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Updated: Sep 6, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Possible predictive clinical and radiological markers in decision making for surgical intervention in patients with
Ulaş Yuksel1, Veysel Burulday2, Suleyman Akkaya1
1Kirikkale University Faculty of Medicine, Department of Neurosurgery, Kirikkale, Turkey.
Background:
The first aim of this study was to compare the clinical data and posterior fossa morphometry obtained during the admission to the hospital between control group individuals (who had not Chiari Malformation (CM) type 1) and CM type 1 patients treated surgically or not. The second aim was to create a valid and reliable scale that can predict the decision-making for surgical intervention simply and easily in these patients.
Materials:
Medical data and radiological images of 70 CM type 1 patients during their admission to the hospital were compared with the data of 69 control group individuals.
Results:
Conservative treatment and/or follow-up was applied to 58 (82.9%) patients, and 12 (17.1%) patients underwent surgery. ROC analysis showed that the presence of myelopathy, tonsillar herniation >8 mm, Chamberlain line >84 mm, McRae line >44.50 mm, and odontoid process-McRae line angle <10.50 degrees could be used as predictive markers in decision-making for surgical intervention (p < 0.05). Logistic Regression analysis revealed that symptoms severity, and McRae line value would be the 'best parameters' in decision-making for surgical intervention (p < 0.05). A scale named the CHIASURG scale developed using this study's parameters showed that the parameters of 'depth of tonsillar herniation', 'Chamberlain line', and 'McRae line' could predict the surgical intervention risk.
Conclusion:
It was found that symptoms severity and McRae line value could be used as predictive markers in decision-making for surgical intervention. Additionally, it was concluded that a new scale called CHIASURG could predict surgical intervention risk validly and reliably.
