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JOURNAL ARTICLE
Alexander T Yahanda, Joyce Koueik, Laurie L Ackerman, P David Adelson, Gregory W Albert, Philipp R Aldana, Tord D Alden, Richard C E Anderson, David F Bauer, Tammy Bethel-Anderson, Karin Bierbrauer, Douglas L Brockmeyer, Joshua J Chern, Daniel E Couture, David J Daniels, Brian J Dlouhy, Susan R Durham, Richard G Ellenbogen, Ramin Eskandari, Herbert E Fuchs, Gerald A Grant, Patrick C Graupman, Stephanie Greene, Jeffrey P Greenfield, Naina L Gross, Daniel J Guillaume, Todd C Hankinson, Gregory G Heuer, Mark Iantosca, Bermans J Iskandar, Eric M Jackson, George I Jallo, James M Johnston, Bruce A Kaufman, Robert F Keating, Nickalus R Khan, Mark D Krieger, Jeffrey R Leonard, Cormac O Maher, Francesco T Mangano, Jonathan Martin, J Gordon McComb, Sean D McEvoy, Thanda Meehan, Arnold H Menezes, Michael S Muhlbauer, Brent R O'Neill, Greg Olavarria, John Ragheb, Nathan R Selden, Manish N Shah, Chevis N Shannon, Joshua S Shimony, Matthew D Smyth, Scellig S D Stone, Jennifer M Strahle, Mandeep S Tamber, James C Torner, Gerald F Tuite, Elizabeth C Tyler-Kabara, Scott D Wait, John C Wellons, William E Whitehead, Tae Sung Park, David D Limbrick, Raheel Ahmed
OBJECTIVE: Congenital anomalies of the atlanto-occipital articulation may be present in patients with Chiari malformation type I (CM-I). However, it is unclear how these anomalies affect the biomechanical stability of the craniovertebral junction (CVJ) and whether they are associated with an increased incidence of occipitocervical fusion (OCF) following posterior fossa decompression (PFD). The objective of this study was to determine the prevalence of condylar hypoplasia and atlas anomalies in children with CM-I and syringomyelia...
April 5, 2024: Journal of Neurosurgery. Pediatrics
#2
JOURNAL ARTICLE
Shiwei Huang, David R Nascene, Ryan Shanley, Isabela Pena-Pino, Troy C Lund, Ashish O Gupta, Paul J Orchard, Carolina Sandoval-Garcia
OBJECTIVE: Craniovertebral junction (CVJ) abnormalities are common and well documented in mucopolysaccharidosis type I-Hurler syndrome (MPS IH), often causing severe spinal canal narrowing. However, the requirement for surgical decompression and/or fusion is uncommon. Although hematopoietic cell transplant (HCT) has been shown to prolong the lives of patients with MPS IH, its effect in halting or reversing musculoskeletal abnormalities is less clear. Unfortunately, there are currently no universal guidelines for imaging or indication for surgical interventions in these patients...
March 15, 2024: Journal of Neurosurgery. Pediatrics
#3
JOURNAL ARTICLE
Yunsen He, Ping Liu, Mengjun Zhang, Lili Guo, Tao Zheng, Yuanpeng Yao, Qiang Zheng, Mingbin Bao, Chuan Jiang, Bo Wu, Jinping Liu
Objective This study aimed to establish a novel grading system, based on the craniovertebral junction compression severity index (CVJCSI) for multidirectional quantification at the foramen magnum plane for Chiari malformation type I (CMI). Methods The CVJCSI grading system was established to stratify patients based on the ventral (modified clivoaxial angle < 138°), dorsal (tonsil herniation), and central (brainstem herniation) CVJ (craniovertebral junction) compression, the CVJCSI grading system was established to stratify patients...
December 2023: Journal of Neurological Surgery. Part B, Skull Base
#4
JOURNAL ARTICLE
Mehmet Emin Akyuz, Mehmet Kürşat Karadag, Mehmet Hakan Sahin
INTRODUCTION: Chiari malformation type 1 (CM1), a complex pathological developmental disorder of the craniovertebral junction, is typically characterized by herniation of the cerebellar tonsils from the foramen magnum. Treatment using posterior fossa decompression alone without taking the ventral cervico-medullary compression into consideration may lead to unsatisfactory treatment outcomes. The current study evaluated the utility of the modified clivoaxial angle (MCAA) in assessing ventral compression and also examined its effect on treatment outcomes...
