Magnetic resonance imaging measures of posterior cranial fossa morphology and cerebrospinal fluid physiology in chiari malformation type i

Noam Alperin, James R. Loftus, Carlos J. Oliu, Ahmet M. Bagci, Sang H. Lee, Birgit Ertl-Wagner, Barth A Green, Raymond Sekula

Research output: Contribution to journalArticle

34 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)515-522
Number of pages8
JournalNeurosurgery
Volume75
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Arnold-Chiari Malformation
Posterior Cranial Fossa
Cerebrospinal Fluid
Magnetic Resonance Imaging
Intracranial Pressure
Encephalocele
Fourth Ventricle
Hydrodynamics
Compliance
Multivariate Analysis

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 journalArticle

Alperin, Noam ; Loftus, James R. ; Oliu, Carlos J. ; Bagci, Ahmet M. ; Lee, Sang H. ; Ertl-Wagner, Birgit ; Green, Barth A ; Sekula, Raymond. / Magnetic resonance imaging measures of posterior cranial fossa morphology and cerebrospinal fluid physiology in chiari malformation type i. In: Neurosurgery. 2014 ; Vol. 75, No. 5. pp. 515-522.
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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.

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KW - Posterior cranial fossa morphology

KW - Quantitative measures

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