This study was focused on a semi-automated morphometric analysis of the cerebellum in the mid-sagittal plane as an alternative to tonsillar descent alone in the evaluation of Chiari malformation type 1 (CMI) patients. Morphometric analyses of posterior fossa structures were performed on mid-sagittal MRI images of 375 individuals (females, > 18 years, 235 CMI and 140 healthy controls). Twenty-six parameters including linear, angular and area measurements together with non-dimensional ratios were calculated. Eighteen parameters were found to be significantly different between CMI and control subjects. Smaller posterior cranial fossa (PCF) area in CMI subjects was attributed to a smaller PCF area anterior to the brainstem. The cerebellar area was found to be larger in CMI subjects as compared to controls (15.1%), even without inclusion of the tonsillar area below the foramen magnum (FM) (8.4%). The larger cerebellar area in CMI subjects was due to cranial–caudal elongation of the cerebellum, predominately below the fastigium. The cerebrospinal fluid spaces below the FM were smaller in CMI subjects as compared to controls. Overall, greater cerebellar crowding was identified in CMI subjects relative to healthy controls. These observations may improve our understanding of the pathophysiology of CMI in adult female patients.
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The authors would like to acknowledge the contributions of Natalie Allen and Audrey Braun in the initial evaluation of the software. The authors would also like to acknowledge Phillip Vorster and Lauren Elicker for their help with consistency testing of CerePro2D. Funding was provided by Conquer Chiari.
Conflict of interest
The authors declare that they have no conflict of interest.
Associate Editor Andreas Anayiotos oversaw the review of this article.
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Biswas, D., Eppelheimer, M.S., Houston, J.R. et al. Quantification of Cerebellar Crowding in Type I Chiari Malformation. Ann Biomed Eng 47, 731–743 (2019). https://doi.org/10.1007/s10439-018-02175-z
- Posterior cranial fossa
- Tonsillar position
- Cerebrospinal fluid