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The evolution of cerebellar tonsillar herniation after cranial vault remodeling surgery

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Abstract

Purpose

We sought to examine the pre- and postoperative changes of cerebellar tonsillar herniation by MR imaging in asymptomatic pediatric patients with nonsyndromic, single-suture craniosynostosis (N-SSSC), who underwent cranial vault remodeling surgery without suboccipital decompression. We required cerebellar tonsillar herniation through foramen magnum ≥3 mm for Chiari type I malformation (CMI). We hypothesized that the increase of intracranial volume by cranial vault remodeling would correct the asymptomatic CMI.

Methods

We identified 9 patients among 121 N-SSSC children undergoing craniofacial surgery from January 2004 to October 2010 with CMI. However, two of them were excluded from the study due to missing postoperative MR images. In the final study population, six were males, five were scaphocephalic, while two were diagnosed with coronal synostosis.

Results

In four of the cases, the CMI was decreased in postoperative MR imaging varying from 6 to 12 mm. In three cases, the herniation remained stable. The median change of cerebellar tonsillar herniation was −6.5 mm.

Conclusions

We conclude that asymptomatic patients with existing CMI may benefit from cranial vault remodeling surgery alone increasing the intracranial volume.

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References

  1. Aitken LA, Lindan CE, Sidney S, Gupta N, Barkovich AJ, Sorel M, Wu YW (2009) Chiari type I malformation in a pediatric population. Pediatr Neurol 40:449–454

    Article  PubMed  Google Scholar 

  2. Barkovich AJ, Wippold FJ, Sherman JL, Citrin CM (1986) Significance of cerebellar tonsillar position on MR. Ajnr 7:795–799

    PubMed  CAS  Google Scholar 

  3. Becker DB, Petersen JD, Kane AA, Cradock MM, Pilgram TK, Marsh JL (2005) Speech, cognitive, and behavioral outcomes in nonsyndromic craniosynostosis. Plast Reconstr Surg 116:400–407

    Article  PubMed  CAS  Google Scholar 

  4. Chern JJ, Gordon AJ, Mortazavi MM, Tubbs RS, Oakes WJ (2011) Pediatric Chiari malformation type 0: a 12-year institutional experience. J Neurosurg Pediatr 8:1–5

    Article  PubMed  Google Scholar 

  5. Cinalli G, Renier D, Sebag G, Sainte-Rose C, Arnaud E, Pierre-Kahn A (1995) Chronic tonsillar herniation in Crouzon’s and Apert’s syndromes: the role of premature synostosis of the lambdoid suture. J Neurosurg 83:575–582

    Article  PubMed  CAS  Google Scholar 

  6. Cinalli G, Chumas P, Arnaud E, Sainte-Rose C, Renier D (1998) Occipital remodeling and suboccipital decompression in severe craniosynostosis associated with tonsillar herniation. Neurosurgery 42:66–71, discussion 71–63

    Article  PubMed  CAS  Google Scholar 

  7. Cinalli G, Spennato P, Sainte-Rose C, Arnaud E, Aliberti F, Brunelle F, Cianciulli E, Renier D (2005) Chiari malformation in craniosynostosis. Childs Nerv Syst 21:889–901

    Article  PubMed  Google Scholar 

  8. Dyste GN, Menezes AH, VanGilder JC (1989) Symptomatic Chiari malformations. An analysis of presentation, management, and long-term outcome. J Neurosurg 71:159–168

    Article  PubMed  CAS  Google Scholar 

  9. Fearon JA, Rhodes J (2009) Pfeiffer syndrome: a treatment evaluation. Plast Reconstr Surg 123:1560–1569

    Article  PubMed  CAS  Google Scholar 

  10. Hukki A, Koljonen V, Karppinen A, Valanne L, Leikola J (2012) Brain anomalies in 121 children with non-syndromic single suture craniosynostosis by MR imaging. Eur J Paediatr Neurol. doi:10.1016/j.ejpn.2012.04.003

  11. Leikola J, Koljonen V, Valanne L, Hukki J (2010) The incidence of Chiari malformation in nonsyndromic, single suture craniosynostosis. Childs Nerv Syst 26:771–774

    Article  PubMed  Google Scholar 

  12. Levitt MR, Niazi TN, Hopper RA, Ellenbogen RG, Ojemann JG (2012) Resolution of syndromic craniosynostosis-associated Chiari malformation type I without suboccipital decompression after posterior cranial vault release. J Neurosurg Pediatr 9:111–115

    Article  PubMed  Google Scholar 

  13. Magge SN, Westerveld M, Pruzinsky T, Persing JA (2002) Long-term neuropsychological effects of sagittal craniosynostosis on child development. J Craniofac Surg 13:99–104

