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Jha DK, Gosal JS, Kumar R, Khera P. Delayed post-operative aggravation of sleep related disturbances in patients of basilar invagination with Chiari malformation: case report and review of the literature. Br J Neurosurg 2023; 37:1867-1871. [PMID: 34251945 DOI: 10.1080/02688697.2021.1947981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
Sleep apnoea is common in patients with Basilar Invagination with Arnorld Chiari Malformation (ACM). Various studies have shown its incidence in the range of 60-70% among such patients. Most of the studies have shown improvement in sleep disturbances after decompressive surgeries for Chiari Malformations. There is no report of postoperative deterioration due to sleep apnoea in these patients. Authors report two cases of basilar invagination associated with ACM and Platybasia, who deteriorated probably due to worsening of pre-existing sleep disorders on 3rd and 7th postoperative days after their surgeries, despite clinico-radiological improvements during their early post-operative courses. Authors discuss literature related to sleep apnoea in basilar invagination associated with Chiari Malformations and share precautions, which are relevant and should be undertaken in such patients especially during early post-operative periods to avoid alarming complication which may occur even in experienced hands.
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Affiliation(s)
- Deepak Kumar Jha
- Departments of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Jaskaran Singh Gosal
- Departments of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Rakesh Kumar
- Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Pushpinder Khera
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
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2
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Vagianou F, Khirani S, De Saint Denis T, Beccaria K, Amaddeo A, Breton S, James S, Paternoster G, Arnaud E, Zerah M, Fauroux B. Impact of sleep-disordered breathing on the management of children with Chiari malformation type I. Pediatr Pulmonol 2022; 57:2954-2962. [PMID: 35962649 DOI: 10.1002/ppul.26113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Children with Chiari malformation type I (CM-I) have an increased risk of sleep apnea. The aim of the study was to describe the management of CM-I patients in relation to symptoms, magnetic resonance imaging (MRI) findings and sleep apnea syndrome (SAS). METHODS We performed a retrospective analysis of clinical charts of all 57 CM-I patients seen between September 2013 and April 2017. RESULTS A total of 45 patients had isolated CM-I or associated co-morbidity (CM-Iia), 5 had craniosynostosis (CM-Ics), and 7 a polymalformative syndrome (CM-Ipm). The prevalence of SAS, defined as an apnea-hypopnea index >1 event/h, was high in CM-I ranging from 50% to 80% according to the CM-I group. The prevalence of central sleep apnea (CSA) was low, with 5 (9%) patients having CSA and only 3 patients with CM-Iia having isolated CSA. A total of 17 patients (30%) had foramen magnum decompression (FMD). Neither positive symptoms of CM-I nor MRI findings alone, nor both combined were good indicators for FMD. No correlation was observed between the cerebellar tonsil descent and SAS in CM-I. But all 5 patients with CSA had a FMD. The combination of MRI findings and/or symptoms of CM-I together with moderate-to-severe SAS best discriminated patients who needed a FMD. CONCLUSION Our findings highlight the importance of a combined evaluation of symptoms, MRI and polygraphy results in the management of CM-I patients.
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Affiliation(s)
- Foteini Vagianou
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,ASV Santé, Gennevilliers, France
| | - Timothée De Saint Denis
- Department of Pediatric Neurosurgery, Centre de référence Chiari, Syringomyélie et Malformations du Rachis et de la Moelle C-MAVEM, et Centre de référence des malformations craniofaciales-CRMR CRANIOST, AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, Centre de référence Chiari, Syringomyélie et Malformations du Rachis et de la Moelle C-MAVEM, et Centre de référence des malformations craniofaciales-CRMR CRANIOST, AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université Paris Cité, VIFASOM, Paris, France
| | - Sylvain Breton
- Department of Pediatric Radiology, AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Syril James
- Department of Pediatric Neurosurgery, Centre de référence Chiari, Syringomyélie et Malformations du Rachis et de la Moelle C-MAVEM, et Centre de référence des malformations craniofaciales-CRMR CRANIOST, AP-HP, Hôpital Necker-Enfants malades, Paris, France.,Clinique Marcel Sembat, Ramsay Générale de Santé, Boulogne Billancourt, France
| | - Giovanna Paternoster
- Department of Pediatric Neurosurgery, Centre de référence Chiari, Syringomyélie et Malformations du Rachis et de la Moelle C-MAVEM, et Centre de référence des malformations craniofaciales-CRMR CRANIOST, AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Eric Arnaud
- Department of Pediatric Neurosurgery, Centre de référence Chiari, Syringomyélie et Malformations du Rachis et de la Moelle C-MAVEM, et Centre de référence des malformations craniofaciales-CRMR CRANIOST, AP-HP, Hôpital Necker-Enfants malades, Paris, France.,Clinique Marcel Sembat, Ramsay Générale de Santé, Boulogne Billancourt, France
| | - Michel Zerah
- Department of Pediatric Neurosurgery, Centre de référence Chiari, Syringomyélie et Malformations du Rachis et de la Moelle C-MAVEM, et Centre de référence des malformations craniofaciales-CRMR CRANIOST, AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université Paris Cité, VIFASOM, Paris, France
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3
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Moore M, Fuell W, Jambhekar SK, Ocal E, Albert GW. Management of Sleep Apnea in Children with Chiari I Malformation: A Retrospective Study. Pediatr Neurosurg 2022; 57:175-183. [PMID: 35203083 DOI: 10.1159/000523779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/23/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The literature indicates that decompression of Chiari I malformations (CM-1) may resolve symptoms of sleep apnea. This study aims to identify the incidence of obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed sleep apnea in a cohort of pediatric CM-1 patients treated at our institution. We also assessed apnea-hypopnea index and symptomatology before and after surgery to investigate if Chiari decompression is a viable treatment for sleep apnea in CM-1 patients. Improvement relative to ENT surgical intervention was also considered. METHODS We identified 75 patients who underwent polysomnography (PSG) from our database of 465 CM-1 patients. Sleep apnea diagnosis was based on the sleep physician's overall interpretation of the PSG. Symptomatology pre- and post-surgery was analyzed. RESULTS Of the 75 CM-1 patients that underwent PSG, 23 were diagnosed with sleep apnea. Sixteen had OSA, 6 had CSA, and 1 had mixed apnea. Twelve OSA patients received ENT intervention. Eight improved and 2 further improved after Chiari decompression. Of the 4 patients that did not improve, one of those later improved following Chiari decompression. Of the 6 CSA patients, 2 underwent Chiari decompression, but only one improved. The mixed apnea patient underwent several ENT interventions that did not relieve symptoms but improved following Chiari decompression. DISCUSSION/CONCLUSIONS Based on our results, sleep apnea in CM-1 patients may be obstructive, central, or mixed and is likely multifactorial. A multidisciplinary approach to the management of these patients is important, including neurosurgery, otolaryngology, and sleep medicine. Future prospective studies will lend further insight into this condition and its management.
