Abstract
Basilar invagination (BI) and Chiari malformation type I CM-I) are the most common adult craniovertebral junction malformations, and they are frequently associated with each other and present synchronously. The relationship between BI and CM-I has remained incompletely understood, and the choice of surgical strategy has remained controversial. This brief review focuses on the different aspects of BI and CM-I, and further discusses the relationship between these two concomitant pathologies on the basis of the concepts proposed over the last three decades.
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References
Nishikawa M, Sakamoto H, Hakuba A, Nakanishi N, Inoue Y. Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa. J Neurosurg. 1997;86(1):40–7.
Ferreira JA, Botelho RV. The odontoid process invagination in normal subjects, Chiari malformation and basilar invagination patients: pathophysiologic correlations with angular craniometry. Surg Neurol Int. 2015;6:118.
Milhorat TH, Nishikawa M, Kula RW, Dlugacz YD. Mechanisms of cerebellar tonsil herniation in patients with Chiari malformations as guide to clinical management. Acta Neurochir. 2010;152(7):1117–27.
Klimo P Jr, Rao G, Brockmeyer D. Congenital anomalies of the cervical spine. Neurosurg Clin N Am. 2007;18(3):463–78.
Menezes AH. Craniocervical developmental anatomy and its implications. Childs Nerv Syst. 2008;24(10):1109–22.
Chamberlain WE. Basilar impression (platybasia): a bizarre developmental anomaly of the occipital bone and upper cervical spine with striking and misleading neurologic manifestations. Yale J Biol Med. 1939;11(5):487–96.
Charnas LR, Marini JC. Communicating hydrocephalus, basilar invagination, and other neurologic features in osteogenesis imperfecta. Neurology. 1993;43(12):2603–8.
Smoker WR. Craniovertebral junction: normal anatomy, craniometry, and congenital anomalies. Radiographics. 1994;14(2):255–77.
Pinter NK, McVige J, Mechtler L. Basilar invagination, basilar impression, and platybasia: clinical and imaging aspects. Curr Pain Headache Rep. 2016;20(8):49.
Smoker WR, Khanna G. Imaging the craniocervical junction. Childs Nerv Syst. 2008;24(10):1123–45.
Cronin CG, Lohan DG, Mhuircheartigh JN, Meehan CP, Murphy J, Roche C. CT evaluation of Chamberlain’s, McGregor’s, and McRae’s skull-base lines. Clin Radiol. 2009;64(1):64–9.
Mc GM. The significance of certain measurements of the skull in the diagnosis of basilar impression. Br J Radiol. 1948;21(244):171–81.
VanGilder JC, Menezes AH, Dolan KD. The craniovertebral junction and its abnormalities. New York: Futura; 1987.
Menezes AH, VanGilder JC. Anomalies of the craniovertebral junction. Philadelphia: Saunders; 1990.
McRae DL, Barnum AS. Occipitalization of the atlas. Am J Roentgenol Radium Ther Nucl Med. 1953;70(1):23–46.
El Asri AC, Akhaddar A, Gazzaz M, et al. Dynamic CT scan of the craniovertebral junction: a role in the management of os odontoideum. Neurol Neurochir Pol. 2010;44(6):603–8.
Gupta V, Khandelwal N, Mathuria SN, Singh P, Pathak A, Suri S. Dynamic magnetic resonance imaging evaluation of craniovertebral junction abnormalities. J Comput Assist Tomogr. 2007;31(3):354–9.
Reijnierse M, Breedveld FC, Kroon HM, Hansen B, Pope TL, Bloem JL. Are magnetic resonance flexion views useful in evaluating the cervical spine of patients with rheumatoid arthritis? Skelet Radiol. 2000;29(2):85–9.
Karhu JO, Parkkola RK, Koskinen SK. Evaluation of flexion/extension of the upper cervical spine in patients with rheumatoid arthritis: an MRI study with a dedicated positioning device compared to conventional radiographs. Acta Radiol. 2005;46(1):55–66.
Bassi P, Corona C, Contri P, Paiocchi A, Loiero M, Mangoni A. Congenital basilar impression: correlated neurological syndromes. Eur Neurol. 1992;32(4):238–43.
Erbengi A, Oge HK. Congenital malformations of the craniovertebral junction: classification and surgical treatment. Acta Neurochir. 1994;127(3–4):180–5.
