Association of Posterior Fossa Morphometric Analyses with Cerebrospinal Fluid Flow Parameters in Patients with Chiari Malformation Type 1

Abstract

Objectives

Chiari malformation (CM) is a congenital condition characterized by herniating cerebellar tonsils (HCTs) into the spinal canal. Although mostly managed through posterior decompression surgery, there is a lack of consensus about the need for surgery in asymptomatic patients or those with mild clinical findings. This study aimed to evaluate cerebrospinal fluid (CSF) flow parameters in patients with CM type 1 (CM-1) and compare them with posterior cranial fossa (PCF) morphometric measurements to use these measurements for predicting disease progression.

Design

Retrospective analysis.

Setting

Department of Neurosurgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Health Sciences University Participants: Adult patients (n = 95; mean age = 40.8 ± 13.8 years; 76 females) diagnosed with CM-1 between January 2017 and October 2018.

Main Outcome Measures

Symptoms at presentation, CSF flow score, PCF morphometric measurements—measured using brain and spinal cord magnetic resonance imaging and computed tomography.

Results

Coughing headache, presence of additional pathology (syringomyelia), PCF volume and height, Boogard's angle, foramen magnum surface area, HCT length, and HCT surface area (HCTSA) were significant factors affecting CSF flow. Further, multivariate regression analysis revealed that the HCT length and HCTSA, the presence of additional pathology, and Boogard's angle were independent predictors of CSF flow scores.

Conclusion

The morphometric measures, HCT length, HCTSA, and Boogard's angle, and the presence of additional pathology are important predictive factors for reduced CSF flow at the craniovertebral junction in patients with CM-1. These factors can help clinicians predict the disease's clinical progression and plan surgical treatment.

Keywords

Boogard's angle - Chiari malformation - cerebrospinal fluid - coughing - headache

Ethical Approval

The Clinical Research Ethics Committee of Diskapi Yildirim Beyazit Training and Research Hospital approved ethically our retrospective examination (approval no.: 55/27; dated: October 15, 2018).

Informed Consent

Approval from the Institutional Review Board was obtained and in keeping with the policies for a retrospective review, informed consent was not required.

Data Availability Statement

Available with the author on request.

Author's Contribution

Study conception and design were carried out by SD, SH, and RO. Data collection was conducted by SD. Analysis and interpretation of the results were performed by SD and SH. The draft manuscript was prepared by SD, SH, RO, and AT, while SD and RO contributed to the critical revision of the article. All authors reviewed the results and approved the final version of the manuscript.

Publication History

Received: 22 January 2025

Accepted: 15 April 2025

Accepted Manuscript online:
17 April 2025

Article published online:
02 May 2025

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