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Affiliation(s)
- Moira Moore
- Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas, USA,
| | - William Fuell
- Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Supriya K Jambhekar
- Sleep Medicine Service, Arkansas Children's Hospital, Little Rock, Arkansas, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Eylem Ocal
- Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas, USA.,Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Gregory W Albert
- Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas, USA.,Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Van Woensel J, Goeminne P, Valcke Y. A case of hypercapnic respiratory failure. Breathe (Sheff) 2021; 17:200217. [PMID: 34295389 PMCID: PMC8291935 DOI: 10.1183/20734735.0217-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022] Open
Abstract
A 55-year-old man was referred to the department of respiratory disease with a polycythaemia. Underlying haematological disease was already excluded. Blood results are shown in table 1. A systematicwork-up is important in case of hypercapnia. Pay attention to the shape of the flow–volume curve and any abnormal breathing sounds. In case of stridor, vocal cord paralysis should be suspected and, if confirmed, neurological investigations are advised.https://bit.ly/34APMi8
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Affiliation(s)
- Julie Van Woensel
- Dept of Pulmonology, Zuyderland Medical Center, Heerlen/Sittard, The Netherlands
| | - Pieter Goeminne
- Dept of pulmonology, AZ Nikolaas Hospital, Sint-Niklaas, Belgium
| | - Yvan Valcke
- Dept of pulmonology, AZ Nikolaas Hospital, Sint-Niklaas, Belgium
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Voutsas G, St-Laurent A, Hutchinson C, Amin R, Drake J, Narang I. The efficacy of neurosurgical intervention on sleep-disordered breathing in pediatric patients with Chiari malformation type I. J Neurosurg Pediatr 2021; 27:611-619. [PMID: 33892471 DOI: 10.3171/2020.11.peds20574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chiari malformation type I (CM-I) involves the herniation of the cerebellar tonsils through the foramen magnum. CM-I is associated with both obstructive sleep apnea (OSA) and central sleep apnea (CSA) in children. The primary management of symptomatic CM-I remains surgical decompression. There is, however, a paucity of data evaluating the efficacy of decompression surgery on outcomes related to sleep-disordered breathing (SDB). The objective of this study was to evaluate SDB outcomes, specifically the need for respiratory support following decompression in pediatric patients with CM-I. METHODS This was a retrospective chart review of all children diagnosed with CM-I when younger than 18 years of age who had polysomnography (PSG) studies pre- and postsurgery, between January 2008 and October 2018 at the Hospital for Sick Children in Toronto. Patient demographics, symptoms, PSG data, ongoing respiratory support, and surgical notes were recorded. Differences in PSG studies obtained pre- and postsurgery were compared using the Wilcoxon test for paired samples. RESULTS A total of 15 children with 15 interventions met inclusion criteria with pre- and postsurgery PSG studies and were considered for statistical analysis. Of the 15 subjects included for analysis, preoperative OSA was present in 2 (13.3%), CSA in 5 (33.3%), mixed SDB (both OSA and CSA) in 4 (26.7%), and no significant SDB in 4 (26.7%). Postoperatively, OSA was present in 3 (20.0%), CSA in 4 (26.7%), mixed SDB in 0 (0%), and no significant SDB in 8 (53.3%). The presence of severe OSA decreased from 4/15 (26.7%) to 2/15 (13.3%) postoperatively, and severe CSA decreased from 5/15 (33.3%) to 2/15 (13.3%) postoperatively. Following decompression surgery, 7/15 subjects (46.7%) required positive airway pressure for management of their SDB. Overall, significant improvements were observed in a number of respiratory parameters following decompression including the following: the total apnea-hypopnea index (AHI) (17.5 ± 48.2 vs 6.1 ± 32.7 events/hour; p = 0.001), obstructive AHI (2.1 ± 16.1 vs 1.0 ± 6.6 events/hour; p = 0.005), central AHI (6.3 ± 48.9 vs 2.7 ± 33.0 events/hour; p = 0.005), and the desaturation index (16.7 ± 49.6 vs 3.8 ± 25.3; p = 0.001). CONCLUSIONS Although decompression surgery led to a significant reduction in obstructive and central events, many children continued to have persistent SDB and required additional positive airway pressure therapy. This information is important and relevant for anticipatory guidance around decompression surgery and the necessity for respiratory support for the management of SDB in pediatric patients with CM-I.