    Article  PubMed  Google Scholar 

  14. Massimi L, Novegno F, di Rocco C (2011) Chiari type I malformation in children. Adv Tech Stand Neurosurg 37:143–211

    Article  PubMed  CAS  Google Scholar 

  15. Meadows J, Kraut M, Guarnieri M, Haroun RI, Carson BS (2000) Asymptomatic Chiari type I malformations identified on magnetic resonance imaging. J Neurosurg 92:920–926

    Article  PubMed  CAS  Google Scholar 

  16. Mikulis DJ, Diaz O, Egglin TK, Sanchez R (1992) Variance of the position of the cerebellar tonsils with age: preliminary report. Radiology 183:725–728

    PubMed  CAS  Google Scholar 

  17. Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, Speer MC (1999) Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 44:1005–1017

    Article  PubMed  CAS  Google Scholar 

  18. 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 86:40–47

    Article  PubMed  CAS  Google Scholar 

  19. Nishizawa S, Yokoyama T, Yokota N, Tokuyama T, Ohta S (2001) Incidentally identified syringomyelia associated with Chiari I malformations: is early interventional surgery necessary? Neurosurgery 49:637–640, discussion 640–631

    PubMed  CAS  Google Scholar 

  20. Novegno F, Caldarelli M, Massa A, Chieffo D, Massimi L, Pettorini B, Tamburrini G, Di Rocco C (2008) The natural history of the Chiari type I anomaly. J Neurosurg Pediatr 2:179–187

    Article  PubMed  Google Scholar 

  21. Oakes W, Tubbs R (2004) Chiari malformations. In: Winn HR (ed) Youman’s neurological surgery. Saunders, Philadelphia, pp 3347–3361

    Google Scholar 

  22. Pouratian N, Sansur CA, Newman SA, Jane JA Jr, Jane JA Sr (2007) Chiari malformations in patients with uncorrected sagittal synostosis. Surg Neurol 67:422–427, discussion 427–428

    Article  PubMed  Google Scholar 

  23. Pueyrredon F, Spaho N, Arroyave I, Vinters H, Lazareff J (2007) Histological findings in cerebellar tonsils of patients with Chiari type I malformation. Childs Nerv Syst 23:427–429

    Article  PubMed  Google Scholar 

  24. Saletti V, Esposito S, Frittoli M, Valentini LG, Chiapparini L, Bulgheroni S, Riva D (2011) Neurological pictures in paediatric Chiari I malformation. Neurol Sci 32(Suppl 3):295–298

    Article  Google Scholar 

  25. Sgouros S, Goldin JH, Hockley AD, Wake MJ (1996) Posterior skull surgery in craniosynostosis. Childs Nerv Syst 12:727–733

    Article  PubMed  CAS  Google Scholar 

  26. Strahle J, Muraszko KM, Buchman SR, Kapurch J, Garton HJ, Maher CO (2011) Chiari malformation associated with craniosynostosis. Neurosurg Focus 31:E2

    Article  PubMed  Google Scholar 

  27. Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO (2011) Chiari malformation type I and syrinx in children undergoing magnetic resonance imaging. J Neurosurg Pediatr 8:205–213

    Article  PubMed  Google Scholar 

  28. Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO (2011) Natural history of Chiari malformation type I following decision for conservative treatment. J Neurosurg Pediatr 8:214–221

    Article  PubMed  Google Scholar 

  29. Tubbs RS, Elton S, Blount JP, Oakes WJ (2001) Preliminary observations on the association between simple metopic ridging in children without trigonocephaly and the Chiari I malformation. Pediatr Neurosurg 35:136–139

    Article  PubMed  CAS  Google Scholar 

  30. Tubbs RS, Wellons JC 3rd, Oakes WJ (2002) Asymmetry of tonsillar ectopia in Chiari I malformation. Pediatr Neurosurg 37:199–202

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cleft Lip and Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland

    J. Leikola & A. Hukki

  2. Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland

    A. Karppinen

  3. Helsinki Medical Imaging Centre, Department of Radiology, Helsinki University Hospital, Helsinki, Finland

    L. Valanne

  4. Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland

    V. Koljonen

  5. Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland

    V. Koljonen

  6. Department of Plastic Surgery, Töölö Hospital, P.O. Box 266, Helsinki, FIN 0029 HUS, Finland

    J. Leikola

Authors
  1. J. Leikola
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  2. A. Hukki
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  3. A. Karppinen
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  4. L. Valanne
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  5. V. Koljonen
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Corresponding author

Correspondence to J. Leikola.

Additional information

Support was provided solely from departmental sources. No financial or other conflict of interest exists regarding financial or other relationship.

J. Leikola and A. Hukki contributed equally to this study.

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Leikola, J., Hukki, A., Karppinen, A. et al. The evolution of cerebellar tonsillar herniation after cranial vault remodeling surgery. Childs Nerv Syst 28, 1767–1771 (2012). https://doi.org/10.1007/s00381-012-1816-7

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  • DOI: https://doi.org/10.1007/s00381-012-1816-7

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