Braden J Lawrence1, Mark Luciano2, John Tew3, Richard G Ellenbogen4, John N Oshinski5, Francis Loth6, Amanda P Culley7, Bryn A Martin8. 1. School of Medicine, University of Washington, Seattle, Washington, USA; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Department of Biological Engineering, University of Idaho, Moscow, Idaho, USA. 2. Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA. 3. Department of Neurosurgery, University of Cincinnati Neuroscience Institute and University of Cincinnati College of Medicine, and Mayfield Clinic, Cincinnati, Ohio, USA. 4. Department of Neurological Surgery, University of Washington, Seattle, Washington, USA. 5. Department of Radiology & Imaging Science and Biomedical Engineering, Emory University, Atlanta, Georgia. 6. Conquer Chiari Research Center, Department of Mechanical Engineering, University of Akron, Ohio, USA. 7. Department of Statistical Science, University of Idaho, Moscow, Idaho, USA. 8. Department of Biological Engineering, University of Idaho, Moscow, Idaho, USA. Electronic address: brynm@uidaho.edu.
Abstract
OBJECTIVE: Type 1 Chiari malformation (CM-I) is a craniospinal disorder historically defined by cerebellar tonsillar position greater than 3-5 mm below the foramen magnum (FM). This definition has come under question because quantitative measurements of cerebellar herniation do not always correspond with symptom severity. Researchers have proposed several additional radiographic diagnostic criteria based on dynamic motion of fluids and/or tissues. The present study objective was to determine if cardiac-related craniocaudal spinal cord tissue displacement is an accurate indicator of the presence of CM-I and if tissue displacement is altered with decompression. METHODS: A cohort of 20 symptomatic patients underwent decompression surgery. Fifteen healthy volunteers were recruited for comparison with the CM-I group. Axial phase-contrast magnetic resonance imaging (PC-MRI) measurements were collected before and after surgery at the FM with cranial-caudal velocity encoding and 20 frames per cardiac cycle with retrospective reconstruction. Spinal cord motion (SCM) at the FM was quantified based on the peak-to-peak integral of average spinal cord velocity. RESULTS: Tissue motion for the presurgical group was significantly greater than controls (P = 0.0009). Motion decreased after surgery (P = 0.058) with an effect size of -0.151 mm and a standard error of 0.066 mm. Postoperatively, no statistical difference from controls in bulk displacement at the FM was found (P = 0.200) after post hoc testing using the Tukey adjustment for multiple comparisons. CONCLUSIONS: These results support SCM measurement by PC-MRI as a possible noninvasive radiographic diagnostic for CM-I. Dynamic measurement of SCM provides unique diagnostic information about CM-I alongside static quantification of tonsillar position and other intracranial morphometrics.
OBJECTIVE: Type 1 Chiari malformation (CM-I) is a craniospinal disorder historically defined by cerebellar tonsillar position greater than 3-5 mm below the foramen magnum (FM). This definition has come under question because quantitative measurements of cerebellar herniation do not always correspond with symptom severity. Researchers have proposed several additional radiographic diagnostic criteria based on dynamic motion of fluids and/or tissues. The present study objective was to determine if cardiac-related craniocaudal spinal cord tissue displacement is an accurate indicator of the presence of CM-I and if tissue displacement is altered with decompression. METHODS: A cohort of 20 symptomatic patients underwent decompression surgery. Fifteen healthy volunteers were recruited for comparison with the CM-I group. Axial phase-contrast magnetic resonance imaging (PC-MRI) measurements were collected before and after surgery at the FM with cranial-caudal velocity encoding and 20 frames per cardiac cycle with retrospective reconstruction. Spinal cord motion (SCM) at the FM was quantified based on the peak-to-peak integral of average spinal cord velocity. RESULTS: Tissue motion for the presurgical group was significantly greater than controls (P = 0.0009). Motion decreased after surgery (P = 0.058) with an effect size of -0.151 mm and a standard error of 0.066 mm. Postoperatively, no statistical difference from controls in bulk displacement at the FM was found (P = 0.200) after post hoc testing using the Tukey adjustment for multiple comparisons. CONCLUSIONS: These results support SCM measurement by PC-MRI as a possible noninvasive radiographic diagnostic for CM-I. Dynamic measurement of SCM provides unique diagnostic information about CM-I alongside static quantification of tonsillar position and other intracranial morphometrics.
Authors: R Shane Tubbs; Joshua Beckman; Robert P Naftel; Joshua J Chern; John C Wellons; Curtis J Rozzelle; Jeffrey P Blount; W Jerry Oakes Journal: J Neurosurg Pediatr Date: 2011-03 Impact factor: 2.375
Authors: R Shane Tubbs; Michael J Lyerly; Marios Loukas; Mohammadali M Shoja; W Jerry Oakes Journal: Childs Nerv Syst Date: 2007-07-18 Impact factor: 1.475
Authors: Theresia I Yiallourou; Jan Robert Kröger; Nikolaos Stergiopulos; David Maintz; Bryn A Martin; Alexander C Bunck Journal: PLoS One Date: 2012-12-21 Impact factor: 3.240
Authors: Chi Wen C Huang; Yu-Ming Chang; Alexander Brook; A Fourie Bezuidenhout; Rafeeque A Bhadelia Journal: Neuroradiology Date: 2020-01-29 Impact factor: 2.804
Authors: Blaise Simplice Talla Nwotchouang; Maggie S Eppelheimer; Dipankar Biswas; Soroush Heidari Pahlavian; Xiaodong Zhong; John N Oshinski; Daniel L Barrow; Rouzbeh Amini; Francis Loth Journal: Magn Reson Med Date: 2020-08-31 Impact factor: 4.668
Authors: Blaise Simplice Talla Nwotchouang; Maggie S Eppelheimer; Soroush Heidari Pahlavian; Jack W Barrow; Daniel L Barrow; Deqiang Qiu; Philip A Allen; John N Oshinski; Rouzbeh Amini; Francis Loth Journal: Ann Biomed Eng Date: 2021-01-04 Impact factor: 4.219
Authors: Mohammadreza Khani; Braden J Lawrence; Lucas R Sass; Christina P Gibbs; Joshua J Pluid; John N Oshinski; Gregory R Stewart; Jillynne R Zeller; Bryn A Martin Journal: PLoS One Date: 2019-02-27 Impact factor: 3.240
Authors: Rick Labuda; Blaise Simplice Talla Nwotchouang; Alaaddin Ibrahimy; Philip A Allen; John N Oshinski; Petra Klinge; Francis Loth Journal: Med Hypotheses Date: 2021-12-14 Impact factor: 1.538
Authors: Maggie S Eppelheimer; Blaise Simplice Talla Nwotchouang; Soroush Heidari Pahlavian; Jack W Barrow; Daniel L Barrow; Rouzbeh Amini; Philip A Allen; Francis Loth; John N Oshinski Journal: Radiology Date: 2021-07-27 Impact factor: 29.146