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Affiliation(s)
- Giorge Voutsas
- 1Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario.,2University of Toronto, Ontario
| | | | - Crystal Hutchinson
- 1Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario
| | - Reshma Amin
- 2University of Toronto, Ontario.,4Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario; and
| | - James Drake
- 2University of Toronto, Ontario.,5Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Indra Narang
- 1Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario.,2University of Toronto, Ontario.,4Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario; and
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Amirifard H, Sadeghniiat-Haghighi K, Najafi A. Treatment emergent obstructive sleep apnea after Chiari surgery: A case report. SLEEP SCIENCE (SAO PAULO, BRAZIL) 2020; 13:176-180. [PMID: 32742590 PMCID: PMC7384529 DOI: 10.5935/1984-0063.20190140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients with Chiari type I malformation may also present with sleep disordered breathing mainly central sleep apnea. Here, we report a patient with Chiari I malformation referred to our clinic because of snoring and sleep disordered breathing. He was a 28-year-old man referred to us for evaluation of snoring. An overnight polysomnography revealed central sleep apnea. On further evaluation of central sleep apnea, the patient found to have Chiari malformation type I on brain MRI. The patient developed obstructive sleep apnea after surgery for Chiari malformation. Accordingly, pap titration was performed for the patient's obstructive sleep apnea. In patients with central sleep apnea comprehensive evaluation of predisposing causes is required. Lesions of central nervous system including Chiari malformation should not be overlooked. Furthermore, after treatment of central sleep apnea follow up PSG is warranted to confirm newly emerged sleep breathing disorder such as obstructive sleep apnea.
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Affiliation(s)
- Hamed Amirifard
- Tehran University of Medical Sciences, Occupational Sleep Research Center, Baharloo Hospital - Tehran - Iran
| | - Khosro Sadeghniiat-Haghighi
- Tehran University of Medical Sciences, Occupational Sleep Research Center, Baharloo Hospital - Tehran - Iran
| | - Arezu Najafi
- Tehran University of Medical Sciences, Occupational Sleep Research Center, Baharloo Hospital - Tehran - Iran
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7
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Herkenrath S, Randerath W. Zentrale Schlafapnoe bei Chiari-Malformation Typ I. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Role of sleep study in children with Chiari malformation and sleep disordered breathing. Childs Nerv Syst 2019; 35:1763-1768. [PMID: 31372737 DOI: 10.1007/s00381-019-04302-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Chiari malformation incorporate numerous forms of congenital or acquired cerebellar herniation through the foramen magnum. This may lead to brain stem, high spinal cord and cranial nerve compression resulting in obstructive and central apneas. This review highlights he high prevalence of sleep-disordered breathing in this population and the importance of refering these patients for sleep studies as part of their workup. METHODS A review of the literature was performed through a PubMed and EMBASE search of original articles and reviews using the key words "chiari" "chiari malformation" "hindbrain herniation" "sleep disordered breathing" "obstructive sleep apnea" "central sleep apnea" "sleep study" and "foramen magnum decompression". DISCUSSION We highlight the pathophysiology of sleep disordered breathing in patients with Chiari malformation, how it can be diagnosed and what the treatment options are. CONCLUSIONS Sleep-disordered breathing is highly prevalent in patients with CM1. Clinicians caring for these patients should be aware of this and prioritise sleep diagnostic testing to allow for early diagnosis and management particularly in the presence of neurological symptoms and specific brain MRI pointers.
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9
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Brito JNPDO, dos Santos BA, Nascimento IF, Martins LA, Tavares CB. Basilar invagination associated with chiari malformation type I: A literature review. Clinics (Sao Paulo) 2019; 74:e653. [PMID: 30970117 PMCID: PMC6448527 DOI: 10.6061/clinics/2019/e653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/23/2018] [Indexed: 11/27/2022] Open
Abstract
Basilar invagination (BI) and Chiari malformation type I (CM-I) are very important anomalies that introduce instability and compression in the occipitocervical transition region and have complex clinical characteristics. These anomalies vary according to the affected structures. The present study revises current knowledge regarding the anatomy, anatomo-physiology, clinical manifestations, and radiological findings of these entities and the associated surgical treatment approaches. A bibliographic survey was performed through a search in the Medline, PubMed, SciELO, Science and LILACS databases. When associated, these craniovertebral malformations result in neurological deficits due to neural parenchyma compression; however, the presence of microtraumas due to repetitive lesions caused by the bulb and cervical marrow instability has been highlighted as a determinant dysfunction. Surgical treatment is controversial and has many technical variations. Surgery is also challenging due to the complex anatomical characteristics and biomechanics of this region. Nevertheless, advances have been achieved in our understanding of related mechanisms, and compression and atlantoaxial instability are considered key elements when selecting the surgical approach.
