Özkal Birol, Özçelik Hakan
Department of Neurosurgery, Alanya Alaaddin Keykubat University, Alanya 07400, Türkiye.
Brain Sci. 2025 Jul 29;15(8):811. doi: 10.3390/brainsci15080811.
Identifying the etiological factors of syringomyelia, which can cause progressive neurological deficits in the spinal cord, is critically important for both diagnosis and treatment. This study aimed to assess the cranial morphometric features of patients with idiopathic syringomyelia by conducting comparative analyses with individuals diagnosed with Chiari Type I, Chiari Type I accompanied by syringomyelia, and healthy controls, in order to elucidate the potential structural contributors to the pathogenesis of idiopathic syringomyelia. In this retrospective and comparative study, a total of 172 patients diagnosed with Chiari Type I and/or syringomyelia between 2016 and 2024, along with 156 radiologically normal individuals, were included. The participants were categorized into four groups: healthy controls, Chiari Type I, Chiari Type I with syringomyelia, and idiopathic syringomyelia (defined as syringomyelia without an identifiable cause). Midline sagittal T1-weighted MR images were used to obtain quantitative measurements of the posterior fossa, cerebellum, intracranial area, and foramen magnum. All measurements were stratified and statistically analyzed by sex. In cases with idiopathic syringomyelia, both the posterior fossa area and the cerebellum/posterior fossa ratio differed significantly from those of healthy controls. In male patients, the foramen magnum diameter was significantly larger in the Chiari + syringomyelia group compared with the idiopathic group. A significant correlation was found between the degree of tonsillar descent and selected morphometric parameters in female subjects, whereas no such correlation was observed in males. Both Chiari groups exhibited significantly smaller posterior fossa dimensions compared with the healthy and idiopathic groups, indicating greater neural crowding. Additionally, in Chiari Type I patients, increasing degrees of tonsillar descent were associated with a decreased incidence of syringomyelia. Anatomical variations such as a reduced posterior fossa area or altered foramen magnum diameter may contribute to the pathogenesis of idiopathic syringomyelia. Cranial morphometric analysis appears to offer diagnostic value in these cases. Further prospective, multicenter studies incorporating advanced neuroimaging modalities, particularly those assessing cerebrospinal fluid dynamics, are warranted to better understand the mechanisms underlying syringomyelia of unknown etiology.
明确脊髓空洞症的病因至关重要，因为它可导致脊髓进行性神经功能缺损，这对诊断和治疗都具有关键意义。本研究旨在通过对诊断为Chiari I型、伴有脊髓空洞症的Chiari I型患者以及健康对照者进行比较分析，评估特发性脊髓空洞症患者的颅骨形态学特征，以阐明特发性脊髓空洞症发病机制中潜在的结构因素。在这项回顾性比较研究中，纳入了2016年至2024年间共172例诊断为Chiari I型和/或脊髓空洞症的患者，以及156例放射学检查正常的个体。参与者被分为四组：健康对照者、Chiari I型、伴有脊髓空洞症的Chiari I型以及特发性脊髓空洞症（定义为无明确病因的脊髓空洞症）。使用中线矢状位T1加权磁共振成像来获取后颅窝、小脑、颅内区域和枕大孔的定量测量数据。所有测量数据按性别进行分层并进行统计学分析。在特发性脊髓空洞症患者中，后颅窝面积以及小脑/后颅窝比值与健康对照者相比有显著差异。在男性患者中，Chiari +脊髓空洞症组的枕大孔直径明显大于特发性脊髓空洞症组。在女性受试者中，扁桃体下疝程度与选定的形态学参数之间存在显著相关性，而在男性中未观察到这种相关性。与健康组和特发性脊髓空洞症组相比，两个Chiari组的后颅窝尺寸均明显较小，表明神经拥挤程度更高。此外，在Chiari I型患者中，扁桃体下疝程度增加与脊髓空洞症发病率降低相关。后颅窝面积减小或枕大孔直径改变等解剖变异可能是特发性脊髓空洞症发病机制的原因。颅骨形态学分析在这些病例中似乎具有诊断价值。有必要开展进一步的前瞻性、多中心研究，纳入先进的神经影像学检查方法，尤其是那些评估脑脊液动力学变化的方法，以更好地了解不明病因脊髓空洞症的发病机制。
