scholarly journals Investigation of The Improvement Rate Regarding The Herniation of Cerebellar Tonsils Following Shunting Procedures in Patients with Chiari Malformation and Associated Hydrocephalus

2020 ◽  
Author(s):  
Mehmet Onur Yuksel ◽  
Salim Katar
Keyword(s):  
Chiari Malformation ◽  
Improvement Rate ◽  
Cerebellar Tonsils

Trzyipółletni chłopiec z malformacją Chiariego typu I – opis przypadku

2017 ◽  
Vol 21 (3) ◽  
Author(s):  
Anna Worch ◽  
Małgorzata Wielopolska
Keyword(s):  
Chiari Malformation ◽  
Foramen Magnum ◽  
Common Type ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Chiari Type I Malformation ◽  
Large Head ◽  
Exacerbation Of Symptoms ◽  
Chiari Type I ◽  
Cerebellar Tonsils

Chiari malformation is the most common structural defect of the posterior fossa and cerebellum, consisting of displacements of hindbrain inclination through the foramen magnum, often associated with syringomyelia. In the most common type I of this disease, only the cerebellar tonsils are descended. Chiari type I malformation may remain asymptomatic in early childhood, however a number of unspecific symptoms, such as: neck pains and headaches, vertigos, balance and sight disorders, may strengthen with age. Because of unspecificity and various exacerbation of symptoms the disease is often misdiagnosed or undiagnosed. We describe a case of a 3.5-year old boy with whom his mother visited a pediatrician because of a chronic cough. During the examination mother of the patient informed that all infections start with vomiting and the patient is not able to stand up from horizontal position without turning first to the side and then to the abdomen. During the examination, a large head circumference was noticed (56 cm, > 97 percentile). MRI showed elongated cerebellar tonsils descended below the foramen magnum (left 14 mm, right 11 mm). Chiari malformation type I with associated syringomyelia was diagnosed. The patient was reffered to neurosurgery consultation.

CFD Modeling for Patient-Specific Analysis of Cerebrospinal Fluid Flow

2007 ◽  
Author(s):  
Alejandro Roldán ◽  
Andrew Wentland ◽  
Oliver Wieben ◽  
Victor Haughton ◽  
Tim Osswald ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Canal ◽  
Chiari Malformation ◽  
Cfd Modeling ◽  
Patient Specific ◽  
Variable Response ◽  
Cervical Spinal Canal ◽  
Upper Cervical ◽  
The Impact ◽  
Cerebellar Tonsils

Chiari malformations are characterized by the cerebellar tonsils extending into the upper cervical spinal canal. Many patients with Chiari malformation experience headaches or develop a cyst in the spinal cord inferior to the cerebellar tonsils. Some symptomatic patients benefit from a surgical procedure to enlarge the foramen magnum and others do not. The causes of symptoms and variable response to surgery remain unknown. Imaging studies have shown that patients with a Chiari malformation exhibit increased cerebrospinal fluid (CSF) velocities compared to subjects without the malformation. Improved methods of analyzing the CSF fluid dynamics are needed to evaluate the impact of increased fluid velocities on pressure differentials in the upper cervical spinal canal and the potential impact of surgery on flow dynamics in patient specific geometries.

Position of Cerebellar Tonsils in the Normal Population and in Patients with Chiari Malformation

1985 ◽  
Vol 9 (6) ◽  
pp. 1033-1036 ◽  
Author(s):  
Ahmed O. Aboulezz ◽  
Klaus Sartor ◽  
Carl A. Geyer ◽  
Mokhtar H. Gado
Keyword(s):  
Chiari Malformation ◽  
Normal Population ◽  
Cerebellar Tonsils

Surgical treatment of Chiari malformation with and without syringomyelia: experience with 177 adult patients

2013 ◽  
Vol 118 (2) ◽  
pp. 232-242 ◽  
Author(s):  
Ulrich Batzdorf ◽  
David L. McArthur ◽  
John R. Bentson
Keyword(s):  
Clinical Outcome ◽  
Posterior Fossa ◽  
Chiari Malformation ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Surgical Decompression ◽  
Imaging Studies ◽  
Clinical Signs And Symptoms ◽  
The Relationship ◽  
Cerebellar Tonsils