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Affiliation(s)
- José Nazareno Pearce de Oliveira Brito
- Departamento de Neurologia e Neurocirurgia, Faculdade de Ciencias Medicas (FACIME), Universidade Estadual do Piaui, Teresina, PI, BR
- Centro Universitário UNINOVAFAPI, Teresina. PI, BR
- Hospital Sao Marcos, Teresina, PI, BR
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Ferré Á, Poca MA, de la Calzada MD, Moncho D, Urbizu A, Romero O, Sampol G, Sahuquillo J. A Conditional Inference Tree Model for Predicting Sleep-Related Breathing Disorders in Patients With Chiari Malformation Type 1: Description and External Validation. J Clin Sleep Med 2019; 15:89-99. [PMID: 30621833 DOI: 10.5664/jcsm.7578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 09/13/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim of this study is to generate and validate supervised machine learning algorithms to detect patients with Chiari malformation (CM) 1 or 1.5 at high risk of the development of sleep-related breathing disorders (SRBD) using clinical and neuroradiological parameters. METHODS We prospectively included two independent datasets. A training dataset (n = 90) was used to obtain the best model, whereas a second dataset was used to validate it (n = 74). In both cohorts, the same clinical, neuroradiological, and sleep studies were carried out. We used two supervised machine learning approaches, multiple logistic regression (MLR) and the unbiased recursive partitioning technique conditional inference tree (URP-CTREE), to detect patients at high risk of SRBD. We then compared the accuracy, sensitivity, and specificity of the two prediction models. RESULTS Age (odds ratio [OR] 1.1 95% confidence interval [CI] 1.05-1.17), sex (OR 0.19 95% CI 0.05-0.67), CM type (OR 4.36 95% CI 1.14-18.5), and clivus length (OR 1.14 95% CI 1.01-1.31) were the significant predictor variables for a respiratory disturbance index (RDI) cutoff that was ≥ 10 events/h using MLR. The URP-CTREE model predicted that patients with CM-1 who were age 52 years or older and males with CM-1 who were older than 29 years had a high risk of SRBD. The accuracy of predicting patients with an RDI ≥ 10 events/h was similar in the two cohorts but in the URP-CTREE model, specificity was significantly greater when compared to MLR in both study groups. CONCLUSIONS Both MLR and URP-CTREE predictive models are useful for the diagnosis of SRBD in patients with CM. However, URP-CTREE is easier to apply and interpret in clinical practice.
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Affiliation(s)
- Álex Ferré
- Clinical Neurophysiology Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.,Multidisciplinary Sleep Unit, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.,Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Barcelona, Spain
| | - María A Poca
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Barcelona, Spain.,Neurosurgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - María Dolore de la Calzada
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dulce Moncho
- Clinical Neurophysiology Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.,Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Aintzane Urbizu
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Ohio
| | - Odile Romero
- Clinical Neurophysiology Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.,Multidisciplinary Sleep Unit, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Madrid, Spain
| | - Gabriel Sampol
- Multidisciplinary Sleep Unit, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Madrid, Spain.,Pneumology Department, Vall d'Hebron Research institute, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Juan Sahuquillo
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Barcelona, Spain.,Neurosurgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
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11
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The effect of posterior fossa decompression in adult Chiari malformation and basilar invagination: a systematic review and meta-analysis. Neurosurg Rev 2017; 41:311-321. [DOI: 10.1007/s10143-017-0857-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/15/2017] [Accepted: 04/13/2017] [Indexed: 02/06/2023]
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12
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Ferré Á, Poca MA, de la Calzada MD, Moncho D, Romero O, Sampol G, Sahuquillo J. Sleep-Related Breathing Disorders in Chiari Malformation Type 1: A Prospective Study of 90 Patients. Sleep 2017; 40:3766874. [DOI: 10.1093/sleep/zsx069] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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14
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Pomeraniec IJ, Ksendzovsky A, Yu PL, Jane JA. Surgical History of Sleep Apnea in Pediatric Patients with Chiari Type 1 Malformation. Neurosurg Clin N Am 2015; 26:543-53. [PMID: 26408064 DOI: 10.1016/j.nec.2015.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sleep apnea represents a relative indication for posterior fossa decompression in pediatric patients with Chiari malformation type 1. Duraplasty was associated with improvement of sleep apnea in 100% of patients and dural splitting with improvement in 50% of patients. Duraplasty and dural splitting were associated with a similar reduction in tonsillar herniation on radiographic imaging of 58% (37% excluding tonsillectomy) and 35%, respectively. Longitudinal follow-up studies of patients with either neurologic deficits or severe symptoms will further elucidate the natural history of Chiari malformation type 1 and more appropriately gauge the risk-benefit tradeoff of surgical intervention.
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Affiliation(s)
- Isaac Jonathan Pomeraniec
- Department of Neurological Surgery, University of Virginia Health Science Center, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Alexander Ksendzovsky
- Department of Neurological Surgery, University of Virginia Health Science Center, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Pearl L Yu
- Department of Neurological Surgery, University of Virginia Health Science Center, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - John A Jane
- Department of Neurological Surgery, University of Virginia Health Science Center, 1215 Lee Street, Charlottesville, VA 22908, USA.
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15
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Guerreiro RB, Bittencourt L, Reis RC, Rotta JM, Tufik S, Botelho RV. Upper airway dimensions in patients with craniocervical junction malformations with and without sleep apnea. A pilot case-control study. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:336-41. [PMID: 25992525 DOI: 10.1590/0004-282x20150008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 12/19/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with craniocervical junction malformations (CCJM) tend to suffer more frequently from sleep respiratory disturbances, which are more frequent and severe in patients with basilar invagination. Here we evaluate if patients with CCJM and sleep respiratory disorders (SRD) present smaller airway dimensions than patients without SRD. METHOD Patients with CCCM with and without sleep respiratory disturbances were evaluated clinically by Bindal's score, modified Mallampati classification, full-night polysomnography and upper airway cone beam tomography. RESULTS Eleven patients had sleep respiratory disorders (SRD), and nine patients performed control group without SRD. CCJM patients with SRD were predominantly female, older, had higher BMI, were more likely to have Mallampati grades 3 and 4 and had statistically significant smaller anteroposterior diameter of the upper airway than patients without SRD. CONCLUSION Patients with CCJM and sleep respiratory disturbances have higher BMI, higher Mallampati score and smaller anterior posterior diameter of the upper airway.
