Advertisement

Systematic review and meta-analysis of imaging characteristics in Chiari I malformation: does anything really matter?

  • Travis J. Atchley
  • Elizabeth N. Alford
  • Brandon G. RocqueEmail author
Original Article
  • 22 Downloads

Abstract

Purpose

Previous studies have attempted to evaluate the utility of preoperative magnetic resonance imaging (MRI) parameters in predicting outcomes in Chiari I malformation. We performed a systematic review and meta-analysis to determine what preoperative imaging features (if any) predict (1) presence of preoperative symptoms or associated findings, (2) need for surgical decompression, or (3) improvement after surgical decompression.

Methods

All publications through June 2018 on PubMed, Embase, and Cochrane Library databases were searched using the keywords “Chiari I malformation” AND “decompression” OR “imaging.” One thousand two hundred ten publications were identified, and 20 were included for our systematic review; nine were included in the meta-analysis.

Results

Tonsil position, clivus gradient, and scoliotic curve of > 20° were all associated with the presence of preoperative syrinx. Degree of scoliotic curve was associated with length of syrinx. Pre-operative findings of central syrinx morphology, shorter syrinx, and scoliotic curve < 20° were associated with post-operative stability/improvement. Post-operative symptomatic improvement was associated with preoperative pB-C2 line ≥ 3 mm, absence of scoliosis, and presence of syrinx. By meta-analysis, there was no significant difference in post-operative improvement between patients with and without syrinx (OR = 0.89; 95% CI 0.58–1.37). Meta-analysis showed no significant difference in post-operative improvement between patients with and without basilar invagination (OR = 1.31; 95% CI 0.72–2.36).

Conclusions

Multiple studies have attempted to identify preoperative imaging parameters to predict post-operative improvement, but no consistently reliable criteria have been defined. This review and meta-analysis highlight the importance of considering each patient’s clinical history and physical exam within the context of associated radiographic abnormalities.

Keywords

Chiari I malformation Posterior fossa decompression Systematic review Meta-analysis 

