Factors predicting the occurrence of syringomyelia in patients with Chiari I malformations

Authors

  • Vijayan Peettakkandy Department of Neurosurgery, Government Medical College Thrissur, Kerala, India
  • Bijukrishnan Rajagopalawarrier Department of Neurosurgery, Government Medical College Thrissur, Kerala, India
  • Sreenath Kuniyil Department of Neurosurgery, Government Medical College Thrissur, Kerala, India
  • Jithin Veliyath Thankaraj Department of Neurosurgery, Government Medical College Thrissur, Kerala, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20193378

Keywords:

Chiari I malformations, Syringomyelia, Tonsillar herniation

Abstract

Background: Chiari I malformations are defined as the downward herniation of cerebellar tonsils more than 5 mm through the foramen magnum. Syringomyelia is a common association of Chiari I malformation.

Methods: This purpose of this study was to determine the various factors predicting the occurrence of syringomyelia in patients with Chiari I malformations. This retrospective study was conducted in Government medical college, Thrissur, Kerala, India. 27 patients admitted with diagnosis of symptomatic Chiari I malformations during the period of January 2015 to January 2019 were selected for the study.

Results: The mean age was 22.8 years and syringomyelia was more common in patients older than 10 years (p value0.005). Females were 17(63%) and males were 10(37%) but there no difference in occurrence of syringomyelia among both sexes(p value is 0.16). Syringomyelia was present in 17(63%) cases. Association between various factors and syringomyelia measured by calculating P value which was 0.005 for age >10 years, 0.16 for sex, 0.093 for duration of symptoms >12 months, 0.05 for tonsillar descend >10mm and 0.097 for hypertension. The p value for the association of duration of symptoms >12months and extend of tonsillar descend is 0.001 Mean duration of symptoms (onset of first symptom to the time of presentation) was 16.3 months and syringomyelia was more common in patients with duration of symptoms more than 12 months but this difference was statistically not significant (p value 0.093). Mean tonsillar descend from the level of foramen magnum was 11.3 mms and syringomyelia was more common in patients with tonsillar herniation more than 10mm (p value 0.05). There is a statistically significant relationship between duration of symptoms more than 12 months and tonsillar descend more than 10mm(p value 0.001).There is no significant association between hypertension and occurrence of syringomyelia in patients with Chiari I malformation.

Conclusions: Incidence of Chiari I Malformations is more among adults and it is slightly higher in females. Syringomyelia is a common association of Chiari I Malformations. The occurrence of syringomyelia in patients with Chiari I Malformations associated with increasing age of patients and extend of tonsillar herniation. There is no statistically significant association between syringomyelia and duration of symptoms or hypertension.

References

Chiari H. Concerning alterations in the cerebellum resulting from cerebral hydrocephalus. Pediat Neurosci. 1987;13(1):3-8.

Dyste G, Menezes AH, Van Gilder JC. Symptomatic Chiari malformations: an analysis of presentation, management and long term outcome. J Neurosurg. 1989;71(2):159-68.

Banerji NK, Millar JHD. Chiari malformation presenting in adult life: Its relationship to syringomyelia. Brain. 1974;97(1):157-68.

Williams B. A critical appraisal of posterior fossa surgery for communicating syringomyelia. Brain. 1978;101(2):223-50

Cahan LD, Bentson JR. Considerations in the diagnosis and treatment of syringomyelia and the Chiari malformation. J Neurosurg. 1982;57(1):24-31.

Menezes AH, Smoker W, Dyste G. Syringomyelia, Chiari malformations and hydromyelia. In: Youman JR, editor. Neurological Surgery. Philadelphia, WB Saunders; 1990: 1421-59.

Levy WJ, Mason L, Hahn JF. Chiari malformation presenting in adults: a surgical experience in 127 cases. Neurosur. 1983;12(4):377-90.

Meadows J, Guarnieri M, Miller K, Haroun R, Kraut M, Carson BS. Type I Chiari malformation: a review of the literature. Neurosurg Q. 2001;11(3):220-9.

Gripp KW, Scott CI, Nicholson L, Magram G, Grissom LE. Chiari malformation and tonsillar ectopia in twin brothers and father with autosomal dominant spondylo-epiphyseal dysplasia tarda. Skeletal Radiol. 1997;26(2):131-3.

Stovner LJ. Headache associated with the Chiari type I malformation. Headache. 1993;33(4):175-81.

Steinbok P. Clinical features of Chiari I malformations. Childs Nerv Sys. 2004;20(5):329-31.

Menezes AH. Chiari I malformations and hydromyelia-complications. Pediatr Neurosurg. 1991-1992;17(3):146-54.

Pascual J, Oterino A, Berciano J. Headache in type I Chiari malformation. Neurol. 1992;42(8):1519-21.

Elster AD, Chen MY. Chiari I malformations: clinical and radiologic reappraisal. Radiol. 1992;183(2):347-53.

Naderi S, Acar F, Acar G, Men S. Resolution of neurogenic arterial hypertension after suboccipital decompression for Chiari malformation. Case Rep. J Neurosurg. 2005;102(6):1147-50.

Tubbs RS, Wellons JC, Blount JP, Oakes WJ, Grabb PA. Cessation of chronic hypertension after posterior fossa decompression in a child with Chiari I malformation. Case report. J Neurosurg. 2004;100(2):194-6.

Parker EC, Teo C, Rahman S, Brodsky MC. Complete resolution of hypertension after decompression of Chiari I malformation. Skull Base Surg. 2000;10(3):149-52.

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Published

2019-07-25

How to Cite

Peettakkandy, V., Rajagopalawarrier, B., Kuniyil, S., & Thankaraj, J. V. (2019). Factors predicting the occurrence of syringomyelia in patients with Chiari I malformations. International Journal of Research in Medical Sciences, 7(8), 2967–2969. https://doi.org/10.18203/2320-6012.ijrms20193378

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Original Research Articles