2023: Frontiers in Surgery
#5
JOURNAL ARTICLE
Mehmet Kürşat Karadag, Mehmet Emin Akyuz, Mehmet Hakan Sahin
BACKGROUND: Cough associated headache is the most common symptom in Chiari malformation type 1 (CM1). However, its pathophysiology and treatment are not clear. The aim of this study was to investigate the relationship between optic nerve sheath diameter (ONSD), an indicator of intracranial pressure, and headache and to investigate its predictive value on postoperative outcome. METHODS: In symptomatic CM1 patients, craniovertebral junction morphometric measurements and ONSD measurements were made from preoperative MR images, and headache intensities and characteristics were evaluated...
2023: Frontiers in Neurology
#6
JOURNAL ARTICLE
Douglas L Brockmeyer, Samuel H Cheshier, Jeff Stevens, Julio C Facelli, Kerry Rowe, John D Heiss, Anthony Musolf, David H Viskochil, Kristina L Allen-Brady, Lisa A Cannon-Albright
OBJECTIVE: Inherited variants predisposing patients to type 1 or 1.5 Chiari malformation (CM) have been hypothesized but have proven difficult to confirm. The authors used a unique high-risk pedigree population resource and approach to identify rare candidate variants that likely predispose individuals to CM and protein structure prediction tools to identify pathogenicity mechanisms. METHODS: By using the Utah Population Database, the authors identified pedigrees with significantly increased numbers of members with CM diagnosis...
November 25, 2022: Journal of Neurosurgery
#7
REVIEW
Vijay M Ravindra, Douglas L Brockmeyer
The term "complex Chiari malformation" (CCM) refers to a subset of clinical and radiographic findings that describe a subpopulation of Chiari patients with craniocervical kyphosis and secondary brainstem compression. These patients are at a greater risk for unsuccessful surgical treatment with standard Chiari surgical decompressive procedures and may require craniocervical fusion and/or odontoid resection. This article reviews concepts related to the diagnosis, management, and treatment of CCM and discusses possible directions for future research...
January 2023: Neurosurgery Clinics of North America
#8
John K Chae, Neelan J Marianayagam, Ibrahim Hussain, Amanda Cruz, Ali A Baaj, Roger Härtl, Jeffrey P Greenfield
BACKGROUND: The authors assessed the connection between clinical outcomes and morphometrics in patients with complex Chiari malformation (CM) who have undergone posterior fossa decompression (PFD) and subsequent occipitocervical fusion (OCF) with or without ventral decompression (VD). OBSERVATIONS: The authors retrospectively reviewed 33 patients with CM aged over 21 years who underwent PFD and OCF with or without endoscopic endonasal odontoidectomy at the authors' institution (21 OCF only and 12 OCF + VD)...
November 29, 2021: J Neurosurg Case Lessons
#9
JOURNAL ARTICLE
Sidharth Mantha, Liam G Coulthard, Robert Campbell
OBJECTIVE: We have previously reported inferior post-operative clinical outcomes in younger children with Chiari type-I malformation (CIM). We sought to quantify the CSF volumetric changes pre- and post-decompression, in a paediatric cohort, to determine whether cisternal volume change is associated with clinical outcomes. METHODS: In this retrospective clinical study, the CSF spaces of the posterior fossa (supracerebellar/quadrigeminal, prepontine, fourth ventricle, cisterna magna) were measured on magnetic resonance images pre- and post-operatively using a semi-automated method...
December 2021: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
#10
JOURNAL ARTICLE
Alexander Spiessberger, Nicholas Dietz, Basil Gruter, Justin Virojanapa
INTRODUCTION: Ehlers-Danlos syndrome (EDS) predisposes to craniocervical instability (CCI) with resulting cranial settling and cervicomedullary syndrome due to ligamentous laxity. This study investigates possible differences in radiographic outcomes and operative complication rate between two surgical techniques in patients with EDS and CCI undergoing craniocervical fusion (CCF): occipital bone (OB) versus occipital condyle (OC) fixation. METHODS: A retrospective search of the institutional operative database between January 07, 2017, and December 31, 2019, was conducted to identify EDS patients who underwent CCF with either OB (Group OB) or OC (Group OC) fixation...