Goel A, Desai K. Surgery for syringomyelia: an analysis based on 163 surgical cases. Acta Neurochir. 2000;142(3):293–301. discussion 301-292.
Sawin PD, Menezes AH. Basilar invagination in osteogenesis imperfecta and related osteochondrodysplasias: medical and surgical management. J Neurosurg. 1997;86(6):950–60.
Smith JS, Shaffrey CI, Abel MF, Menezes AH. Basilar invagination. Neurosurgery. 2010;66(3 Suppl):39–47.
Menezes AH. Evaluation and treatment of congenital and developmental anomalies of the cervical spine. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2004;1(2):188–97.
Goel A, Bhatjiwale M, Desai K. Basilar invagination: a study based on 190 surgically treated patients. J Neurosurg. 1998;88(6):962–8.
Menezes AH. Surgical approaches: postoperative care and complications “transoral–transpalatopharyngeal approach to the craniocervical junction”. Childs Nerv Syst. 2008;24(10):1187–93.
Elster AD, Chen MY. Chiari I malformations: clinical and radiologic reappraisal. Radiology. 1992;183(2):347–53.
Aboulezz AO, Sartor K, Geyer CA, Gado MH. Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: a quantitative approach with MR imaging. J Comput Assist Tomogr. 1985;9(6):1033–6.
Armonda RA, Citrin CM, Foley KT, Ellenbogen RG. Quantitative cine-mode magnetic resonance imaging of Chiari I malformations: an analysis of cerebrospinal fluid dynamics. Neurosurgery. 1994;35(2):214–23. discussion 223-214.
Milhorat TH, Chou MW, Trinidad EM, et al. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 1999;44(5):1005–17.
Milhorat TH, Bolognese PA, Nishikawa M, et al. Association of Chiari malformation type I and tethered cord syndrome: preliminary results of sectioning filum terminale. Surg Neurol. 2009;72(1):20–35.
Cinalli G, Spennato P, Sainte-Rose C, et al. Chiari malformation in craniosynostosis. Childs Nerv Syst. 2005;21(10):889–901.
Atkinson JL, Weinshenker BG, Miller GM, Piepgras DG, Mokri B. Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases. J Neurosurg. 1998;88(2):237–42.
Elisevich K, Fontaine S, Bertrand G. Syringomyelia as a complication of Paget’s disease. Case report. J Neurosurg. 1987;66(4):611–3.
Lee M, Rezai AR, Wisoff JH. Acquired Chiari-I malformation and hydromyelia secondary to a giant craniopharyngioma. Pediatr Neurosurg. 1995;22(5):251–4.
Morioka T, Shono T, Nishio S, Yoshida K, Hasuo K, Fukui M. Acquired Chiari I malformation and syringomyelia associated with bilateral chronic subdural hematoma. Case report. J Neurosurg. 1995;83(3):556–8.
Rocque BG, Oakes WJ. Surgical treatment of Chiari I malformation. Neurosurg Clin N Am. 2015;26(4):527–31.
Fischbein R, Saling JR, Marty P, et al. Patient-reported Chiari malformation type I symptoms and diagnostic experiences: a report from the national Conquer Chiari Patient Registry database. Neurol Sci. 2015;36(9):1617–24.
Mueller DM, Oro JJ. Prospective analysis of presenting symptoms among 265 patients with radiographic evidence of Chiari malformation type I with or without syringomyelia. J Am Acad Nurse Pract. 2004;16(3):134–8.
Hofkes SK, Iskandar BJ, Turski PA, Gentry LR, McCue JB, Haughton VM. Differentiation between symptomatic Chiari I malformation and asymptomatic tonsilar ectopia by using cerebrospinal fluid flow imaging: initial estimate of imaging accuracy. Radiology. 2007;245(2):532–40.
Tubbs RS, Lyerly MJ, Loukas M, Shoja MM, Oakes WJ. The pediatric Chiari I malformation: a review. Childs Nerv Syst. 2007;23(11):1239–50.
Panigrahi M, Reddy BP, Reddy AK, Reddy JJ. CSF flow study in Chiari I malformation. Childs Nerv Syst. 2004;20(5):336–40.
Tubbs RS. Definitions and anatomic considerations in Chiari I malformation and associated syringomyelia. Neurosurg Clin N Am. 2015;26(4):487–93.
