ArticleNeuroradiology2015
Tonsillar pulsatility before and after surgical decompression for children with Chiari malformation type 1: an application for true fast imaging with steady state precession.
Article in Neuroradiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 33 citations in OpenAlex.
- Predictors of syrinx presentation and outcomes in pediatric Chiari malformation type I: a single institution experience of 218 consecutive syrinx patients.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2024Article
- Surgical Management of Chiari Malformation Type I in the Pediatric Population: A Single-Center Experience.Journal of clinical medicine · 2024Article
- Insights on the Hydrodynamics of Chiari Malformation.Journal of clinical medicine · 2022Article
- Bony decompression vs duraplasty for Chiari I malformation: does the eternal dilemma matter?Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2019Review
- Dynamic cerebellar herniation in Chiari patients during the cardiac cycle evaluated by dynamic magnetic resonance imaging.Neuroradiology · 2019Article
- Cerebellar tonsil ectopia measurement in type I Chiari malformation patients show poor inter-operator reliability.Fluids and barriers of the CNS · 2018Article
- Cardiac-Related Spinal Cord Tissue Motion at the Foramen Magnum is Increased in Patients with Type I Chiari Malformation and Decreases Postdecompression Surgery.World neurosurgery · 2018Article
- Management of parturients in active labor with Arnold Chiari malformation, tonsillar herniation, and syringomyelia.Surgical neurology international · 2017Article
- "Stealth cranioplasty:" A novel endeavor for symptomatic adult Chiari I patients with syringomyelia: Technical note, appraisal, and philosophical considerations.Journal of craniovertebral junction & spineArticle
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Authors and funding
6 authors at 3 institutions in 1 country.
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Abstract
introductionWe hypothesize that surgical decompression for Chiari malformation type 1 (CM-1) is associated with statistically significant decrease in tonsillar pulsatility and that the degree of pulsatility can be reliably assessed regardless of the experience level of the reader.
methodsAn Institutional Review Board (IRB)-approved Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study was performed on 22 children with CM-1 (8 males; mean age 11.4 years) who had cardiac-gated true-FISP sequence and phase-contrast cerebrospinal fluid (CSF) flow imaging as parts of routine magnetic resonance (MR) imaging before and after surgical decompression. The surgical technique (decompression with or without duraplasty) was recorded for each patient. Three independent radiologists with different experience levels assessed tonsillar pulsatility qualitatively and quantitatively and assessed peritonsillar CSF flow qualitatively. Results were analyzed. To evaluate reliability, Fleiss kappa for multiple raters on categorical variables and intra-class correlation for agreement in pulsatility ratings were calculated.
resultsAfter surgical decompression, the degree of tonsillar pulsatility appreciably decreased, confirmed by t test, both qualitatively (p values <0.001, <0.001, and 0.045 for three readers) and quantitatively (amount of decrease/p value for three readers 0.7 mm/<0.001, 0.7 mm/<0.001, and 0.5 mm/0.022). There was a better agreement among the readers in quantitative assessment of tonsillar pulsatility (kappa 0.753-0.834), compared to qualitative assessment of pulsatility (kappa 0.472-0.496) and qualitative assessment of flow (kappa 0.056 to 0.203). Posterior fossa decompression with duraplasty led to a larger decrease in tonsillar pulsatility, compared to posterior fossa decompression alone.
conclusionTonsillar pulsatility in CM-1 is significantly reduced after surgical decompression. Quantitative assessment of tonsillar pulsatility was more reliable across readers than qualitative assessments of tonsillar pulsatility or CSF flow.
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