Skip to main content

Advertisement

SpringerLink
Log in

Morphometric features of posterior cranial fossa are different between Chiari I malformation with and without syringomyelia

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To investigate whether the posterior cranial fossa (PCF) morphology in Chiari I malformation without syringomyelia (also called syrinx) (CMI-only) is different from that in Chiari I malformation with syrinx (CMI-S).

Methods

Nineteen CMI patients without syrinx constituted the CMI-only group, whereas 48 CMI patients with syrinx were assigned to the CMI-S group. Another cohort of 40 age-matched asymptomatic adolescents was enrolled to serve as the control group. Six measurements were evaluated and compared between these three groups from T1-weighted magnetic resonance (MR) imaging, including the length of the clivus (AB), the anteroposterior diameter of the foramen magnum (BC), the length of the supraocciput (CD), the anteroposterior diameter of the posterior fossa (DA), the posterior fossa height (BE) and the clivus gradient (\({\angle }\alpha\)). The posterior cranial fossa morphology in relation to syrinx severity was also investigated.

Results

Compared to the normal controls, the AB, CD, DA, BE and \({\angle }\alpha\) were significantly larger in the CMI-S group. Similar changes in AB, CD, DA and BE were also demonstrated in the CMI-only group, while the clivus gradient (\({\angle }\alpha\)) was found to be normal when compared with the control group. A significantly decreased clivus gradient was observed in the CMI-S group as compared to CMI-only group. In addition, the clivus was significantly flattened in patients with a distended-syrinx in comparison to those with a non-distended syrinx.

Conclusions

Small size of the posterior fossa was detected both in CMI cases with and without syrinx. The clivus gradient served as the only morphologic difference in the PCF between CMI-S and CMI-only patients and was correlated with the severity of the syrinx, may support the theory that the restricted circulation of cerebrospinal fluid at the anterior paramedial subarachnoid space contributes to the formation of a syrinx.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Levine DN (2004) The pathogenesis of syrinx associated with lesions at the foramen magnum: a critical review of existing theories and proposal of a new hypothesis. J Neurol Sci 220(1–2):3–21

    Article  PubMed  Google Scholar 

  2. Chang HS, Nakagawa H (2003) Hypothesis on the pathophysiology of syrinx based on simulation of cerebrospinal fluid dynamics. J Neurol Neurosurg Psychiatry 74(3):344–347

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Nishikawa M, Sakamoto H, Hakuba A, Nakanishi N, Inoue Y (1997) Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa. J Neurosurg 86(1):40–47

    Article  CAS  PubMed  Google Scholar 

  4. Milhorat TH, Chou MW, Trinidad EM, Kula RW et al (1999) Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 44(5):1005–1017

    Article  CAS  PubMed  Google Scholar 

  5. Levy LM (2003) MR identification of Chiari pathophysiology by using spatial and temporal CSF flow indices and implications for syrinx. AJNR Am J Neuroradiol 24(2):165–166

    PubMed  Google Scholar 

  6. Driver CJ, Volk HA, Rusbridge C, Van Ham LM (2013) An update on the pathogenesis of syrinx secondary to Chiari-like malformations in dogs. Veterinary J 198(3):551–559

    Article  CAS  Google Scholar 

  7. Heiss JD, Snyder K, Peterson MM, Patronas NJ et al (2012) Pathophysiology of primary spinal syrinx. J Neurosurg Spine 17(5):367–380

    Article  PubMed  PubMed Central  Google Scholar 

  8. Vega A, Quintana F, Berciano J (1990) Basichondrocranium anomalies in adult Chiari type I malformation: a morphometric study. J Neurol Sci 99(2–3):137–145

    Article  CAS  PubMed  Google Scholar 

  9. Nishikawa M, Sakamoto H, Hakuba A, Nakanishi N, Inoue Y (1997) Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa. J Neurosurg 86(1):40–47

    Article  CAS  PubMed  Google Scholar 

  10. Karagoz F, Izgi N, Kapijcijoglu SS (2002) Morphometric measurements of the cranium in patients with Chiari type I malformation and comparison with the normal population. Acta Neurochir (Wien) 144(2):165–171 (discussion 171)

    Article  CAS  Google Scholar 

  11. Bagci AM, Lee SH, Nagornaya N, Green BA, Alperin N (2013) Automated posterior cranial fossa volumetry by MRI: applications to Chiari malformation type I. AJNR Am J Neuroradiol 34(9):1758–1763

