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Chiari I malformation after cranial radiation therapy in childhood: a dynamic process associated with changes in clival growth

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Abstract

Object

The small posterior fossa is believed to be relevant to the development of Chiari I malformation (CMI). In this study, we evaluated children with supratentorial tumors developing CMI after radiation therapy (RT) that involved the skull base. Changes in clivus and supraocciput growth rate were correlated with tonsillar herniation.

Methods

Ten children who underwent RT for supratentorial tumors at St. Jude Children's Research Hospital (1994–2008) developed CMI on follow-up magnetic resonance imaging (MRI). Four other patients with supratentorial tumor and CMI who did not receive RT were identified. Length of the supraocciput, basisphenoid, and basichondrium and extent of tonsillar herniation were measured on serial midsagittal MRI.

Results

Over the median follow-up of 85.5 months, basisphenoid annual growth rate was significantly lower in children receiving RT for suprasellar tumor (n = 8) than those who did not (p = 0.04). Growth of clivus and basisphenoid was significantly lower in the first 12 months after RT in children who received RT for suprasellar tumor (p = 0.03 and p = 0.04, respectively). In these patients, tonsillar herniation increased over 24 months after RT, reaching maximal descent at a mean of 20.2 months; this resolved as clival growth returned to normal. No patient was symptomatic.

Conclusions

In these children, restriction of clival growth occurred after RT for suprasellar tumors. Changes in clival growth were associated with changes in the extent of tonsillar herniation. This supports the importance of the small posterior fossa and reduced clival length in the etiology of CMI.

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Acknowledgements

The authors are grateful to Ms. Tina Davis for the assistance with manuscript preparation.

Conflict of interest

The authors declare that they have no conflict of interest in relation to this submission.

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Authors and Affiliations

  1. Department of Neurosurgery, Frenchay Hospital, Bristol, England

    Kristian Aquilina

  2. Division of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Thomas E. Merchant

  3. Semmes-Murphey Clinic, Semmes-Murphey Neurologic and Spine Institute, 1211 Union Avenue, Suite 200, Memphis, TN, 38104, USA

    Frederick A. Boop & Robert A. Sanford

Authors
  1. Kristian Aquilina
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  2. Thomas E. Merchant
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  3. Frederick A. Boop
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  4. Robert A. Sanford
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Correspondence to Frederick A. Boop.

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Aquilina, K., Merchant, T.E., Boop, F.A. et al. Chiari I malformation after cranial radiation therapy in childhood: a dynamic process associated with changes in clival growth. Childs Nerv Syst 25, 1429–1436 (2009). https://doi.org/10.1007/s00381-009-0982-8

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  • DOI: https://doi.org/10.1007/s00381-009-0982-8

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