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Morphometric analysis of foramen magnum dimensions and intracranial volume in pediatric Chiari I malformation

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Abstract

Purpose

Foramen magnum dimensions and intracranial volume in Chiari I malformations in children were studied, and the statistical relationship between patient demographics, radiological features and foramen magnum morphometry was investigated.

Methods

Linear measurements were used to calculate the intracranial volume using preoperative magnetic resonance images and computed tomogram images. The area of the foramen magnum was obtained independently using computer imaging software and a regression formula. The result of 21 pediatric patients was compared with a matched control group.

Results

The area of the foramen magnum was within the range of the expected value deduced using a formula based on the intracranial volume. There was no statistical difference in the area and linear dimensions of the foramen magnum in the study and control groups. Six patients (28%) had a foramen magnum in close proximity to a spherical shape.

Conclusion

The authors provide a simple, accurate and reproducible method of estimating foramen magnum area in the pediatric Chiari I group. The irregular shape of the foramen magnum is accentuated by developmental bony and soft tissue anomalies at the cranio-vertebral junction in Chiari malformation. Consequently, an individualized cross-sectional assessment of the foramen magnum in relation to the hindbrain tissue in the same plane is required to study the initiation and propagation of the Chiari I symptomatology.

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Acknowledgements

The authors would like to thank Mr. Subbukrishna, Department of Statistics at NIMHANS, Bangalore for analyzing data and Ms. Kalavathi, Secretary, Department of Radiology, at our institute for retrieving and organizing radiological images from PACS archive.

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Authors and Affiliations

  1. Department of Neurosurgery, Sri Satya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore, 560066, Karnataka, India

    Sunil V. Furtado, Darpan J. Thakre, Prasanna K. Venkatesh & A. S. Hegde

  2. Department of Radiology, Sri Satya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore, 560066, Karnataka, India

    Kalyan Reddy

Authors
  1. Sunil V. Furtado
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  2. Darpan J. Thakre
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  3. Prasanna K. Venkatesh
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  4. Kalyan Reddy
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  5. A. S. Hegde
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Corresponding author

Correspondence to Sunil V. Furtado.

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Comment

Since the original proposal by Chiari to group different anomalies of the posterior cranial fossa into one category, sharing primary hydrocephalus as main causative factor, the eponym “Arnold-Chiari malformations” has continued to be used to indicate congenital and acquired conditions resulting in a hypoplastic posterior cranial fossa and caudally herniating hindbrain structures into the upper cervical canal. Although Chiari type I and Chiari type II have some common features, nowadays they are considered completely unrelated conditions. In the present paper, the authors report on the results they obtained by utilizing a morphologic analysis of the FM size in subjects with Chiari type I malformation and in a matched control group. The dimensions of the FM did not differ between the study and the control group, a finding which further differentiates patients with Chiari I from those with Chiari type II malformation, whose FM is larger than normal as a result of a congenital malformation process [1]. Consequently, the results of the study here considered appear to support an acquired cephalo-cranial disproportion in Chiari type I malformation, unable to affect the size of the FM rather than an early congenital malformative process, similar to that of Chiari type II, which conversely results in an abnormally large diameter of the FM and upper spinal canal.

The clinical implications are obvious.

Reference

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C. Di Rocco,

Rome, Italy

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Furtado, S.V., Thakre, D.J., Venkatesh, P.K. et al. Morphometric analysis of foramen magnum dimensions and intracranial volume in pediatric Chiari I malformation. Acta Neurochir 152, 221–227 (2010). https://doi.org/10.1007/s00701-009-0480-5

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  • DOI: https://doi.org/10.1007/s00701-009-0480-5

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