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MRI characteristics of syringomyelia associated with foramen magnum arachnoiditis: differentiation from Chiari malformation

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Abstract

Background

It is important to distinguish foramen magnum arachnoiditis (FMA) from Chiari malformation (CM) before surgery because the operative strategies for these diseases differ. In the current study, we compared pretreatment magnetic resonance imaging (MRI) of FMA with CM and investigated the MRI findings useful to differentiate between these diseases.

Methods

We retrospectively reviewed patients with FMA or CM aged ≥ 18 years who underwent surgeries at our institution between 2007 and 2019. The morphologies of the syrinx, neural elements, and posterior cranial fossa were preoperatively evaluated with MRI. We used the receiver operating characteristic (ROC) curve for the fourth ventricle-to-syrinx distance (FVSD).

Results

Ten patients with FMAs and 179 with CMs were included. FVSD in the FMA group was significantly shorter than that in the CM group (7.5 mm [IQR, 2.8–10 mm] in FMA vs. 29.9 mm [IQR, 16.3–52.9 mm] in CM, p < 0.0001). The other MRI findings that showed the height, size, and length of the syrinx; size of the foramen magnum; degree of cerebellar tonsillar descent; shape of the cerebellar tonsil; and dorsal subarachnoid space at the foramen magnum differed significantly between the two groups. The ROC curve analysis showed that patients whose FVSD was less than 11 mm could be diagnosed with FMA with a specificity of 90% and sensitivity of 96%.

Conclusions

A more cranial syrinx development (FVSD < 11 mm) appears to be the characteristic MRI finding in FMA.

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Abbreviations

AP:

Anteroposterior

AUC:

Area under the curve

CISS:

Constructive interference in a steady-state

CM:

Chiari malformation

CM-with-IA:

Chiari malformation with intra-arachnoid operation

CSF:

Cerebrospinal fluid

FMA:

Foramen magnum arachnoiditis

FMD:

Foramen magnum decompression

MRI:

Magnetic resonance imaging

ROC:

Receiver operating characteristic

SAS:

Subarachnoid space

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Acknowledgements

We would like to thank Dr. Shinji Yasuno and Dr. Sho Takahashi for timely consultation as well as technical help regarding planning of study design and statistical analysis, Dr. Kentaro Watanabe for medical illustrations, and Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Neurosurgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Keisuke Hatano, Hiroki Ohashi, Daichi Kawamura, Akira Isoshima, Hiroyasu Nagashima, Satoru Tochigi, So Ohashi, Jun Takei, Akihiko Teshigawara, Satoshi Tani, Yuichi Murayama & Toshiaki Abe

  2. Department of Neurosurgery, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan

    Akira Isoshima

  3. Department of Neurosurgery, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan

    Hiroyasu Nagashima

  4. Department of Neurosurgery, The Jikei University Kashiwa Hospital, 163–1 Kashiwashita, Kashiwa-shi, Chiba, 277-8567, Japan

    Satoru Tochigi & Akihiko Teshigawara

  5. Department of Neurosurgery, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Kawasaki-shi Saiwai-ku, Kanagawa, 212-0014, Japan

    So Ohashi

  6. Department of Neurosurgery, Mishima Central Hospital, 1–3 Midoricho, Mishima-shi, Shizuoka, 411–0848, Japan

    Toshiaki Abe

Authors
  1. Keisuke Hatano
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  2. Hiroki Ohashi
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  7. So Ohashi
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  11. Yuichi Murayama
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Corresponding author

Correspondence to Keisuke Hatano.

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Ethical approval

The Institutional Review Board of Jikei University Hospital approved the study protocol and waived the requirement for informed consent because the study was minimal risk and could not be conducted practically without a waiver.

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The authors declare no competing interests.

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Hatano, K., Ohashi, H., Kawamura, D. et al. MRI characteristics of syringomyelia associated with foramen magnum arachnoiditis: differentiation from Chiari malformation. Acta Neurochir 163, 1593–1601 (2021). https://doi.org/10.1007/s00701-021-04845-9

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  • DOI: https://doi.org/10.1007/s00701-021-04845-9

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