Journal article
Cognitive and Psychological Functioning in Chiari Malformation Type I Before and After Surgical Decompression - A Prospective Cohort Study
Neurosurgery, Vol.89(6), pp.1087-1096
12/01/2021
DOI: 10.1093/neuros/nyab353
PMCID: PMC8600175
PMID: 34662899
Abstract
BACKGROUND: Chiari Malformation Type I (CM-I) is defined as cerebellar tonsil displacement more than 5 mm below the foramen magnum. This displacement can alter cerebrospinal fluid flow at the cervicomedullary junction resulting in Valsalva-induced headaches and syringomyelia and compress the brainstem resulting in bulbar symptoms. However, little is known about cognitive and psychological changes in CM-I.
OBJECTIVE: To prospectively assess cognitive and psychological performance in CM-I and determine whether changes occur after surgical decompression.
METHODS: Blinded evaluators assessed symptomatic CM-I patients ages >= 18 with a battery of neuropsychological and psychological tests. Testing was conducted preoperatively and 6 to 18 mo postoperatively. Data were converted to Z-scores based on normative data, and t-tests were used to analyze pre-post changes.
RESULTS: A total of 26 patients were included, with 19 completing both pre- and post-op cognitive assessments. All patients had resolution of Valsalva-induced headaches and there was improvement in swallowing dysfunction (P <.0001), ataxia (P =.008), and sleep apnea (P =.021). Baseline performances in visual perception and construction (z = -1.11, P =.001) and visuospatial memory (z = -0.93, P =.002) were below average. Pre-post comparisons showed that CM-I patients had stable cognitive and psychological functioning after surgery, without significant changes from preoperative levels.
CONCLUSION: CM-I patients had below average performance in visuospatial and visuoconstructional abilities preoperatively. Prospective longitudinal data following surgery demonstrated improved neurologic status without any decline in cognition or psychological functioning. Routine pre- and postoperative formal neuropsychological assessment in CM-I patients help quantify cognitive and behavioral changes associated with surgical decompression.
Details
- Title: Subtitle
- Cognitive and Psychological Functioning in Chiari Malformation Type I Before and After Surgical Decompression - A Prospective Cohort Study
- Creators
- Scott C. Seaman - University of IowaCarolina Deifelt Streese - University of Iowa Hospitals and ClinicsKenneth Manzel - University of IowaJanina Kamm - The Chicago School of Professional PsychologyArnold H. Menezes - University of IowaDaniel Tranel - University of IowaBrian J. Dlouhy - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.89(6), pp.1087-1096
- Publisher
- Oxford Univ Press
- DOI
- 10.1093/neuros/nyab353
- PMID
- 34662899
- PMCID
- PMC8600175
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Number of pages
- 10
- Grant note
- P50 MH0942581; U01 NS103780 / NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA Kiwanis International Neuroscience Research Foundation
- Language
- English
- Date published
- 12/01/2021
- Academic Unit
- Neurology; Stead Family Department of Pediatrics; Psychological and Brain Sciences; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
- Record Identifier
- 9984303912602771
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