks. There were no significant differences in the magnitude or timing of motion throughout the hindbrain between CM-I patients with and without syringomyelia. Increased tonsillar tissue strain correlated with Valsalva headaches (p = 0.03).

CONCLUSIONS

Cerebellar tonsillar motion may be a potential marker of CM-I and may have use in tailoring surgical procedures. The lack of association with syringomyelia suggests that tonsillar motion alone is not the driver of syrinx formation. Tonsillar tissue strain may play a part in the pathophysiology of Valsalva headaches.

Authors+Show Affiliations

Faculty of Medicine, University of New South Wales;Faculty of Medicine and Health Sciences, Macquarie University; and.Faculty of Medicine and Health Sciences, Macquarie University; and.Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26722953

Citation

Leung, Vannessa, et al. "Cerebellar and Hindbrain Motion in Chiari Malformation With and Without Syringomyelia." Journal of Neurosurgery. Spine, vol. 24, no. 4, 2016, pp. 546-55.
Leung V, Magnussen JS, Stoodley MA, et al. Cerebellar and hindbrain motion in Chiari malformation with and without syringomyelia. J Neurosurg Spine. 2016;24(4):546-55.
Leung, V., Magnussen, J. S., Stoodley, M. A., & Bilston, L. E. (2016). Cerebellar and hindbrain motion in Chiari malformation with and without syringomyelia. Journal of Neurosurgery. Spine, 24(4), 546-55. https://doi.org/10.3171/2015.8.SPINE15325
Leung V, et al. Cerebellar and Hindbrain Motion in Chiari Malformation With and Without Syringomyelia. J Neurosurg Spine. 2016;24(4):546-55. PubMed PMID: 26722953.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cerebellar and hindbrain motion in Chiari malformation with and without syringomyelia. AU - Leung,Vannessa, AU - Magnussen,John S, AU - Stoodley,Marcus A, AU - Bilston,Lynne E, Y1 - 2016/01/01/ PY - 2016/1/2/entrez PY - 2016/1/2/pubmed PY - 2016/8/26/medline KW - AP = anteroposterior KW - CLM = Chiari-like malformation KW - CM-I = Chiari malformation Type I KW - Chiari malformation KW - GRASS = gradient recalled acquisition in steady state KW - PC = phase contrast KW - PFD = posterior fossa decompression KW - SI = superoinferior KW - SSAS = spinal subarachnoid space KW - bFFE = balanced fast-field echo KW - balanced fast-field echo KW - brain motion KW - cerebellar tonsils KW - cervical KW - syringomyelia SP - 546 EP - 55 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 24 IS - 4 N2 - OBJECTIVE: The pathogenesis of syringomyelia associated with Chiari malformation type I (CM-I) is unclear. Theories of pathogenesis suggest the cerebellar tonsils may obstruct CSF flow or alter pressure gradients, or their motion might act as a piston to increase CSF pressure in the spinal subarachnoid space. This study was performed to measure cerebellar tonsillar and hindbrain motion in CM-I and assess the potential contributions to syrinx formation. METHODS: Sixty-four CM-I patients and 25 controls were retrospectively selected from a clinical database, and all subjects had undergone cardiac-gated cine balanced fast-field echo MRI. There were a total of 36 preoperative CM-I scans, which consisted of 15 patients with and 21 patients without syringomyelia. Nineteen patients underwent paired pre- and postoperative imaging. Anteroposterior (AP) and superoinferior (SI) movements of the tip of the cerebellar tonsils, obex, fastigium of the fourth ventricle, pontomedullary junction, and cervicomedullary junction were measured. The distance between the fastigium and tip of the tonsils was used to calculate tonsillar tissue strain (Δi/i0). RESULTS: CM-I patients had significantly greater cerebellar tonsillar motion in both the AP and SI directions than controls (AP +0.34 mm [+136%], p < 0.001; SI +0.49 mm [+163%], p < 0.001). This motion decreased after posterior fossa decompression (AP -0.20 mm [-33%], p = 0.001; SI -0.29 mm [-36%]; p < 0.001), but remained elevated above control levels (AP +56%, p = 0.021; SI +67%, p = 0.015). Similar trends were seen for all other tracked landmarks. There were no significant differences in the magnitude or timing of motion throughout the hindbrain between CM-I patients with and without syringomyelia. Increased tonsillar tissue strain correlated with Valsalva headaches (p = 0.03). CONCLUSIONS: Cerebellar tonsillar motion may be a potential marker of CM-I and may have use in tailoring surgical procedures. The lack of association with syringomyelia suggests that tonsillar motion alone is not the driver of syrinx formation. Tonsillar tissue strain may play a part in the pathophysiology of Valsalva headaches. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/26722953/Cerebellar_and_hindbrain_motion_in_Chiari_malformation_with_and_without_syringomyelia_ L2 - https://thejns.org/doi/10.3171/2015.8.SPINE15325 DB - PRIME DP - Unbound Medicine ER -