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Anatomical progression of the Chiari II malformation
J R Ruge1, J Masciopinto, B B Storrs
1Lutheran General Children's Medical Center, Park Ridge, IL 60068.
Summary
Chiari II malformation shows continuous anatomic change in children with meningomyelocele. This skull base alteration may explain clinical deterioration in older patients due to new forces.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Medical Imaging
Background:
- Chiari II malformation is a complex congenital brain abnormality.
- Meningomyelocele is a severe birth defect affecting the spinal cord.
- The relationship between Chiari II malformation and the cranial base is not fully understood.
Purpose of the Study:
- To investigate ongoing anatomic changes between Chiari II malformation and the cranial base.
- To assess the progression of Chiari II malformation in relation to skull base anatomy.
- To correlate these changes with clinical outcomes in affected children.
Main Methods:
- Serial magnetic resonance imaging (MRI) scans were reviewed in 22 children with meningomyelocele.
- A specific ratio (B/A) was calculated to quantify the Chiari II malformation and foramen magnum relationship.
- This ratio was compared across serial MRI scans to detect changes over time.
Main Results:
- Eighteen out of 22 children demonstrated an increased B/A ratio, indicating progressive change.
- Two children showed a decrease in the ratio, and two remained unchanged.
- The findings suggest continuous anatomic alteration in the Chiari II malformation and skull base.
Conclusions:
- The study confirms ongoing anatomic changes in the Chiari II malformation and cranial base relationship.
- These dynamic changes may contribute to clinical deterioration in older children.
- Compressive and traction forces resulting from these alterations are hypothesized to cause symptoms.