Journal article
Fourth Ventricle Enlargement in Chiari Malformation Type I
World neurosurgery, Vol.133, pp.e259-e266
01/2020
DOI: 10.1016/j.wneu.2019.08.230
PMID: 31513955
Abstract
How Chiari malformation type I (CM-I) affects posterior fossa brain structures and produces various symptoms remains unclear. The fourth ventricle is surrounded by critical structures required for normal function. The foramen of Magendie can be obstructed in CM-I; therefore, fourth ventricle changes may occur. To test this hypothesis, we assessed fourth ventricle volume in CM-I compared with healthy controls.\nUsing our database from 2007–2016, we studied 72 patients with CM-I and 30 age-matched healthy control subjects. Fourth and lateral ventricle volumes and posterior fossa volumes (PFV) were assessed and correlated with clinical signs and symptoms. Statistical analysis was performed.\nPatients with CM-I had larger fourth ventricle volumes compared with control subjects (1.31 vs. 0.95 mL; P = 0.012). There were no differences in lateral ventricle volume or PFV. CM-I fourth ventricle volume was associated with tonsillar descent (P = 0.030). CM-I fourth ventricle volume variance was larger than healthy controls (F71,29 = 8.33; P < 0.0001). Patients with CM-I with severe signs and symptoms had a significantly larger fourth ventricle than patients with CM-I with mild signs and symptoms (1.565 vs. 1.015 mL; P = 0.0002).\nThe fourth ventricle can be enlarged in CM-I independent of lateral ventricle size and is associated with greater tonsillar descent. Most importantly, fourth ventricle enlargement was associated with a worse clinical and radiographic presentation independent of PFV. Fourth ventricle enlargement can affect critical structures and may be a mechanism contributing to symptoms unexplained by tonsil descent. Fourth ventricle enlargement is a useful adjunct in assessing CM-I.
Details
- Title: Subtitle
- Fourth Ventricle Enlargement in Chiari Malformation Type I
- Creators
- Scott C Seaman - Departments of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USAJeffrey D Dawson - Department of Biostatistics, College of Public Health, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAVincent Magnotta - Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAArnold H Menezes - Departments of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USABrian J Dlouhy - Departments of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.133, pp.e259-e266
- DOI
- 10.1016/j.wneu.2019.08.230
- PMID
- 31513955
- NLM abbreviation
- World Neurosurg
- ISSN
- 1878-8750
- eISSN
- 1878-8769
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 01/2020
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Public Health Administration; Psychiatry; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Biostatistics; Neurosurgery; Otolaryngology
- Record Identifier
- 9984070209402771
Metrics
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