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Affiliation(s)
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - José Marcus Rotta
- Departamento de Neurocirurgia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Sérgio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Vale JMD, Silva E, Pereira IG, Marques C, Sanchez-Serrano A, Torres AS. Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation. J Bras Pneumol 2015; 40:574-8. [PMID: 25410846 PMCID: PMC4263339 DOI: 10.1590/s1806-37132014000500014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/20/2013] [Indexed: 12/03/2022] Open
Abstract
The Chiari malformation type I (CM-I) has been associated with sleep-disordered
breathing, especially central sleep apnea syndrome. We report the case of a
44-year-old female with CM-I who was referred to our sleep laboratory for suspected
sleep apnea. The patient had undergone decompressive surgery 3 years prior. An
arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory
disturbance index of 108 events/h, and all were central apnea events. Treatment with
adaptive servo-ventilation was initiated, and central apnea was resolved. This report
demonstrates the efficacy of servo-ventilation in the treatment of central sleep
apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a
history of decompressive surgery.
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The association between sleep-disordered breathing and magnetic resonance imaging findings in a pediatric cohort with Chiari 1 malformation. Can Respir J 2014; 22:31-6. [PMID: 25379655 DOI: 10.1155/2015/831569] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The prevalence of sleep-disordered breathing (SDB) reported in the literature for Chiari malformation type 1 (CM1) is uniformly high (24% to 70%). In Canada, there is limited access to pediatric polysomnography (PSG). Therefore, the identification of clinical features would be invaluable for triaging these children. OBJECTIVE To identify demographic features, clinical symptoms/signs and radiological findings associated with SDB in a large pediatric cohort with CM1. METHODS A retrospective review was conducted on children with CM1 who underwent baseline PSG. Data were collected on patient demographics (age, sex, weight, height, body mass index), clinical symptoms (chart review and clinical questionnaires), diagnostic imaging of the brain and cervicothoracic spine, and medical history at the time of referral. RESULTS A total of 68 children were included in the review. The mean (± SD) age of the children at the time of PSG was 7.33 ± 4.01 years; 56% (n=38) were male. There was a 49% prevalence of SDB in this cohort based on the overall apnea-hypopnea index. Obstructive sleep apnea was the predominant type of SDB. Tonsillar herniation was significantly correlated with obstructive apnea-hypopnea index (r=0.24; P=0.036). CONCLUSIONS A direct relationship between the degree of cerebellar tonsillar herniation and obstructive sleep apnea was demonstrated. However, further prospective studies that include neurophysiological assessment are needed to further translate the central nervous system imaging findings to predict the presence of SDB.
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St Louis EK, Jinnur P, McCarter SJ, Duwell EJ, Benarroch EE, Kantarci K, Pichelmann MA, Silber MH, Boeve BF, Olson EJ, Morgenthaler TI, Somers VK. Chiari 1 Malformation Presenting as Central Sleep Apnea during Pregnancy: A Case Report, Treatment Considerations, and Review of the Literature. Front Neurol 2014; 5:195. [PMID: 25386156 PMCID: PMC4208407 DOI: 10.3389/fneur.2014.00195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 09/16/2014] [Indexed: 12/05/2022] Open
Abstract
Purpose: Chiari malformation (CM) type-1 frequently causes obstructive or central sleep-disordered breathing (SDB) in both adults and children, although SDB is relatively rare as a presenting manifestation in the absence of other neurological symptoms. The definitive treatment of symptomatic CM is surgical decompression. We report a case that is, to our knowledge, a novel manifestation of central sleep apnea (CSA) due to CM type-1 with severe exacerbation and initial clinical presentation during pregnancy. Methods: Case report from tertiary care comprehensive sleep medicine center with literature review of SDB manifestations associated with CM type-1. PubMed search was conducted between January 1982 and October 2013. Results: We report a 25-year-old woman with severe CSA initially presenting during her first pregnancy that eventually proved to be caused by CM type-1. The patient was successfully treated preoperatively by adaptive servoventilation (ASV), with effective resolution of SDB following surgical decompression, and without recurrence in a subsequent pregnancy. Our literature review found that 58% of CM patients with SDB had OSA alone, 28% had CSA alone, 8 (10%) had mixed OSA/CSA, and 6 (8%) had hypoventilation. Of CM patients presenting with SDB, 50% had OSA, 42% had CSA, 8% had mixed OSA/CSA, and 10.4% had hypoventilation. We speculate that CSA may develop in CM patients in whom brainstem compression results in excessive central chemoreflex sensitivity with consequent hypocapnic CSA. Conclusion: Chiari malformation type-1 may present with a diversity of SDB manifestations, and timely recognition and surgical referral are necessary to prevent further neurological deficits. ASV therapy can effectively manage CSA caused by CM type-1, which may initially present during pregnancy.
