Abstract
BACKGROUND: It has been well documented that, along with tonsillar herniation, Chiari Malformation Type I (CMI) is associated with smaller posterior cranial fossa (PCF) and altered cerebrospinal fluid (CSF) flow and tissue motion in the craniocervical junction. OBJECTIVE: This study assesses the relationship between PCF volumetry and CSF and tissue dynamics toward a combined imaging-based morphological-physiological characterization of CMI. Multivariate analysis is used to identify the subset of parameters that best discriminates CMI from a healthy cohort. METHODS: Eleven length and volumetric measures of PCF, including crowdedness and 4th ventricle volume, 4 measures of CSF and cord motion in the craniocervical junction, and 5 global intracranial measures, including intracranial compliance and pressure, were measured by magnetic resonance imaging (MRI) in 36 symptomatic CMI subjects (28 female, 37 6 11 years) and 37 control subjects (24 female, 36 6 12 years). The CMI group was further divided based on symptomatology into "typical" and "atypical" subgroups. RESULTS: Ten of the 20 morphologic and physiologic measures were significantly different between the CMI and the control cohorts. These parameters also had less variability and stronger significance in the typical CMI compared with the atypical. The measures with the most significance were clival and supraocciput lengths, PCF crowdedness, normalized PCF volume, 4th ventricle volume, maximal cord displacement (P , .001), and MR measure of intracranial pressure (P = .007). Multivariate testing identified cord displacement, PCF crowdedness, and normalized PCF as the strongest discriminator subset between CMI and controls. MR measure of intracranial pressure was higher in the typical CMI cohort compared with the atypical. CONCLUSION: The identified 10 complementing morphological and physiological measures provide a more complete and symptomatology-relevant characterization of CMI than tonsillar herniation alone.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 515-522 |
| Number of pages | 8 |
| Journal | Neurosurgery |
| Volume | 75 |
| Issue number | 5 |
| DOIs | |
| State | Published - 2014 |
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Keywords
- Cerebrospinal fluid flow dynamics
- Chiari malformation
- Magnetic resonance imaging
- Posterior cranial fossa morphology
- Quantitative measures
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
Magnetic resonance imaging measures of posterior cranial fossa morphology and cerebrospinal fluid physiology in chiari malformation type i. / Alperin, Noam; Loftus, James R.; Oliu, Carlos J.; Bagci, Ahmet M.; Lee, Sang H.; Ertl-Wagner, Birgit; Green, Barth A; Sekula, Raymond.
In: Neurosurgery, Vol. 75, No. 5, 2014, p. 515-522.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Magnetic resonance imaging measures of posterior cranial fossa morphology and cerebrospinal fluid physiology in chiari malformation type i
AU - Alperin, Noam
AU - Loftus, James R.
AU - Oliu, Carlos J.
AU - Bagci, Ahmet M.
AU - Lee, Sang H.
AU - Ertl-Wagner, Birgit
AU - Green, Barth A
AU - Sekula, Raymond
PY - 2014
Y1 - 2014
N2 - BACKGROUND: It has been well documented that, along with tonsillar herniation, Chiari Malformation Type I (CMI) is associated with smaller posterior cranial fossa (PCF) and altered cerebrospinal fluid (CSF) flow and tissue motion in the craniocervical junction. OBJECTIVE: This study assesses the relationship between PCF volumetry and CSF and tissue dynamics toward a combined imaging-based morphological-physiological characterization of CMI. Multivariate analysis is used to identify the subset of parameters that best discriminates CMI from a healthy cohort. METHODS: Eleven length and volumetric measures of PCF, including crowdedness and 4th ventricle volume, 4 measures of CSF and cord motion in the craniocervical junction, and 5 global intracranial measures, including intracranial compliance and pressure, were measured by magnetic resonance imaging (MRI) in 36 symptomatic CMI subjects (28 female, 37 6 11 years) and 37 control subjects (24 female, 36 6 12 years). The CMI group was further divided based on symptomatology into "typical" and "atypical" subgroups. RESULTS: Ten of the 20 morphologic and physiologic measures were significantly different between the CMI and the control cohorts. These parameters also had less variability and stronger significance in the typical CMI compared with the atypical. The measures with the most significance were clival and supraocciput lengths, PCF crowdedness, normalized PCF volume, 4th ventricle volume, maximal cord displacement (P , .001), and MR measure of intracranial pressure (P = .007). Multivariate testing identified cord displacement, PCF crowdedness, and normalized PCF as the strongest discriminator subset between CMI and controls. MR measure of intracranial pressure was higher in the typical CMI cohort compared with the atypical. CONCLUSION: The identified 10 complementing morphological and physiological measures provide a more complete and symptomatology-relevant characterization of CMI than tonsillar herniation alone.
AB - BACKGROUND: It has been well documented that, along with tonsillar herniation, Chiari Malformation Type I (CMI) is associated with smaller posterior cranial fossa (PCF) and altered cerebrospinal fluid (CSF) flow and tissue motion in the craniocervical junction. OBJECTIVE: This study assesses the relationship between PCF volumetry and CSF and tissue dynamics toward a combined imaging-based morphological-physiological characterization of CMI. Multivariate analysis is used to identify the subset of parameters that best discriminates CMI from a healthy cohort. METHODS: Eleven length and volumetric measures of PCF, including crowdedness and 4th ventricle volume, 4 measures of CSF and cord motion in the craniocervical junction, and 5 global intracranial measures, including intracranial compliance and pressure, were measured by magnetic resonance imaging (MRI) in 36 symptomatic CMI subjects (28 female, 37 6 11 years) and 37 control subjects (24 female, 36 6 12 years). The CMI group was further divided based on symptomatology into "typical" and "atypical" subgroups. RESULTS: Ten of the 20 morphologic and physiologic measures were significantly different between the CMI and the control cohorts. These parameters also had less variability and stronger significance in the typical CMI compared with the atypical. The measures with the most significance were clival and supraocciput lengths, PCF crowdedness, normalized PCF volume, 4th ventricle volume, maximal cord displacement (P , .001), and MR measure of intracranial pressure (P = .007). Multivariate testing identified cord displacement, PCF crowdedness, and normalized PCF as the strongest discriminator subset between CMI and controls. MR measure of intracranial pressure was higher in the typical CMI cohort compared with the atypical. CONCLUSION: The identified 10 complementing morphological and physiological measures provide a more complete and symptomatology-relevant characterization of CMI than tonsillar herniation alone.
KW - Cerebrospinal fluid flow dynamics
KW - Chiari malformation
KW - Magnetic resonance imaging
KW - Posterior cranial fossa morphology
KW - Quantitative measures
UR - http://www.scopus.com/inward/record.url?scp=84926098735&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84926098735&partnerID=8YFLogxK
U2 - 10.1227/NEU.0000000000000507
DO - 10.1227/NEU.0000000000000507
M3 - Article
C2 - 25328981
AN - SCOPUS:84926098735
VL - 75
SP - 515
EP - 522
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 5
ER -