October 2020: Journal of Craniovertebral Junction and Spine
#11
JOURNAL ARTICLE
Anousheh Sayah, April D Farley, Eric C Munoz, Faheem A Sandhu, Frank Berkowitz
OBJECTIVE: An abnormally decreased clivoaxial angle (CXA) is used during the clinical evaluation for corrective skull base surgery. Published normal ranges of CXA using x-ray, computed tomography, or magnetic resonance imaging (MRI) vary dramatically, especially with neck flexion or extension. The aim of this study was to use high-resolution MRI to determine the normal range of CXA in various neck positions using a reproducible measurement technique. METHODS: The CXA was measured in 10 healthy volunteers on sagittal T2 SPACE c-spine MRI in supine and prone positions and with the neck both neck and extended...
March 8, 2021: Neuroradiology Journal
#12
JOURNAL ARTICLE
Nicholas Sader, Walter Hader, Aaron Hockley, Valerie Kirk, Adetayo Adeleye, Jay Riva-Cambrin
OBJECTIVE: Chiari 1.5 malformation is a subgroup of the Chiari malformation in which tonsillar descent into the foramen magnum is accompanied by brainstem descent. No data exist on whether operative decompression in patients with Chiari 1.5 improves sleep-related breathing disorders (SRBDs) and whether there are radiological parameters predicting improvement. METHODS: The authors performed a retrospective cohort study of consecutive pediatric patients with Chiari 1...
January 29, 2021: Journal of Neurosurgery. Pediatrics
#13
Hoang Gia Du, Vu Xuan Phuoc, Nguyen Duc Hoang, Tran Trung Dung, Nguyen Van Trung
BACKGROUND: To aim of the present paper was to evaluate the results of halo traction and transarticular screw fixation combined with bone autoplasty in patients with severe atlantoaxial dislocation. CASE PRESENTATION: This is a retrospective study of severe cases of atlantoaxial dislocation in nine patients (six men and three women) treated with preoperative halo traction and posterior C1-C2 transarticular screw fixation combined with bone autoplasty from June 2006 to June 2011 at the Saint Paul Hospital (Hanoi)...
November 13, 2020: Orthopaedic Surgery
#14
JOURNAL ARTICLE
Vijay M Ravindra, Rajiv R Iyer, Al-Wala Awad, Robert J Bollo, Huirong Zhu, Douglas L Brockmeyer
OBJECTIVE: The authors' objective was to better understand the anatomical load-bearing relationship between the atlantooccipital joint and the upper cervical spine and its influence on the clinical behavior of patients with Chiari malformation type I (CM-I) and craniocervical pathology. METHODS: In a single-center prospective study of patients younger than 18 years with CM-I from 2015 through 2017 (mean age 9.91 years), the authors measured the occipital condyle-C2 sagittal vertebral alignment (C-C2SVA; defined as the position of a plumb line from the midpoint of the occiput (C0)-C1 joint relative to the posterior aspect of the C2-3 disc space), the pB-C2 (a line perpendicular to a line from the basion to the posteroinferior aspect of the C2 body on sagittal MRI), and the CXA (clivoaxial angle)...
July 17, 2020: Journal of Neurosurgery. Pediatrics
#15
JOURNAL ARTICLE
Jennifer M Strahle, Rukayat Taiwo, Christine Averill, James Torner, Chevis N Shannon, Christopher M Bonfield, Gerald F Tuite, Tammy Bethel-Anderson, Jerrel Rutlin, Douglas L Brockmeyer, John C Wellons, Jeffrey R Leonard, Francesco T Mangano, James M Johnston, Manish N Shah, Bermans J Iskandar, Elizabeth C Tyler-Kabara, David J Daniels, Eric M Jackson, Gerald A Grant, Daniel E Couture, P David Adelson, Tord D Alden, Philipp R Aldana, Richard C E Anderson, Nathan R Selden, Lissa C Baird, Karin Bierbrauer, Joshua J Chern, William E Whitehead, Richard G Ellenbogen, Herbert E Fuchs, Daniel J Guillaume, Todd C Hankinson, Mark R Iantosca, W Jerry Oakes, Robert F Keating, Nickalus R Khan, Michael S Muhlbauer, J Gordon McComb, Arnold H Menezes, John Ragheb, Jodi L Smith, Cormac O Maher, Stephanie Greene, Michael Kelly, Brent R O'Neill, Mark D Krieger, Mandeep Tamber, Susan R Durham, Greg Olavarria, Scellig S D Stone, Bruce A Kaufman, Gregory G Heuer, David F Bauer, Gregory Albert, Jeffrey P Greenfield, Scott D Wait, Mark D Van Poppel, Ramin Eskandari, Timothy Mapstone, Joshua S Shimony, Ralph G Dacey, Matthew D Smyth, Tae Sung Park, David D Limbrick
OBJECTIVE: Scoliosis is frequently a presenting sign of Chiari malformation type I (CM-I) with syrinx. The authors' goal was to define scoliosis in this population and describe how radiological characteristics of CM-I and syrinx relate to the presence and severity of scoliosis. METHODS: A large multicenter retrospective and prospective registry of pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for clinical and radiological characteristics of CM-I, syrinx, and scoliosis (coronal curve ≥ 10°)...
