Sequential morphological change of Chiari malformation type II following surgical repair of myelomeningocele

Kimiaki Hashiguchi, Takato Morioka, Nobuya Murakami, Osamu Togao, Hiwatashi Akio, Masayuki Ochiai, Goki Eriguchi, Junji Kishimoto, Koji Iihara

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: To document long-term morphological changes of Chiari type II malformation (CM-II) following closure of spina bifida manifesta (SBM). Methods: We retrospectively evaluated postnatal magnetic resonance images of the CM-II and posterior fossa (PF) in 28 consecutive cases. We measured changes in vertebral level and length of the cerebellar peg (CP), cerebrospinal fluid (CSF) spaces anterior and posterior to the cerebrospinal junction, PF area, and the anteroposterior diameters of the foramen magnum (FM) and C1 vertebra. We examined the morphological differences between the cases with and without ventriculoperitoneal (VP) shunting and derived predicted means by nonlinear mixed-effect modeling. Results: At birth, there were significant differences in CP length, PF area, and FM and C1 diameters between those who underwent VP shunting and those who did not. In cases with a CP below C1, VP shunting was required in every case but one. In those with visible CSF space at birth, VP shunts were not required. In 17 of 18 cases with a CP below C1, the vertebral level ascended by mean two vertebral levels (range 0–5 levels) within 4–6 months of delivery. In the remaining case, slowly progressive hydrocephalus and delayed CP descent required VP shunting at 8 months. Predicted mean CP length and FM and C1 diameters were greater in those who underwent VP shunting, but there was no difference in predicted mean PF area. Conclusion: The morphology of CM-II and the presence of hydrocephalus influence each other in children who have undergone postnatal SBM repair.

Original languageEnglish
Pages (from-to)1069-1078
Number of pages10
JournalChild's Nervous System
Volume32
Issue number6
DOIs
Publication statusPublished - Jun 1 2016

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Arnold-Chiari Malformation
Foramen Magnum
Meningomyelocele
Spina Bifida Cystica
Hydrocephalus
Cerebrospinal Fluid
Parturition
Ventriculoperitoneal Shunt
Spine
Magnetic Resonance Spectroscopy

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Sequential morphological change of Chiari malformation type II following surgical repair of myelomeningocele. / Hashiguchi, Kimiaki; Morioka, Takato; Murakami, Nobuya; Togao, Osamu; Akio, Hiwatashi; Ochiai, Masayuki; Eriguchi, Goki; Kishimoto, Junji; Iihara, Koji.

In: Child's Nervous System, Vol. 32, No. 6, 01.06.2016, p. 1069-1078.

Research output: Contribution to journalArticle

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abstract = "Purpose: To document long-term morphological changes of Chiari type II malformation (CM-II) following closure of spina bifida manifesta (SBM). Methods: We retrospectively evaluated postnatal magnetic resonance images of the CM-II and posterior fossa (PF) in 28 consecutive cases. We measured changes in vertebral level and length of the cerebellar peg (CP), cerebrospinal fluid (CSF) spaces anterior and posterior to the cerebrospinal junction, PF area, and the anteroposterior diameters of the foramen magnum (FM) and C1 vertebra. We examined the morphological differences between the cases with and without ventriculoperitoneal (VP) shunting and derived predicted means by nonlinear mixed-effect modeling. Results: At birth, there were significant differences in CP length, PF area, and FM and C1 diameters between those who underwent VP shunting and those who did not. In cases with a CP below C1, VP shunting was required in every case but one. In those with visible CSF space at birth, VP shunts were not required. In 17 of 18 cases with a CP below C1, the vertebral level ascended by mean two vertebral levels (range 0–5 levels) within 4–6 months of delivery. In the remaining case, slowly progressive hydrocephalus and delayed CP descent required VP shunting at 8 months. Predicted mean CP length and FM and C1 diameters were greater in those who underwent VP shunting, but there was no difference in predicted mean PF area. Conclusion: The morphology of CM-II and the presence of hydrocephalus influence each other in children who have undergone postnatal SBM repair.",
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AU - Morioka, Takato

AU - Murakami, Nobuya

AU - Togao, Osamu

AU - Akio, Hiwatashi

AU - Ochiai, Masayuki

AU - Eriguchi, Goki

AU - Kishimoto, Junji

AU - Iihara, Koji

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AB - Purpose: To document long-term morphological changes of Chiari type II malformation (CM-II) following closure of spina bifida manifesta (SBM). Methods: We retrospectively evaluated postnatal magnetic resonance images of the CM-II and posterior fossa (PF) in 28 consecutive cases. We measured changes in vertebral level and length of the cerebellar peg (CP), cerebrospinal fluid (CSF) spaces anterior and posterior to the cerebrospinal junction, PF area, and the anteroposterior diameters of the foramen magnum (FM) and C1 vertebra. We examined the morphological differences between the cases with and without ventriculoperitoneal (VP) shunting and derived predicted means by nonlinear mixed-effect modeling. Results: At birth, there were significant differences in CP length, PF area, and FM and C1 diameters between those who underwent VP shunting and those who did not. In cases with a CP below C1, VP shunting was required in every case but one. In those with visible CSF space at birth, VP shunts were not required. In 17 of 18 cases with a CP below C1, the vertebral level ascended by mean two vertebral levels (range 0–5 levels) within 4–6 months of delivery. In the remaining case, slowly progressive hydrocephalus and delayed CP descent required VP shunting at 8 months. Predicted mean CP length and FM and C1 diameters were greater in those who underwent VP shunting, but there was no difference in predicted mean PF area. Conclusion: The morphology of CM-II and the presence of hydrocephalus influence each other in children who have undergone postnatal SBM repair.

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