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Affiliation(s)
- Erik K St Louis
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Section of Sleep Neurology, Mayo Clinic , Rochester, MN , USA ; Department of Neurology, Mayo Clinic , Rochester, MN , USA ; Department of Medicine, Mayo Clinic , Rochester, MN , USA ; Sleep Clinical Research Unit Laboratory, Mayo Clinic Hospital, Mayo Clinic , Rochester, MN , USA
| | - Praveen Jinnur
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Department of Medicine, Mayo Clinic , Rochester, MN , USA
| | - Stuart J McCarter
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Department of Neurology, Mayo Clinic , Rochester, MN , USA ; Department of Medicine, Mayo Clinic , Rochester, MN , USA ; Sleep Clinical Research Unit Laboratory, Mayo Clinic Hospital, Mayo Clinic , Rochester, MN , USA
| | - Ethan J Duwell
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Department of Neurology, Mayo Clinic , Rochester, MN , USA ; Department of Medicine, Mayo Clinic , Rochester, MN , USA ; Sleep Clinical Research Unit Laboratory, Mayo Clinic Hospital, Mayo Clinic , Rochester, MN , USA
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic , Rochester, MN , USA
| | | | - Michael H Silber
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Section of Sleep Neurology, Mayo Clinic , Rochester, MN , USA ; Department of Neurology, Mayo Clinic , Rochester, MN , USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Section of Sleep Neurology, Mayo Clinic , Rochester, MN , USA ; Department of Neurology, Mayo Clinic , Rochester, MN , USA
| | - Eric J Olson
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Department of Medicine, Mayo Clinic , Rochester, MN , USA
| | - Timothy I Morgenthaler
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN , USA ; Department of Medicine, Mayo Clinic , Rochester, MN , USA
| | - Virend K Somers
- Department of Medicine, Mayo Clinic , Rochester, MN , USA ; Sleep Clinical Research Unit Laboratory, Mayo Clinic Hospital, Mayo Clinic , Rochester, MN , USA
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19
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Mangubat EZ, Wilson T, Mitchell BA, Byrne RW. Chiari I malformation associated with atlanto-occipital assimilation presenting as orthopnea and cough syncope: a case report and review of literature. J Neurol Surg Rep 2014; 75:e1-4. [PMID: 25083365 PMCID: PMC4110142 DOI: 10.1055/s-0033-1348953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 04/13/2013] [Indexed: 12/03/2022] Open
Abstract
Although it is not uncommon for patients with Chiari I malformations to present with respiratory complaints, cough syncope is a rare presenting symptom. We report an adult patient who harbored both a Chiari I malformation and atlanto-occipital assimilation who complained of cough syncope, orthopnea, and central sleep apnea. The patient underwent decompressive craniectomy of the posterior fossa and cervical level 2 laminectomy. However, due to a possible initial underappreciation of the profound narrowing of the foramen magnum as a result of these concomitant pathologies, the patient may have had continued impaired cerebrospinal fluid flow, leading to a symptomatic pseudomeningocele and requiring a more extensive decompression that included a cervical level 3 laminectomy as well as a temporary lumbar drain. On 2-year follow-up, he has remained asymptomatic.
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Affiliation(s)
- Erwin Zeta Mangubat
- Department of Neurosurgery, Rush Professional Office Building, Chicago, Illinois, United States
| | - Tom Wilson
- Department of Neurosurgery, Rush Professional Office Building, Chicago, Illinois, United States
| | - Brian A. Mitchell
- Department of Neurosurgery, Rush Professional Office Building, Chicago, Illinois, United States
| | - Richard W. Byrne
- Department of Neurosurgery, Rush Professional Office Building, Chicago, Illinois, United States
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20
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Roohi F, Gropen T, Kula RW. Sudden unexpected nocturnal death in Chiari type 1 malformation and potential role of opioid analgesics. Surg Neurol Int 2014; 5:17. [PMID: 24778905 PMCID: PMC3994690 DOI: 10.4103/2152-7806.126931] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/23/2013] [Indexed: 11/17/2022] Open
Abstract
Background: Chiari malformation type 1 (CM1) is a common congenital anomaly of the craniocervical junction. CM1 is reported to run a usually benign course and patients typically experience no symptoms or chronic, slowly progressive symptoms. However, recent reports indicate that a subset of patients with CM1 may present with acute deterioration and sudden unexpected death (SUD). We report a case of SUD during sleep in a young man with CM1, which we believe was related to the administration of common and therapeutic doses of narcotic analgesics for the management of pain. We will clarify the pathophysiology of acute deterioration and SUD in CM1 and the possibility that the adverse effects of opiate analgesics likely were the leading cause of death in our patient. Case Description: In this review, we present a 29-year-old male with worsening headache secondary to previously diagnosed CM1. The patient died suddenly and unexpectedly after administration of common and therapeutic doses of narcotic analgesics for the management of pain. Conclusion: The mechanism(s) of acute neurological deterioration and sudden death in patients with CM1 remains poorly understood. We believe the rapid fatal deterioration in our patient following administration of opioids suggests that this category of medication may cause sudden unexpected “neurogenic” cardiac death in CM1 patients by inducing sleep-related breathing difficulties and associated hypercapnia. Hypercapnia by further increasing intracranial pressure can result in a sudden pressure-induced decompensation of the cardiopulmonary control centers in the brain stem and cause instantaneous cardiorespiratory arrest.
