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Child's Nervous System
Published in: Child's Nervous System 6/2016

01-06-2016 | Original Paper

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

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

Published in: Child's Nervous System | Issue 6/2016

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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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Metadata
Title
Sequential morphological change of Chiari malformation type II following surgical repair of myelomeningocele
Authors
Kimiaki Hashiguchi
Takato Morioka
Nobuya Murakami
Osamu Togao
Akio Hiwatashi
Masayuki Ochiai
Goki Eriguchi
Junji Kishimoto
Koji Iihara
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 6/2016
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-016-3041-2

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