Object This study aims to show the relationship between clinical outcome in patients who underwent surgical decompression for Chiari malformation (CM) and postoperative imaging studies, with particular emphasis on the subarachnoid cisterns of the posterior fossa. Methods One hundred seventy-seven patients with CM, including 97 with syringomyelia, underwent posterior fossa decompressive surgery. Both the dura and arachnoid were opened in 150 of these patients, and 135 underwent reduction of the cerebellar tonsils. The patients' clinical signs and symptoms were evaluated at 2 time points after surgery. Their imaging studies were analyzed specifically for the size of the retrotonsillar and subtonsillar cisterns and the syringomyelic cavities. The authors evaluated the relationship between these imaging findings and clinical parameters. Results Clinical improvement correlated strongly with enlargement of the subarachnoid cisterns, and enlargement of the cisterns also correlated with reduction in size of the syrinx cavities. Symptoms related to syringomyelia responded to reduction in size of the syrinx cavities. Conclusions Surgical decompression of the posterior fossa should aim to create relatively large subarachnoid cisterns and reduce the size of the syrinx cavity. Reduction of the cerebellar tonsils by surgical means, together with duraplasty, achieves this goal and thereby improves the clinical outcome for patients with CM. An incidental observation of the study is that obesity increases the likelihood of headache in patients with CM.

Postnatal ascent of the cerebellar tonsils in Chiari malformation Type II following surgical repair of myelomeningocele

2008 ◽  
Vol 2 (3) ◽  
pp. 188-193 ◽  
Author(s):  
Nobuhito Morota ◽  
Satoshi Ihara
Keyword(s):  
Chiari Malformation ◽  
Surgical Repair ◽  
Type Ii ◽  
Spinal Level ◽  
Vp Shunt ◽  
Group 2 ◽  
Myelomeningocele Repair ◽  
Cerebellar Tonsils ◽  
Group 1

Object Postnatal improvement in Chiari malformation type II (CM-II) following surgical repair of myelomeningocele was evaluated. Methods The authors reviewed data obtained in 20 cases in which patients underwent postnatal myelomeningocele repair within the first 48 hours after birth between October 2002 and September 2006. In 14 patients (Group 1), myelomeningocele was diagnosed in utero and the infants were delivered by cesarean section at 35–39 weeks' gestation (mean 36.4). The 6 infants in Group 2 were born after full-term gestation (39–41 weeks), and their myelomeningoceles were diagnosed postnatally. In all 20 patients, the myelomeningoceles were surgically repaired postnatally. Dynamic change of the herniated cerebellar tonsils in CM-II before and after the myelomeningocele repair, associated hydrocephalus, and symptomatic CM-II were analyzed. Results In Group 1, the CM-II was confirmed before myelomeningocele repair in 13 cases (93%). The spinal level of the caudal end of the cerebellar tonsils ranged from C-2 to C-7. Ascent of the cerebellar tonsils was observed in 11 patients (range 1–4 spinal levels, mean 2 levels) and continued even after ventriculoperitoneal (VP) shunt placement in most patients. A VP shunt was required for the treatment of hydrocephalus in 12 patients (86%). Symptomatic CM-II developed in 8 of 13 patients (61%), 3 of whom required surgical decompression. In Group 2, CM-II was confirmed in 5 infants (83%), with the cerebellar tonsils at a spinal level of C-2 to C-4 or C-5. Ascent of the cerebellar tonsils was observed in 4 patients (range 1–1.5 spinal levels, average 1.1 levels), and no patient had symptomatic CM-II. A VP shunt was placed in 5 patients (83%). No patient was lost to follow-up during the 18-month follow-up period. The only statistically significant difference between the 2 groups was the presence of symptomatic CM-II in Group 2 (p = 0.02). Conclusions Patients showed ascent of the cerebellar tonsils after postnatal myelomeningocele repair. Placement of a VP shunt helped promote the ascent. However, postnatal myelomeningocele repair in the patients in Group 1 failed to consistently prevent development of symptomatic CM-II. This limited experience suggests that postnatal repair of myelomeningocele can partially reverse the anatomical CM-II, but symptomatic CM-II cannot be prevented in some patients when the repair is performed after 36 weeks' gestation.

