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Syrinx resolution is correlated with the upward shifting of cerebellar tonsil following posterior fossa decompression in pediatric patients with Chiari malformation type I

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Abstract

Purpose

Chiari malformation type I (CMI) is characterized by deformed hindbrain. This study aimed to quantitatively evaluate the alterations in position of hindbrain after Posterior fossa decompression (PFD), and to identify the factors associated with syrinx resolution in pediatric patients with CMI.

Methods

Eighty-seven patients, aged from 5 to 18 years, who underwent PFD for CMI between September 2006 and September 2012 were retrospectively reviewed. On mid-sagittal MR images, the position of medulla oblongata and cerebellum was quantitatively evaluated preoperatively and at follow-up. The maximal syrinx/cord (S/C) ratio and syrinx length were also measured. Significant improvement of syrinx was defined as a more than 20 % decrease in maximal S/C ratio or length on follow-up MRI.

Results

Neurological deficits were found in 51 of the 87 patients preoperatively and 37 (72.4 %) of them obtained improvement of their symptoms at the last visit. Overall, upward shifting of the tip of cerebellar tonsil was observed in 66 (75.9 %) patients at the last follow-up. Moreover, the mean longitudinal distance of the tip of cerebella tonsil changed from 16.47 ± 5.00 to 13.89 ± 4.38 mm (P < 0.001) at final follow-up. Significant syrinx resolution was noticed in 79 (90.8 %) cases. Pointed cerebellar tonsils were found in 85 (97.7 %) of our patients preoperatively and 78 (91.8 %) of them acquired round cerebellar tonsils after PFD. The improvement of maximal S/C ratio was significantly correlated with upward shifting of the tip of cerebellar tonsil (P = 0.023).

Conclusions

Following PFD for CMI, position and morphology of the cerebellar tonsil could revert to normal in most of the pediatric patients, and the upward shifting of the tip of cerebellar tonsil is significantly correlated with syrinx improvement. From this study, PFD without shunting may be effective for syrinx secondary to CMI in pediatric population.

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (Grant No. 81371912). No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Spinal Surgery, The Drum Tower Clinical Medical College of Nanjing Medical University, Zhongshan Road No. 321, 210008, Nanjing, China

    Dingding Xie, Long Jiang & Zezhang Zhu

  2. Department of Spinal Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, 210008, Nanjing, China

    Yong Qiu, Shifu Sha, Zhen Liu, Huang Yan, Ling Chen, Benlong Shi & Zezhang Zhu

Authors
  1. Dingding Xie
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  2. Yong Qiu
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  3. Shifu Sha
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  4. Zhen Liu
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  5. Long Jiang
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  6. Huang Yan
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  7. Ling Chen
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  8. Benlong Shi
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  9. Zezhang Zhu
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Correspondence to Zezhang Zhu.

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Xie, D., Qiu, Y., Sha, S. et al. Syrinx resolution is correlated with the upward shifting of cerebellar tonsil following posterior fossa decompression in pediatric patients with Chiari malformation type I. Eur Spine J 24, 155–161 (2015). https://doi.org/10.1007/s00586-014-3680-5

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  • DOI: https://doi.org/10.1007/s00586-014-3680-5

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