Faculty Collaboration Database

Is there a relationship between the extent of tonsillar ectopia and the severity of the clinical Chiari syndrome? Acta Neurochir (Wien) 2020 Jul;162(7):1531-1538

Date

12/25/2019

Pubmed ID

31873796

DOI

10.1007/s00701-019-04171-1

Scopus ID

2-s2.0-85076896049 (requires institutional sign-in at Scopus site)   17 Citations

Abstract

BACKGROUND: Chiari 1 malformation is diagnosed if the cerebellar tonsils extend at least 5 mm below the opisthion-basion line.

OBJECTIVE: To examine the correlation of the extent of tonsillar ectopia with the prevalence and severity of the symptoms associated with the Chiari malformation.

METHODS: Patients (N = 428) were grouped according to the extent of tonsillar ectopia on the mid-sagittal MRI image (group 1, 0-< 3 mm; group 2, 3-5 mm; group 3, > 5 mm). Groups were compared regarding demographics, symptoms, neurological signs, pain score, and response to HADS and sf-36 questionnaires. Results were analyzed using one-way ANOVA, chi-square, and two sample Z test, and Student's t test for pairwise comparison, (statistical significance p < 0.05). A logistic regression analysis was performed to determine the relationship between tonsillar ectopia and the probability of a patient reporting any particular symptom.

RESULTS: There were 97,148 and 183 patients in groups 1, 2, and 3 respectively. Groups did not differ with regard to antecedent trauma or female preponderance. Patients in group 1 were more symptomatic than those in groups 2 and 3 with regard to some symptoms, (p = 0.04-p = 0.000). Regression analysis confirmed an inverse relationship between the extent of tonsillar ectopia and the likelihood of many symptoms. The pain score was greatest in group 1, (p = 0.006). Prevalence of objective signs of myelopathy did not differ between groups except for Hoffmann sign which was more prevalent in group 1, (p = 0.034). HADS and sf-36 scores did not differ between groups.

CONCLUSION: The severity of the symptoms associated with the Chiari malformation does not correlate directly with the extent of tonsillar ectopia. The extent of tonsillar ectopia should be re-evaluated as the threshold for diagnosis of Chiari 1 malformation.

Author List

Heffez DS, Broderick J, Connor M, Mitchell M, Galezowska J, Golchini R, Ghorai J

Author

Dan S. Heffez MD Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Arnold-Chiari Malformation
Choristoma
Female
Humans
Magnetic Resonance Imaging
Male
Palatine Tonsil