Notes

Acknowledgments

Dr. Alford completed this work as a UAB Women’s Leadership Council Clinical Research scholar.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Altman DG (1991) Practical statistics for medical research. London, Chapman and Hall. Available: http://onlinelibrary.wiley.com/doi/abs/10.1002/sim.4780101015. Accessed 27 May 2019
  2. 2.
    Arora P, Behari S, Banerji D, Chhabra DK, Jain VK (2004) Factors influencing the outcome in symptomatic Chiari I malformation. Neurol India 52:470–474PubMedGoogle Scholar
  3. 3.
    Deng X, Wu L, Yang C, Tong X, Xu Y (2013) Surgical treatment of Chiari I malformation with ventricular dilation. Neurol Med Chir (Tokyo) 53:847–852CrossRefGoogle Scholar
  4. 4.
    Furtado SV, Thakar S, Hegde AS (2011) Correlation of functional outcome and natural history with clinicoradiological factors in surgically managed pediatric Chiari I malformation. Neurosurgery 68:319–328CrossRefGoogle Scholar
  5. 5.
    Genitori L, Peretta P, Nurisso C, Macinante L, Mussa F (2000) Chiari type I anomalies in children and adolescents: minimally invasive management in a series of 53 cases. Childs Nerv Syst 16:707–718CrossRefGoogle Scholar
  6. 6.
    Greenberg JK, Yarbrough CK, Radmanesh A, Godzik J, Yu M, Jeffe DB, Smyth MD, Park TS, Piccirillo JF, Limbrick DD (2015) The Chiari Severity Index: a preoperative grading system for Chiari malformation type 1. Neurosurgery 76:279–285CrossRefGoogle Scholar
  7. 7.
    Grinnon ST, Miller K, Marler JR, Lu Y, Stout A, Odenkirchen J et al (2012) National Institute of Neurological Disorders and Stroke. NINDS Common Data Elements; 2018. Available from: https://www.commondataelements.ninds.nih.gov/CDE.aspx.
  8. 8.
    Halvorson KG, Kellogg RT, Keachie KN, Grant GA, Muh CR, Waldau B (2016) Morphometric analysis of predictors of cervical syrinx formation in the setting of Chiari I malformation. Pediatr Neurosurg 51:137–141CrossRefGoogle Scholar
  9. 9.
    Hekman KE, Aliaga L, Straus D, Luther A, Chen J, Sampat A, Frim D (2012) Positive and negative predictors for good outcome after decompressive surgery for Chiari malformation type 1 as scored on the Chicago Chiari Outcome Scale. Neurol Res 34:694–700CrossRefGoogle Scholar
  10. 10.
    (2016) IBM SPSS Statistics for Mac. IBM Corp, ArmonkGoogle Scholar
  11. 11.
    Kalb S, Perez-Orribo L, Mahan M, Theodore N, Nakaji P, Bristol RE (2012) Evaluation of operative procedures for symptomatic outcome after decompression surgery for Chiari type I malformation. J Clin Neurosci 19:1268–1272CrossRefGoogle Scholar
  12. 12.
    Khatwa U, Ramgopal S, Mylavarapu A, Prabhu SP, Smith E, Proctor M, Scott M, Pai V, Zarowski M, Kothare SV (2013) MRI findings and sleep apnea in children with Chiari I malformation. Pediatr Neurol 48:299–307CrossRefGoogle Scholar
  13. 13.
    Klekamp J (2015) Chiari I malformation with and without basilar invagination: a comparative study. Neurosurg Focus 38:E12CrossRefGoogle Scholar
  14. 14.
    Krieger MD, Falkinstein Y, Bowen IE, Tolo VT, McComb JG (2011) Scoliosis and Chiari malformation type I in children: Clinical article. J Neurosurg Pediatr 7:25–29CrossRefGoogle Scholar
  15. 15.
    Ladner TR, Dewan MC, Day MA, Shannon CN, Tomycz L, Tulipan N et al (2014) Evaluating the relationship of the pB–C2 line to clinical outcomes in a 15-year single-center cohort of pediatric Chiari I malformation. J Neurosurg Pediatr 15:178–188CrossRefGoogle Scholar
  16. 16.
    Lee S, Wang K-C, Cheon J-E, Phi JH, Lee JY, Cho B-K, Kim SK (2014) Surgical outcome of Chiari I malformation in children: clinico-radiological factors and technical aspects. Childs Nerv Syst 30:613–623CrossRefGoogle Scholar
  17. 17.
    Losurdo A, Dittoni S, Testani E, Di Blasi C, Scarano E, Mariotti P et al (2013) Sleep disordered breathing in children and adolescents with Chiari malformation type I. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med 9:371–377Google Scholar
  18. 18.
    Luciano MG, Batzdorf U, Kula RW, Rocque BG, Maher CO, Heiss J et al (2019) Development of common data elements for use in Chiari malformation type I clinical research: an NIH/NINDS Project. Neurosurgery Available: https://academic.oup.com/neurosurgery/advancearticle/doi/10.1093/neuros/nyy475/5299237. Accessed 23 May 2019
  19. 19.
    Moher D, Liberati A, Tetzlaff J, Altman DG Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement 7Google Scholar
  20. 20.
    Munshi I, Frim D, Stine-Reyes R, Weir BKA, Hekmatpanah J, Brown F (2000) Effects of posterior fossa decompression with and without duraplasty on Chiari malformation-associated hydromyelia. Neurosurgery 46:1384–1390CrossRefGoogle Scholar
  21. 21.
    Nagoshi N, Iwanami A, Toyama Y, Nakamura M (2014) Factors contributing to improvement of syringomyelia after foramen magnum decompression for Chiari type I malformation. J Orthop Sci 19:418–423CrossRefGoogle Scholar
  22. 22.
    Oldfield EH, Muraszko K, Shawker TH, Patronas NJ (1994) Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. J Neurosurg 80:3–15CrossRefGoogle Scholar
  23. 23.
    Ono A, Suetsuna F, Ueyama K, Yokoyama T, Aburakawa S, Numasawa T, Wada K, Toh S (2007) Surgical outcomes in adult patients with syringomyelia associated with Chiari malformation type I: the relationship between scoliosis and neurological findings. J Neurosurg Spine 6:216–221CrossRefGoogle Scholar
  24. 24.
    Ono A, Ueyama K, Okada A, Echigoya N, Yokoyama T, Harata S (2002) Adult scoliosis in syringomyelia associated with Chiari I malformation. Spine 27:E23–E28CrossRefGoogle Scholar
  25. 25.
    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 23:427–429CrossRefGoogle Scholar
  26. 26.
    Saez RJ, Onofrio BM, Yanagihara T (1976) Experience with Arnold-Chiari malformation, 1960 to 1970. J Neurosurg 416–422CrossRefGoogle Scholar
  27. 27.
    Schijman E (2004) History, anatomic forms, and pathogenesis of Chiari I malformations. Childs Nerv Syst 20:323–328CrossRefGoogle Scholar
  28. 28.
    Spena G, Bernucci C, Garbossa D, Valfrè W, Versari P (2010) Clinical and radiological outcome of craniocervical osteo-dural decompression for Chiari I-associated syringomyelia. Neurosurg Rev 33:297–304CrossRefGoogle Scholar
  29. 29.
    Strahle J, Smith BW, Martinez M, Bapuraj JR, Muraszko KM, Garton HJL, Maher CO (2015) The association between Chiari malformation type I, spinal syrinx, and scoliosis. J Neurosurg Pediatr 15:607–611CrossRefGoogle Scholar
  30. 30.
    The Cochrane Collaboration (2014) Review manager. The Nordic Cochrane Center, CopenhagenGoogle Scholar
  31. 31.
    Tubbs RS, Lyerly MJ, Loukas M, Shoja MM, Oakes WJ (2007) The pediatric Chiari I malformation: a review. Childs Nerv Syst 23:1239–1250CrossRefGoogle Scholar
  32. 32.
    Yan H, Han X, Jin M, Liu Z, Xie D, Sha S, Qiu Y, Zhu Z (2016) Morphometric features of posterior cranial fossa are different between Chiari I malformation with and without syringomyelia. Eur Spine J 25:2202–2209CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurological SurgeryUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Division of Pediatric NeurosurgeryChildren’s of Alabama–University of Alabama at BirminghamBirminghamUSA

Personalised recommendations