Early descriptions of the Arnold-Chiari malformation

1972 ◽  
Vol 37 (5) ◽  
pp. 543-547 ◽  
Author(s):  
Peter W. Carmel ◽  
William R. Markesbery
Keyword(s):  
Brain Stem ◽  
Chiari Malformation ◽  
Fourth Ventricle ◽  
Cervical Canal ◽  
Content Type ◽  
Anatomical Features ◽  
John Cleland ◽  
Arnold Chiari Malformation ◽  
The Brain ◽  
Cerebellar Tonsils

✓ John Cleland described an unusual congenital anomaly of the brain stem in 1883 in which the medulla was elongated, the fourth ventricle extended into the cervical canal, and the inferior vermis distorted caudally. In 1891 Chiari described two types of brain stem malformation; in one the cerebellar tonsils extended into the cervical canal without medullary deformation, while in the other there was caudal extension of the brain stem and cerebellum and prolongation of the inferior vermis into the cervical canal. The second type was termed the “Arnold-Chiari” malformation by other authors in 1907, and corresponds to the condition described earlier by Cleland. The anatomical features and differences between the types of malformation are tabulated.

scholarly journals Dynamic Cerebellar Tonsils in Chiari Malformation

2019 ◽  
Vol 206 ◽  
pp. 295 ◽  
Author(s):  
Michael U. Antonucci ◽  
Alex Drohan
Keyword(s):  
Chiari Malformation ◽  
Cerebellar Tonsils

scholarly journals Cerebellar and hindbrain motion in Chiari malformation with and without syringomyelia

2016 ◽  
Vol 24 (4) ◽  
pp. 546-555 ◽  
Author(s):  
Vannessa Leung ◽  
John S. Magnussen ◽  
Marcus A. Stoodley ◽  
Lynne E. Bilston
Keyword(s):  
Chiari Malformation ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Pressure Gradients ◽  
Chiari Malformation Type I ◽  
Tonsillar Tissue ◽  
Tissue Strain ◽  
Potential Marker ◽  
Spinal Subarachnoid Space ◽  
Cerebellar Tonsils

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.

scholarly journals Isolated unilateral trismus as a presentation of Chiari malformation: case report

2016 ◽  
Vol 17 (5) ◽  
pp. 533-536 ◽  
Author(s):  
Michelle Feinberg ◽  
Parker Babington ◽  
Shawn Sood ◽  
Robert Keating
Keyword(s):  
Weight Loss ◽  
Chiari Malformation ◽  
Complete Resolution ◽  
Foramen Magnum ◽  
Decompression Surgery ◽  
Type I ◽  
Radiological Evaluation ◽  
Significant Weight Loss ◽  
Postoperative Mri ◽  
Cerebellar Tonsils

The authors present a case of Chiari malformation manifesting as isolated trismus, describe the typical symptoms associated with Chiari malformation, and discuss the potential anatomical causes for this unique presentation. A 3-year-old boy presented with inability to open his jaw for 6 weeks with associated significant weight loss. The results of medical and radiological evaluation were negative except for Type I Chiari malformation with cerebellar tonsils 12 mm below the level of the foramen magnum. The patient underwent Chiari decompression surgery. Postoperatively, his ability to open his mouth was significantly improved, allowing resumption of a regular diet. Postoperative MRI revealed almost complete resolution of the syringobulbia. To the best of the authors' knowledge, this is the first reported case of isolated trismus from Chiari malformation with syringobulbia.

scholarly journals Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

2003 ◽  
Vol 61 (2B) ◽  
pp. 368-375 ◽  
Author(s):  
José Alberto Gonçalves da Silva ◽  
Maurus Marques de Almeida Holanda
Keyword(s):  
Spinal Cord ◽  
Retrospective Study ◽  
Chiari Malformation ◽  
Fourth Ventricle ◽  
Basilar Impression ◽  
Group I ◽  
Dural Graft ◽  
Large Opening ◽  
Dural Opening ◽  
Cerebellar Tonsils

The present study shows the results of 53 patients who have been treated surgically for basilar impression (BI), Chiari malformation (CM), and syringomyelia (SM). The patients were divided into two groups. Group I (24 patients) underwent osteodural decompression with large inferior occipital craniectomy, laminectomy from C 1 to C 3, dural opening in Y format, dissection of arachnoid adhesion between the cerebellar tonsils, medulla oblongata and spinal cord, large opening of the fourth ventricle and dural grafting with the use of bovine pericardium. Group II patients (29 patients) underwent osteodural-neural decompression with the same procedures described above plus dissection of the arachnoid adherences of the vessels of the region of the cerebellar tonsils, and tonsillectomy (amputation) in 10 cases, and as for the remainning 19 cases, intrapial aspiration of the cerebellar tonsils was performed. The residual pial sac was sutured to the dura in craniolateral position. After completion of the suture of the dural grafting, a thread was run through the graft at the level of the created cisterna magna and fixed to the cervical aponeurosis so as to move the dural graft on a posterior- caudal direction, avoiding, in this way, its adherence to the cerebellum.

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