August 16, 2019: Journal of Neurosurgery. Pediatrics
#16
JOURNAL ARTICLE
Yunsen He, Tao Zheng, Bo Wu, Jiyang Wang
OBJECTIVE: To investigate the influence of Modified clivoaxial angle (MCAA) on the surgical planning and outcome in adult patients with Chiari malformation type I (CMI). METHODS: Clinical data of 268 adult patients undergoing Posterior fossa decompression without (PFD) or with duraplasty (PFDD) or with Resection of tonsils (RT) for CMI over 10 years were reviewed retrospectively, with outcome evaluated by CCOS. By means of ROC curve, the threshold of MCAA was calculated to stratify the patients...
July 12, 2019: World Neurosurgery
#17
JOURNAL ARTICLE
David D Gonda, Meng Huang, Valentina Briceño, Sandi K Lam, Thomas G Luerssen, Andrew Jea
BACKGROUND: Upper airway obstruction leading to dyspnea and dysphagia after occipitocervical fusion is a rare complication that has significant morbidity. OBJECTIVE: To estimate the frequency of postoperative dyspnea and dysphagia in children after occipitocervical fusion and to identify variables associated with its occurrence. METHODS: We retrospectively reviewed outcomes from all pediatric occipitocervical fusions at our institution between 2007 and 2014...
June 19, 2019: Operative Neurosurgery (Hagerstown, Md.)
#18
JOURNAL ARTICLE
Lichao Ma, Liuji Guo, Xiaodan Li, Jie Qin, Wenle He, Xiang Xiao, Lijun Lu, Yikai Xu, Yuankui Wu
OBJECTIVES: To investigate the diagnostic value of clivopalate angle (CPA) for basilar invagination (BI) at magnetic resonance imaging (MRI). METHODS: In this retrospective case-control study, CPA, clivodens angle (CDA), and clivoaxial angle (CXA) were measured on midsagittal MR images from 112 patients with BI (22 men; mean age, 43.9 years ± 13.1 years; range, 21-79 years) and 200 control subjects (57 men; mean age, 47.1 years ± 13.3 years; range, 20-80 years)...
July 2019: European Radiology
#19
JOURNAL ARTICLE
Correction of clivoaxial angle deformity in the setting of suboccipital craniectomy: technical note.
Daniel Felbaum, Steven Spitz, Faheem A Sandhu
A subset of patients with Chiari Type I malformation may develop neurological dysfunction secondary to an abnormally obtuse clivoaxial angle (CXA) and clivoaxial deformity causing deformative stress injury to the neural axis. Clivoaxial deformity can occur after initial standard suboccipital craniectomy, duraplasty, and C-1 laminectomy for brainstem compression, or severe clivoaxial deformity may be present in conjunction with a Chiari malformation. Clivoaxial deformity and abnormal CXA can be treated with an occipitocervical fusion (OCF)...
July 2015: Journal of Neurosurgery. Spine
#20
JOURNAL ARTICLE
Robert J Bollo, Jay Riva-Cambrin, Meghan M Brockmeyer, Douglas L Brockmeyer
OBJECT: Chiari malformation Type I (CM-I) is a congenital anomaly often treated by decompressive surgery. Patients who fail to respond to standard surgical management often have complex anomalies of the craniovertebral junction and brainstem compression, requiring reduction and occipitocervical fusion. The authors hypothesized that a subgroup of "complex" patients defined by specific radiographic risk factors may have a higher rate of requiring occipitocervical fusion. METHODS: A retrospective review was conducted of clinical and radiographic data in pediatric patients undergoing surgery for CM-I between 1995 and 2010...
August 2012: Journal of Neurosurgery. Pediatrics
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