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Affiliation(s)
- Fereydoon Roohi
- State University of New York. Down State Medical Center. 339 Hicks Street, Brooklyn, NY 11201, USA
| | - Toby Gropen
- State University of New York. Down State Medical Center. 339 Hicks Street, Brooklyn, NY 11201, USA
| | - Roger W Kula
- The Chiari Institute, North Shore-Long Island Jewish Heath System. 611 Northern Boulevard, Suite 150, Great Neck, NY 11021, USA
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21
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Chiari I malformation associated with atlanto-occipital assimilation presenting as orthopnea and cough syncope. J Clin Neurosci 2014; 21:320-3. [DOI: 10.1016/j.jocn.2013.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 03/10/2013] [Indexed: 11/20/2022]
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22
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Lee A, Chen ML, Abeshaus S, Poliakov A, Ojemann JG. Posterior fossa tumors and their impact on sleep and ventilatory control: A clinical perspective. Respir Physiol Neurobiol 2013; 189:261-71. [DOI: 10.1016/j.resp.2013.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/23/2013] [Accepted: 05/22/2013] [Indexed: 11/28/2022]
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23
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Silva JAGD, Santos Jr. AAD, Costa MDDLD, Almeida EBD. Suboccipital craniectomy with opening of the fourth ventricle and duraplasty: study of 192 cases of craniovertebral malformations. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:609-14. [DOI: 10.1590/0004-282x20130105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Indexed: 11/22/2022]
Abstract
The prime objective in the surgical treatment of basilar impression (BI), Chiari malformation (CM), and/or syringomyelia (SM) is based on restoration of the normal cerebrospinal fluid (CSF) dynamics at the craniovertebral junction and creation of a large artificial cisterna magna, avoiding the caudal migration of the hindbrain. It is observed that a large craniectomy might facilitate an upward migration of the posterior fossa structures. There are many surgical techniques to decompress the posterior fossa; however, a gold standard approach remains unclear. The authors present the results of 192 cases of BI, CM, and SM treated between 1975 and 2008 and whose surgical treatment was characterized by a large craniectomy without tonsillectomy with the patient in the sitting position, large opening of the fourth ventricle, and duraplasty.
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Khatwa U, Ramgopal S, Mylavarapu A, Prabhu SP, Smith E, Proctor M, Scott M, Pai V, Zarowski M, Kothare SV. MRI findings and sleep apnea in children with Chiari I malformation. Pediatr Neurol 2013; 48:299-307. [PMID: 23498564 DOI: 10.1016/j.pediatrneurol.2012.12.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 12/17/2012] [Indexed: 02/06/2023]
Abstract
Chiari I malformation is characterized by downward herniation of the cerebellar tonsils through the foramen magnum. Scant data are available on the clinical course, relationship to the extent of herniation on magnetic resonance imaging in Chiari I malformation and the presence of sleep-disordered breathing on polysomnography. Retrospective analysis was performed looking at polysomnographic findings of children diagnosed with Chiari I malformation. Details on how Chiari I malformation was diagnosed, brainstem magnetic resonance imaging findings, and indications for obtaining the polysomnogram in these patients were reviewed. We also reviewed available data on children who had decompression surgery followed by postoperative polysomnography findings. Twenty-two children were identified in our study (11 males, median age 10 years, range 1 to 18). Three had central sleep apnea, five had obstructive sleep apnea, and one had both obstructive and central sleep apnea. Children with sleep-disordered breathing had excessive crowding of the brainstem structures at the foramen magnum and were more likely to have a greater length of herniation compared with those children without sleep-disordered breathing (P = 0.046). Patients with central sleep apneas received surgical decompression, and their conditions were significantly improved on follow-up polysomnography. These data suggest that imaging parameters may correlate with the presence of sleep-disordered breathing in children with Chiari I malformation.
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Affiliation(s)
- Umakanth Khatwa
- Division of Respiratory Disease, Department of Pediatric Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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25
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Driessen C, Joosten KFM, Florisson JMG, Lequin M, van Veelen MLC, Dammers R, Bredero-Boelhouwer H, Tasker RC, Mathijssen IMJ. Sleep apnoea in syndromic craniosynostosis occurs independent of hindbrain herniation. Childs Nerv Syst 2013; 29:289-96. [PMID: 23007866 DOI: 10.1007/s00381-012-1922-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 09/05/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Hindbrain herniation (HH) is frequently found in syndromic craniosynostosis. It may cause impairment of the respiratory centres and manifest as sleep-disordered breathing. Our aim was to quantify sleep apnoea caused by HH in children with syndromic craniosynostosis. METHODS Seventy-one children with syndromic and complex craniosynostosis (aged 0-18 years) underwent prospective magnetic resonance imaging and a sleep study. The position of the cerebellar tonsils and respiratory parameters were evaluated and analysed. None of the included patients had undergone previous foramen magnum decompression. RESULTS HH was present in 35% of the patients and was more frequent in children with Crouzon syndrome (63%) than in other types of craniosynostosis (p = .018). There was a positive association between the position of the cerebellar tonsils and papilledema (p = .002). Sleep studies of children with craniosynostosis and HH were not different from those without HH. Obstructive sleep apnoea syndrome was not more prevalent in children with HH compared to those without HH (p = .12). A cluster analysis using indices of apnoea revealed that three new clusters between which age was significantly different (p = .025). CONCLUSION Sleep apnoea in syndromic craniosynostosis is not caused by HH. Rather, our evidence suggests that sleep-disordered breathing in craniosynostosis may be caused by brain stem immaturity in young children or upper airway obstruction. Therefore, as long as the child remains asymptomatic, our preferred management of HH is to be conservative and provide regular neurosurgical follow-up.
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Affiliation(s)
- Caroline Driessen
- Department of Plastic, Reconstructive and Hand Surgery, Dutch Craniofacial Centre, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands.
