ArticleActa neurochirurgica2010
Mechanisms of cerebellar tonsil herniation in patients with Chiari malformations as guide to clinical management.
Article in Acta neurochirurgica, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 105 papers, 2 of them syntheses that pooled it.
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105 citing papers in PubMed, 2 syntheses or guidelines pooled it, 250 citations in OpenAlex.
- From gene to geometry: the molecular morphogenesis of the fourth ventricle angle and its role in predicting brainstem dysfunction among Chiari I malformation patients.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026Pooled it
- The effect of filum terminale sectioning for Chiari 1 malformation treatment: systematic review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2020Pooled it
- Clinical and MRI morphometric characterization of symptomatic cerebellar tonsillar ectopia.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- Morphometric assessment of the posterior cranial fossa and its contents in patients with chiari malformation type I and type 0.Acta neurochirurgica · 2026Article
- Association of Posterior Fossa Morphometric Analyses with Cerebrospinal Fluid Flow Parameters in Patients with Chiari Malformation Type 1.Journal of neurological surgery. Part B, Skull base · 2026Article
- MRI-morphometric characterization of Chiari malformation types 0 and 1 with syringomyelia: implications for diagnosis and pathogenesis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Observational
- An epidemiological analysis of cranio-vertebral morphometrics other than tonsillar position in symptomatic, adult, female Chiari malformation type I.Scientific reports · 2026Article
- Chiari Malformation and Hindbrain Descent: Characterization and New Classification Based on Mechanism and Pathogenesis, and Surgical Management.Neurospine · 2025Article
- Article
- Variants in Chromatin Remodeling Genes Are Involved in Patients With Chiari Malformation Type 1.Birth defects research · 2025Article
- Follow-up of syringomyelia due to Chiari type I malformation with phase-contrast magnetic resonance imaging in a professional athlete.Surgical neurology international · 2025Article
- The Genetics of Chiari 1 Malformation.Journal of clinical medicine · 2024Review
- Article
- Volumetric assessment of Posterior cranial fossa in a West African population.World neurosurgery: X · 2024Article
- Evaluation and Treatment of Patients with Small Posterior Cranial Fossa and Chiari Malformation, Types 0 and 1.Advances and technical standards in neurosurgery · 2024Article
- Decoding Chiari Malformation and Syringomyelia: From Epidemiology and Genetics to Advanced Diagnosis and Management Strategies.Brain sciences · 2023Review
- Research process, recap, and prediction of Chiari malformation based on bicentennial history of nomenclature and terms misuse.Neurosurgical review · 2023Review
- The Role of Neurophysiology in Managing Patients with Chiari Malformations.Journal of clinical medicine · 2023Review
- Study on the relationship between vertebrobasilar dolichoectasia and posterior cranial fossa space.Heliyon · 2023Article
- A Critical Update of the Classification of Chiari and Chiari-like Malformations.Journal of clinical medicine · 2023Review
45 more citing papers are in PubMed but not listed here.
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe pathogenesis of Chiari malformations is incompletely understood. We tested the hypothesis that different etiologies have different mechanisms of cerebellar tonsil herniation (CTH), as revealed by posterior cranial fossa (PCF) morphology.
methodsIn 741 patients with Chiari malformation type I (CM-I) and 11 patients with Chiari malformation type II (CM-II), the size of the occipital enchondrium and volume of the PCF (PCFV) were measured on reconstructed 2D-CT and MR images of the skull. Measurements were compared with those in 80 age- and sex-matched healthy control individuals, and the results were correlated with clinical findings.
resultsSignificant reductions of PCF size and volume were present in 388 patients with classical CM-I, 11 patients with CM-II, and five patients with CM-I and craniosynostosis. Occipital bone size and PCFV were normal in 225 patients with CM-I and occipitoatlantoaxial joint instability, 55 patients with CM-I and tethered cord syndrome (TCS), 30 patients with CM-I and intracranial mass lesions, and 28 patients with CM-I and lumboperitoneal shunts. Ten patients had miscellaneous etiologies. The size and area of the foramen magnum were significantly smaller in patients with classical CM-I and CM-I occurring with craniosynostosis and significantly larger in patients with CM-II and CM-I occurring with TCS.
conclusionsImportant clues concerning the pathogenesis of CTH were provided by morphometric measurements of the PCF. When these assessments were correlated with etiological factors, the following causal mechanisms were suggested: (1) cranial constriction; (2) cranial settling; (3) spinal cord tethering; (4) intracranial hypertension; and (5) intraspinal hypotension.
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