Tubbs RS, Beckman J, Naftel RP, et al. Institutional experience with 500 cases of surgically treated pediatric Chiari malformation type I. J Neurosurg Pediatr. 2011;7(3):248–56.
Kagawa M, Jinnai T, Matsumoto Y, et al. Chiari I malformation accompanied by assimilation of the atlas, Klippel-Feil syndrome, and syringomyelia: case report. Surg Neurol. 2006;65(5):497–502. discussion 502
Rocque BG, George TM, Kestle J, Iskandar BJ. Treatment practices for Chiari malformation type I with syringomyelia: results of a survey of the American Society of Pediatric Neurosurgeons. J Neurosurg Pediatr. 2011;8(5):430–7.
Doughty KE, Tubbs RS, Webb D, Oakes WJ. Delayed resolution of Chiari I–associated hydromyelia after posterior fossa decompression: case report and review of the literature. Neurosurgery. 2004;55(3):711.
Klekamp J. Surgical treatment of Chiari I malformation—analysis of intraoperative findings, complications, and outcome for 371 foramen magnum decompressions. Neurosurgery. 2012;71(2):365–80. discussion 380.
Sakushima K, Tsuboi S, Yabe I, et al. Nationwide survey on the epidemiology of syringomyelia in Japan. J Neurol Sci. 2012;313(1–2):147–52.
Schijman E, Steinbok P. International survey on the management of Chiari I malformation and syringomyelia. Childs Nerv Syst. 2004;20(5):341–8.
Durham SR, Fjeld-Olenec K. Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I in pediatric patients: a meta-analysis. J Neurosurg Pediatr. 2008;2(1):42–9.
Hankinson T, Tubbs RS, Wellons JC. Duraplasty or not? An evidence-based review of the pediatric Chiari I malformation. Childs Nerv Syst. 2011;27(1):35–40.
Hayhurst C, Richards O, Zaki H, Findlay G, Pigott TJ. Hindbrain decompression for Chiari–syringomyelia complex: an outcome analysis comparing surgical techniques. Br J Neurosurg. 2008;22(1):86–91.
Menezes AH, Greenlee JD, Donovan KA. Honored guest presentation: lifetime experiences and where we are going: Chiari I with syringohydromyelia–controversies and development of decision trees. Clin Neurosurg. 2005;52:297–305.
Milhorat TH, Bolognese PA. Tailored operative technique for Chiari type I malformation using intraoperative color Doppler ultrasonography. Neurosurgery. 2003;53(4):899–905. discussion 905-896.
Goel A. Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation. J Neurosurg Spine. 2015;22(2):116–27.
Goel A. Atlantoaxial facetal distraction spacers: indications and techniques. J Craniovertebr Junction Spine. 2016;7(3):127–8.
Goel A. Basilar invagination, Chiari malformation, syringomyelia: a review. Neurol India. 2009;57(3):235–46.
Visocchi M, Trevisi G, Iacopino DG, Tamburrini G, Caldarelli M, Barbagallo GM. Odontoid process and clival regeneration with Chiari malformation worsening after transoral decompression: an unexpected and previously unreported cause of “accordion phenomenon”. Eur Spine J. 2015;24(Suppl 4):S564–8.
Klekamp J. Chiari I malformation with and without basilar invagination: a comparative study. Neurosurg Focus. 2015;38(4):E12.
Aghakhani N, Parker F, David P, et al. Long-term follow-up of Chiari-related syringomyelia in adults: analysis of 157 surgically treated cases. Neurosurgery. 2009;64(2):308–15. discussion 315
Arora P, Behari S, Banerji D, Chhabra DK, Jain VK. Factors influencing the outcome in symptomatic Chiari I malformation. Neurol India. 2004;52(4):470–4.
Klekamp J. Neurological deterioration after foramen magnum decompression for Chiari malformation type I: old or new pathology? J Neurosurg Pediatr. 2012;10(6):538–47.
Naftel RP, Tubbs RS, Menendez JY, Wellons JC 3rd, Pollack IF, Oakes WJ. Worsening or development of syringomyelia following Chiari I decompression: case report. J Neurosurg Pediatr. 2013;12(4):351–6.
Goldstein HE, Anderson RC. Craniovertebral junction instability in the setting of Chiari I malformation. Neurosurg Clin N Am. 2015;26(4):561–9.
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Liao, C. et al. (2019). The Relationship Between Basilar Invagination and Chiari Malformation Type I: A Narrative Review. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_16
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