Systematic Review and Meta-analysis of Imaging Characteristics in Chiari I Malformation: Does Anything Really Matter?

Overview

Journal Childs Nerv Syst

Specialty Pediatrics

Date 2019 Nov 9

PMID 31701278

Citations 9

Authors

Travis J Atchley

Elizabeth N Alford

Brandon G Rocque

Affiliations

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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.

Citing Articles

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Craniocervical Morphometry in Pomeranians-Part II: Associations with Chiari-like Malformation and Syringomyelia.

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Use of Intraoperative Neuromonitoring in Surgical Treatment of Acute Presentation of Chiari I Malformation: A Case Report.

Ng C, Vazquez S, Auerbach-Tash R, Naftchi A, Dominguez J, Singh A J Neurol Surg Rep. 2023; 84(1):e26-e30.

PMID: 36923100 PMC: 10010903. DOI: 10.1055/a-2028-6419.

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