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26
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Udayakumaran S. Rare manifestation of a craniovertebral junction anomaly: is blue breath holding always benign? Pediatr Neurosurg 2013; 49:297-9. [PMID: 25170990 DOI: 10.1159/000365763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/05/2014] [Indexed: 11/19/2022]
Abstract
Breath-holding or reflex anoxic seizures predominantly occur in preschool children and usually resolve by late childhood, rarely persisting through adolescence and into adulthood. Investigations are generally unnecessary. Education and reassurance is the mainstay of management. In this report, the author describes a case in which an infant presented with breath-holding spells due to a significant craniovertebral anomaly, and underwent a C1-C2 posterior stabilization. Following the stabilization of his dislocation the breath-holding spells never reappeared. Authors have previously described a rare manifestation of craniovertebral junction anomaly. Additionally, it is important to recognize that in a subset of patients breath-holding spells may be hazardous and not benign.
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Affiliation(s)
- Suhas Udayakumaran
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
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27
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28
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Kalb S, Perez-Orribo L, Mahan M, Theodore N, Nakaji P, Bristol RE. Evaluation of operative procedures for symptomatic outcome after decompression surgery for Chiari type I malformation. J Clin Neurosci 2012; 19:1268-72. [DOI: 10.1016/j.jocn.2012.01.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 01/19/2012] [Accepted: 01/21/2012] [Indexed: 01/20/2023]
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29
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da Silva JAG, dos Santos AA, Melo LRS, de Araújo AF, Regueira GP. Posterior fossa decompression with tonsillectomy in 104 cases of basilar impression, Chiari malformation and/or syringomyelia. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 69:817-23. [PMID: 22042188 DOI: 10.1590/s0004-282x2011000600018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 05/27/2011] [Indexed: 11/22/2022]
Abstract
The prime objective in the surgical treatment of basilar impression (BI), Chiari malformation (CM) and/or syringomyelia (SM) is based on the restoration of the normal cerebrospinal fluid (CSF) dynamics at the craniovertebral junction through the creation of a large artificial cisterna magna. A small suboccipital craniectomy has been emphasized to avoid caudal migration of the hindbrain structures into the vertebral canal. Nevertheless, the results showed downward migration of the hindbrain related to that type of craniectomy. The authors present, otherwise, the results of 104 cases of BI, CM and/or SM, whose surgical treatment was characterized by a large craniectomy with the patient in the sitting position, tonsillectomy, large opening of the fourth ventricle and duraplasty with creation of a large artificial cisterna magna. A significant upward migration of the posterior fossa structures was detected by postoperative magnetic resonance imaging.
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30
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Abstract
Chiari malformation type I (CMI) is a morphological diagnosis defined as the inferior displacement of the cerebellum through the foramen magnum. In parallel to this basic definition of CMI, there are diagnoses that co-exist with CMI in selected patients. In addition, there are specific constellations of clinical symptoms and signs reported in the literature that occur non-randomly in patients affected by CMI. There is no established system that categorizes these CMI-related conditions or even defines them as causes or consequences of CMI. Identifying the relationship between CMI and these associated disorders may allow greater understanding of CMI etiology and potentially inform CMI management.
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Affiliation(s)
- Ruth-Mary deSouza
- Department of Surgery, University Hospital, Coventry and Warwickshire, UK
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31
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Avellaneda Fernández A, Isla Guerrero A, Izquierdo Martínez M, Amado Vázquez ME, Barrón Fernández J, Chesa i Octavio E, De la Cruz Labrado J, Escribano Silva M, Fernández de Gamboa Fernández de Araoz M, García-Ramos R, García Ribes M, Gómez C, Insausti Valdivia J, Navarro Valbuena R, Ramón JR. Malformations of the craniocervical junction (Chiari type I and syringomyelia: classification, diagnosis and treatment). BMC Musculoskelet Disord 2009; 10 Suppl 1:S1. [PMID: 20018097 PMCID: PMC2796052 DOI: 10.1186/1471-2474-10-s1-s1] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chiari disease (or malformation) is in general a congenital condition characterized by an anatomic defect of the base of the skull, in which the cerebellum and brain stem herniate through the foramen magnum into the cervical spinal canal. The onset of Chiari syndrome symptoms usually occurs in the second or third decade (age 25 to 45 years). Symptoms may vary between periods of exacerbation and remission. The diagnosis of Chiari type I malformation in patients with or without symptoms is established with neuroimaging techniques. The most effective therapy for patients with Chiari type I malformation/syringomyelia is surgical decompression of the foramen magnum, however there are non-surgical therapy to relieve neuropathic pain: either pharmacological and non-pharmacological. Pharmacological therapy use drugs that act on different components of pain. Non-pharmacological therapies are primarily based on spinal or peripheral electrical stimulation. It is important to determine the needs of the patients in terms of health-care, social, educational, occupational, and relationship issues, in addition to those derived from information aspects, particularly at onset of symptoms. Currently, there is no consensus among the specialists regarding the etiology of the disease or how to approach, monitor, follow-up, and treat the condition. It is necessary that the physicians involved in the care of people with this condition comprehensively approach the management and follow-up of the patients, and that they organize interdisciplinary teams including all the professionals that can help to increase the quality of life of patients.
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Affiliation(s)
- Alfredo Avellaneda Fernández
- Carlos III Health Institute. Sinesio Delgado n. 6 (pavilion 12), 28029, Madrid, Spain
- Spanish Society of Primary Care. c/ Narváez, 15 1º Izda 28009, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Carmen Gómez
- Spanish Society of Medical-Physical Rehabilitation of Madrid, Spain
| | | | | | - José R Ramón
- Carlos III Health Institute. Sinesio Delgado n. 6 (pavilion 12), 28029, Madrid, Spain
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