Chuang Ya-Chen, Carrasquilla Alejandro, Bilgili Gizem, Pionteck Aymeric, Liu Xinyan, Abderezaei Javid, Quinones Addison, Shuman William H, Zhao Shan, Ellenbogen Richard, Shrivastava Raj K, Kurt Mehmet
Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
World Neurosurg. 2024 Nov;191:e279-e288. doi: 10.1016/j.wneu.2024.08.105. Epub 2024 Aug 26.
Chiari malformation type I (CM-1) is a complex disorder in which tonsillar herniation through the foramen magnum (FM) manifests with a spectrum of clinical symptoms. This work analyzes morphometric and volumetric characteristics of CM-1 patients.
With institutional review board approval, we retrospectively reviewed a total of 72 adult CM-1 patients and 26 healthy adult volunteers who underwent volumetric magnetic resonance brain imaging. Clinical data were retrospectively extracted from the electronic medical record. We analyzed multidimensional morphometric and volumetric features within the posterior cranial fossa and correlated these features with syrinx formation and the decision to undergo surgical decompression.
In our study, CM-1 patients had decreased cerebellar (CBL), brainstem, and fourth ventricular volumes but larger tonsillar volume with increased total tonsillar length. CM-1 patients who underwent surgery had significantly more neural tissue within the cross-sectional area of the cisterna magna. Logistic regression demonstrated that combining neural tissue at the FM with CBL and fourth ventricular volumes led to a great degree of correlation with syrinx formation (area under the curve: 0.911).
Our findings suggest that the amount of tissue at the FM correlates with CM-1 patients who underwent decompressive surgery, more so than tonsillar length. Additionally, the combination of neural tissue at the FM, CBL, and fourth ventricular volumes led to a great degree of correlation with syrinx formation. Together, these findings suggest that a global compressive phenomenon within the posterior fossa leads to CM-1 symptomatology and syrinx formation.
I型Chiari畸形（CM-1）是一种复杂的疾病，其中小脑扁桃体通过枕骨大孔（FM）疝出，并伴有一系列临床症状。本研究分析了CM-1患者的形态学和体积特征。
经机构审查委员会批准，我们回顾性分析了72例成年CM-1患者和26名健康成年志愿者，这些患者均接受了脑部容积磁共振成像检查。临床数据从电子病历中回顾性提取。我们分析了后颅窝内的多维形态学和体积特征，并将这些特征与空洞形成以及是否接受手术减压的决定进行关联。
在我们的研究中，CM-1患者的小脑（CBL）、脑干和第四脑室体积减小，但扁桃体体积增大，扁桃体总长度增加。接受手术的CM-1患者在枕大池横截面积内的神经组织明显更多。逻辑回归分析表明，将枕骨大孔处的神经组织与小脑和第四脑室体积相结合，与空洞形成具有高度相关性（曲线下面积：0.911）。
我们的研究结果表明，枕骨大孔处的组织量与接受减压手术的CM-1患者相关，比扁桃体长度更具相关性。此外，枕骨大孔处的神经组织、小脑和第四脑室体积相结合，与空洞形成具有高度相关性。总之，这些结果表明后颅窝内的整体压迫现象导致了CM-1症状和空洞形成。
