Chiari I malformation—neuropsychological functions and quality of life
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To assess the neuropsychological (NP) functioning and quality of life (QOL) before and 3 months after surgery on adults with Chiari I malformation (CMI).
Patients and methods
All adult patients who had been diagnosed with CMI were invited to participate. Those who participated were assessed using a Hospital Anxiety and Depression scale (HAD) and NP examinations. Their QOL was assessed using the self-reported life satisfaction checklist, LiSat-11 and the five-dimensional EuroQol measurement of health outcome, EQ-5D-5L. All assessments were carried out both before and 3 months after surgery was performed. Demographic data and comorbidities were also registered.
Of the 11 patients who underwent NP assessment, the majority demonstrated cognitive functioning within the normal range. However, postoperatively, their performance in verbal learning, psychomotor speed, colour naming speed and the ability to manage interference through response selection and inhibition (aspects of executive functioning) was significantly improved. Thirteen patients completed QOL assessments. When LiSat-11 item domains were compared with those of healthy subjects, patients reported a lower level of satisfaction with their life quality both before and after surgery. However, the EQ-5D-5L measurements, i.e., the descriptive system and the visual analogue, indicated that their QOL of life was significantly improved after surgery.
There is scarcely any literature documenting effects of surgery on the QOL of CMI patients. The study we present here breaks new ground by comparing pre- and postoperative NP functions in CMI. We also examine the value of surgery for improving both NP functions and QOL in CMI.
KeywordsArnold-Chiari malformation Cognitive dysfunction Decompressive craniectomy Psychological tests Quality of life Treatment outcome
We would like to thank all the patients who participated in this study. Special thanks are also owed to Gudrun Barrows, Clinical Coordinator at the Department of Neurosurgery, Sahlgrenska University Hospital, for her invaluable help with the administration of this study.
This research received funding from Rune och Ulla Amlövs Stiftelse för Neurologisk och Reumatologisk Forskning and Göteborg Läkaresällskap (Gothenburg Medical Society). The sponsor had no role in the design or conduct of this research.
Compliance with ethical standards
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent- licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
The study was approved by the regional ethics board of the University of Gothenburg (Diary nr 865–14) and was carried out following the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Bakim B, Goksan Yavuz B, Yilmaz A, Karamustafalioglu O, Akbiyik M, Yayla S, Yuce I, Alpak G, Tankaya O (2013) The quality of life and psychiatric morbidity in patients operated for Arnold-Chiari malformation type I. Int J Psychiatry Clin Pract 17:259–263. https://doi.org/10.3109/13651501.2013.778295 CrossRefGoogle Scholar
- 4.Barkovich AJ, Wippold FJ, Sherman JL, Citrin CM (1986) Significance of cerebellar tonsillar position on MR. AJNR Am J Neuroradiol 7:795–799Google Scholar
- 6.Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B (2017) Valuing health-related quality of life: an EQ-5D-5L value set for England. Health Econ. https://doi.org/10.1002/hec.3564
- 9.Fischbein R, Saling JR, Marty P, Kropp D, Meeker J, Amerine J, Chyatte MR (2015) Patient-reported Chiari malformation type I symptoms and diagnostic experiences: a report from the national Conquer Chiari Patient Registry database. Neurol Sci 36:1617–1624. https://doi.org/10.1007/s10072-015-2219-9 CrossRefGoogle Scholar
- 10.Grosso S, Scattolini R, Paolo G, Di Bartolo RM, Morgese G, Balestri P (2001) Association of Chiari I malformation, mental retardation, speech delay, and epilepsy: a specific disorder? Neurosurgery 49:1099–1103; discussion 1103-1094 Google Scholar
- 20.Lugaresi A, Zucconi M, Gerardi R, Sforza E, Contin M, Cortelli P, Cirignotta F (1987) Autonomic failure in a case of Chiari malformation type I. Funct Neurol 2:511–513Google Scholar
- 25.Parker SL, Godil SS, Zuckerman SL, Mendenhall SK, Wells JA, Shau DN, McGirt MJ (2013) Comprehensive assessment of 1-year outcomes and determination of minimum clinically important difference in pain, disability, and quality of life after suboccipital decompression for Chiari malformation I in adults. Neurosurgery 73:569–581; discussion 581. https://doi.org/10.1227/neu.0000000000000032 CrossRefGoogle Scholar
- 28.Rosenthal R, Cooper H, Hedges L (1994) Parametric measures of effect size. The handbook of research synthesis:231–244Google Scholar
- 34.Tubbs RS, Shoja MM, Ardalan MR, Shokouhi G, Loukas M (2008) Hindbrain herniation: a review of embryological theories. Ital J Anat Embryol 113:37–46Google Scholar