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Clivus length distinguishes between asymptomatic healthy controls and symptomatic adult women with Chiari malformation type I

  • Diagnostic Neuroradiology
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Abstract

Purpose

While the presence of cerebellar tonsillar descent in radiological images has been used as evidence of Chiari malformation type I (CMI), tonsillar ectopia alone is insufficient to identify individuals with symptomatic CMI. This study sought to identify differences in brain morphology between symptomatic CMI and healthy controls in adult females.

Methods

Two hundred and ten adult females with symptomatic CMI and 90 age- and body mass index-matched asymptomatic female controls were compared using seven brain morphometric measures visible on magnetic resonance images. The CMI and control groups were divided into four subgroups based on the tonsillar position (TP) relative to the foramen magnum: group 1 was made up of healthy controls with normal TP (TP < 0 mm); group 2 was comprised of control individuals with low-lying TP (1–5 mm); group 3 was comprised of symptomatic CMI patients with low-lying TP (1–5 mm); group 4 contained symptomatic CMI patients with severe tonsillar descent (6–13 mm).

Results

All morphometrics for symptomatic CMI with severe tonsillar descent were significantly different than those for both control groups. The CMI group with low-lying TP was significantly different for four measures when compared to controls with normal TP. However, only clivus length was statistically different between the CMI and healthy control groups with low-lying TP.

Conclusion

This study demonstrates that clivus length distinguishes adult female healthy individuals with low-lying tonsils from those with symptomatic CMI. Further investigation is required to understand the importance of a shorter clivus length on CMI symptomatology and pathophysiology.

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Acknowledgements

The authors wish to thank Conquer Chiari for providing funding for this research work. The authors would also like to acknowledge the contribution of Natalie Allen, and Audrey Braun for their support in the morphometric measurements.

Funding

The study was funded by Conquer Chiari.

Author information

Authors and Affiliations

  1. Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, USA

    Blaise Simplice Talla Nwotchouang, Maggie S. Eppelheimer & Francis Loth

  2. Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Akron, OH, USA

    Alaaddin Ibrahimy & Francis Loth

  3. Department of Psychology, Middle Tennessee State University, Murfreesboro, TN, USA

    James R. Houston

  4. Fluids and structure (FaST) Laboratory, Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, USA

    Dipankar Biswas

  5. Conquer Chiari, Wexford, PA, USA

    Richard Labuda

  6. Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA

    Jayapalli Rajiv Bapuraj

  7. Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, OH, USA

    Philip A. Allen

  8. Department of Neurosurgery, University of Chicago, Chicago, IL, USA

    David Frim

Authors
  1. Blaise Simplice Talla Nwotchouang
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  2. Maggie S. Eppelheimer
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Contributions

BSTN was responsible for data processing, data analysis, and manuscript writing. ME and DB were responsible for software development, data analysis, manuscript review and editing. AI and JH were responsible for data analysis, manuscript review, and editing. RL, JB, PA, and FL were responsible for project oversight and providing expertise in neuroradiology.

Corresponding author

Correspondence to Blaise Simplice Talla Nwotchouang.

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Conflict of interest

Author Jayapalli Rajiv Bapuraj is a recipient of a research grant from Conquer Chiari.

Ethical approval

This study was approved by the local institutional review board at The University of Akron. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Nwotchouang, B.S.T., Eppelheimer, M.S., Ibrahimy, A. et al. Clivus length distinguishes between asymptomatic healthy controls and symptomatic adult women with Chiari malformation type I. Neuroradiology 62, 1389–1400 (2020). https://doi.org/10.1007/s00234-020-02453-5

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