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Amer TA, el-Shmam OM (1997) Chiari malformation type I: a new MRI classification. Magn Reson Imaging 15(4):397–403

    Article  CAS  PubMed  Google Scholar 

  13. Dufton JA, Habeeb SY, Heran MK, Mikulis DJ, Islam O (2011) Posterior fossa measurements in patients with and without Chiari I malformation. Can J Neurol Sci 38(3):452–455

    Article  PubMed  Google Scholar 

  14. Sweeney KJ, Caird J, Sattar MT et al (2013) Spinal level of myelomeningocele lesion as a contributing factor in posterior fossa volume, intracranial cerebellar volume, and cerebellar ectopia. J Neurosurg Pediatr 11(2):p154–p159

    Article  Google Scholar 

  15. Zhu Z, Sha S, Sun X, Liu Z, et al (2014) Tapering of the cervical spinal canal in patients with distended or nondistended syringes secondary to chiari type I malformation. AJNR Am J Neuroradiol 35(10):2021–2026

    Article  CAS  PubMed  Google Scholar 

  16. Nash J, Cheng JS, Meyer GA, Remler BF (2002) Chiari type I malformation: overview of diagnosis and treatment. WMJ 101(8):35–40

    PubMed  Google Scholar 

  17. Stovner LJ, Bergan U, Nilsen G, Sjaastad O (1993) Posterior cranial fossa dimensions in the Chiari I malformation: relation to pathogenesis and clinical presentation. Neuroradiology 35(2):113–118

    Article  CAS  PubMed  Google Scholar 

  18. Karagoz F, Izgi N, Kapijcijoglu SS (2002) Morphometric measurements of the cranium in patients with Chiari type I malformation and comparison with the normal population. Acta Neurochir (Wien) 144(2):165–171 (discussion 171)

    Article  CAS  Google Scholar 

  19. Sekula RF Jr, Jannetta PJ, Casey KF, Marchan EM, Sekula LK, McCrady CS (2005) Dimensions of the posterior fossa in patients symptomatic for Chiari I malformation but without cerebellar tonsillar descent. Cerebrospinal Fluid Res 18(2):11

    Article  Google Scholar 

  20. Tubbs RS, McGirt MJ, Oakes WJ (2003) Surgical experience in 130 pediatric patients with Chiari I malformations. J Neurosurg 99(2):291–296

    Article  PubMed  Google Scholar 

  21. Hwang HS, Moon JG, Kim CH, Oh SM, Song JH, Jeong JH (2013) The comparative morphometric study of the posterior cranial fossa : what is effective approaches to the treatment of Chiari malformation type 1. J Korean Neurosurg Soc 54(5):405–410

    Article  PubMed  PubMed Central  Google Scholar 

  22. Xie D, Qiu Y, Sha S et al (2015) Syrinx resolution is correlated with the upward shifting of cerebellar tonsil following posterior fossa decompression in pediatric patients with Chiari malformation type I. Eur Spine J 24(1):p155–p161

    Article  Google Scholar 

  23. Krueger KD, Haughton VM, Hetzel S (2010) Peak CSF velocities in patients with symptomatic and asymptomatic Chiari I malformation. AJNR Am J Neuroradiol 31(10):1837–1841

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Pinna G, Alessandrini F, Alfieri A, Rossi M, Bricolo A (2000) Cerebrospinal fluid flow dynamics study in Chiari I malformation: implications for syrinx formation. Neurosurg Focus 8(3):E3

    Article  CAS  PubMed  Google Scholar 

  25. Bunck AC, Kroeger JR, Juettner A, Brentrup A et al (2012) Magnetic resonance 4D flow analysis of cerebrospinal fluid dynamics in Chiari I malformation with and without syrinx. Eur Radiol 22(9):1860–1870

    Article  PubMed  Google Scholar 

  26. Quigley MF, Iskandar B, Quigley ME, Nicosia M, Haughton V (2004) Cerebrospinal fluid flow in foramen magnum: temporal and spatial patterns at MR imaging in volunteers and in patients with Chiari I malformation. Radiology 232(1):229–236

    Article  PubMed  Google Scholar 

  27. Wang CS, Wang X, Fu CH, Wei LQ, Zhou DQ, Lin JK (2014) Analysis of cerebrospinal fluid flow dynamics and morphology in Chiari I malformation with cine phase-contrast magnetic resonance imaging. Acta Neurochir (Wien) 156(4):707–713

