SYMPTOMATIC CHIARI MALFORMATION IN ADULTS - A NEW CLASSIFICATION BASED ON MAGNETIC-RESONANCE-IMAGING WITH CLINICAL AND PROGNOSTIC-SIGNIFICANCE

被引:183
作者
PILLAY, PK [1 ]
AWAD, IA [1 ]
LITTLE, JR [1 ]
HAHN, JF [1 ]
机构
[1] CLEVELAND CLIN FDN,DEPT NEUROL SURG,580 9500 EUCLID AVE,CLEVELAND,OH 44195
关键词
CHIARI MALFORMATION; MAGNETIC RESONANCE IMAGING; SYRINGOMYELIA;
D O I
10.1227/00006123-199105000-00001
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Thirty-five consecutive adults with Chiari malformation and progressive symptoms underwent surgical treatment at a single institution over a 3-year period. All patients underwent magnetic resonance imaging scan before and after surgery. Images of the craniovertebral junction confirmed tonsillar herniation in all cases and allowed the definition of two anatomically distinct categories of the Chiari malformation in this age group. Twenty of the 35 patients had concomitant syringomyelia and were classified as Type A. The remaining 15 patients had evidence of frank herniation of the brain stem below the foramen magnum without evidence of syringomyelia and were labeled Type B. Type A patients had a predominant central cord symptomatology; Type B patients exhibited signs and symptoms of brain stem or cerebellar compression. The principal surgical procedure consisted of decompression of the foramen magnum, opening of the fourth ventricular outlet, and plugging of the obex. Significant improvement in preoperative symptoms and signs was observed in 9 of the 20 patients (45%) with syringomyelia (Type A), as compared to 13 of the 15 patients (87%) without syringomyelia (Type B). Postoperative reduction in syrinx volume was observed in 11 of the 20 patients with syringomyelia, including all 9 patients with excellent results. Magnetic resonance imaging has allowed a classification of the adult Chiari malformation in adults based on objective anatomic criteria, with clinical and prognostic relevance. The presence of syringomyelia implies a less favorable response to surgical intervention.
引用
收藏
页码:639 / 645
页数:7
相关论文
共 30 条
[1]  
Aboulker J, 1979, NEUROCHIRURGIE S1, V25, P1
[2]   CRANIOVERTEBRAL ANOMALIES [J].
APPLEBY, A .
PROCEEDINGS OF THE ROYAL SOCIETY OF MEDICINE-LONDON, 1969, 62 (07) :729-&
[3]  
BALL MJ, 1972, LANCET, V2, P799
[4]   CHIARI MALFORMATION PRESENTING IN ADULT LIFE - ITS RELATIONSHIP TO SYRINGOMYELIA [J].
BANERJI, NK ;
MILLAR, JHD .
BRAIN, 1974, 97 (MAR) :157-&
[5]  
BARKOVICH A, 1986, AJNR, V7, P759
[7]   COMPARISON OF METRIZAMIDE COMPUTED-TOMOGRAPHY AND MAGNETIC-RESONANCE IMAGING IN THE EVALUATION OF LESIONS AT THE CERVICOMEDULLARY JUNCTION [J].
BOSLEY, TM ;
COHEN, DA ;
SCHATZ, NJ ;
ZIMMERMAN, RA ;
BILANIUK, LT ;
SAVINO, PJ ;
SERGOTT, RS .
NEUROLOGY, 1985, 35 (04) :485-492
[8]   CONSIDERATIONS IN THE DIAGNOSIS AND TREATMENT OF SYRINGOMYELIA AND THE CHIARI MALFORMATION [J].
CAHAN, LD ;
BENTSON, JR .
JOURNAL OF NEUROSURGERY, 1982, 57 (01) :24-31
[9]   EARLY DESCRIPTIONS OF ARNOLD-CHIARI MALFORMATION - CONTRIBUTION OF JOHN CLELAND [J].
CARMEL, PW ;
MARKESBERY, WR .
JOURNAL OF NEUROSURGERY, 1972, 37 (05) :543-+
[10]   CONCERNING ALTERATIONS IN THE CEREBELLUM RESULTING FROM CEREBRAL HYDROCEPHALUS [J].
CHIARI, H .
PEDIATRIC NEUROSCIENCE, 1987, 13 (01) :3-8