    Article  Google Scholar 

  28. Martin BA, Kalata W, Shaffer N, Fischer P, Luciano M, Loth F (2013) Hydrodynamic and longitudinal impedance analysis of cerebrospinal fluid dynamics at the craniovertebral junction in type I Chiari malformation. PLoS One 8(10):e75335

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Yiallourou TI, Kroger JR, Stergiopulos N, Maintz D, Martin BA, Bunck AC (2012) Comparison of 4D phase-contrast MRI flow measurements to computational fluid dynamics simulations of cerebrospinal fluid motion in the cervical spine. PLoS One 7(12):e52284

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Clarke EC, Stoodley MA, Bilston LE (2013) Changes in temporal flow characteristics of CSF in Chiari malformation Type I with and without syrinx: implications for theory of syrinx development. J Neurosurg 118(5):1135–1140

    Article  PubMed  Google Scholar 

  31. Tubbs RS, Elton S, Grabb P, Dockery SE, Bartolucci AA, Oakes WJ (2001) Analysis of the posterior fossa in children with the Chiari 0 malformation. Neurosurgery 48(5):1050–1054 (discussion 1054-1055)

    Article  CAS  PubMed  Google Scholar 

  32. Aydin S, Hanimoglu H, Tanriverdi T, Yentur E, Kaynar MY (2005) Chiari type I malformations in adults: a morphometric analysis of the posterior cranial fossa. Surg Neurol 64(3):237–241 (discussion 241)

    Article  PubMed  Google Scholar 

  33. Trigylidas T, Baronia B, Vassilyadi M, Ventureyra EC (2008) Posterior fossa dimension and volume estimates in pediatric patients with Chiari I malformations.Child’s nervous system: ChNS Off J Int Soc Pediatr Neurosurg 24(3):329–336

    Article  CAS  Google Scholar 

  34. Dagtekin A, Avci E, Kara E, Uzmansel D et al (2011) Posterior cranial fossa morphometry in symptomatic adult Chiari I malformation patients: comparative clinical and anatomical study. Clin Neurol Neurosurg 113(5):399–403

    Article  PubMed  Google Scholar 

  35. Urbizu A, Poca MA, Vidal X, Rovira A, Sahuquillo J, Macaya A (2013) MRI-based morphometric analysis of posterior cranial fossa in the diagnosis of chiari malformation type I. J Neuroimaging 24(3):250–256

    Article  PubMed  Google Scholar 

  36. Marin-Padilla M, Marin-Padilla TM (1981) Morphogenesis of experimentally induced Arnold-Chiari malformation. J Neurol Sci 50(1):29–55

    Article  CAS  PubMed  Google Scholar 

  37. Marin-Padilla M (1991) Cephalic axial skeletal-neural dysraphic disorders: embryology and pathology. Canadian J Neurol Sci Le J Canadien des Sci Neurologiques 18(2):153–169

    CAS  Google Scholar 

  38. Dufton JA, Habeeb SY, Heran MK, Mikulis DJ, Islam O (2011) Posterior fossa measurements in patients with and without Chiari I malformation. Can J Neurol Sci 38(3):452–455

    Article  PubMed  Google Scholar 

  39. Botelho RV, Ferreira ED (2013) Angular craniometry in craniocervical junction malformation. Neurosurg Rev 36(4):603–610 (discussion 610)

    Article  PubMed  PubMed Central  Google Scholar 

  40. Iskandar BJ, Quigley M, Haughton VM (2004) Foramen magnum cerebrospinal fluid flow characteristics in children with Chiari I malformation before and after craniocervical decompression. J Neurosurg 101(2 Suppl):169–178

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China

    Huang Yan, Xiao Han, Mengran Jin, Zhen Liu, Dingding Xie, Shifu Sha, Yong Qiu & Zezhang Zhu

Authors
  1. Huang Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiao Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mengran Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dingding Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shifu Sha
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yong Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zezhang Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zezhang Zhu.

Ethics declarations

Funding

This work was supported by National Key Clinical Department and the National Natural Science Foundation (Grant No. 81371912). None of the authors received financial support for this study.

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yan, H., Han, X., Jin, M. et al. Morphometric features of posterior cranial fossa are different between Chiari I malformation with and without syringomyelia. Eur Spine J 25, 2202–2209 (2016). https://doi.org/10.1007/s00586-016-4410-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4410-y

Keywords

Search

Navigation