Mon, Feb 3, 2025
Volume 3, Issue 2 (9-2017)
Iran J Neurosurg 2017, 3(2): 36-38 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Goel A. Chiari Formation: Atlantoaxial Instability is the Cause. Iran J Neurosurg 2017; 3 (2) :36-38
URL: http://irjns.org/article-1-96-en.html
URL: http://irjns.org/article-1-96-en.html
Department of Neurosurgery, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai – 400012, India , dratul@gmail.com
Abstract: (6100 Views)
The entity of Chiari formation was described by Hans Chiari in 1891 [1,2]. Since then the subject has been evaluated elaborately by a number of authors. However, it may only be correct to state that confusion in the understanding of pathogenesis and the nature of anomaly, significance of associated abnormal soft tissue and bone anomalies and more importantly the treatment of the entity has not been resolved. The number of described treatment patterns are a testimony to the inadequacy of the understanding. The general consensus is that uncal herniation and tonsillar herniation are both similar in their pathogenesis wherein the part of the temporal brain or the cerebellum are pushed out of their compartment through a hiatus or hole into the other body compartment. In the process of herniation, there is congestion of space and compromise of the neural structures in the vicinity that
leads to neurological symptoms or deficits. The factor that causes the push in case of Chiari malformation is unclear. However, the presence of an increased volume of cerebellar mass, a smaller volume of the posterior cranial fossa bone compartment or a combination of both these factors could be
the possible cause. The general understanding is that the addition of the tonsillar volume in the foramen magnum limits the space for the
neural structures that are compressed and results in related symptoms. Foramen magnum decompression is an established and a gold standard form of treatment.
leads to neurological symptoms or deficits. The factor that causes the push in case of Chiari malformation is unclear. However, the presence of an increased volume of cerebellar mass, a smaller volume of the posterior cranial fossa bone compartment or a combination of both these factors could be
the possible cause. The general understanding is that the addition of the tonsillar volume in the foramen magnum limits the space for the
neural structures that are compressed and results in related symptoms. Foramen magnum decompression is an established and a gold standard form of treatment.
Type of Study: Editorial |
References
1. Chiari H. Ueber Veranderungen des Kleinhirns, des Pons und der Medulla oblongata infolge von kongenitaler Hydrocephalie des Grosshirns. Denkschr Akad Wiss, Wien. 1895; 63:71-116.
2. Chiari H: Ueber Verinderungen des Kleinhirns infolge von Hydrocephalie des Grosshirns. Deulsch Med Wschr. 1981; 17(42):1172-5. [DOI:10.1055/s-0029-1206803]
3. Goel A, Bhatjiwale M, Desai K. Basilar invagination: a study based on 190 surgically treated patients. J Neurosurg. 1998; 88(6):962-8. [DOI:10.3171/jns.1998.88.6.0962] [PMID]
4. Goel A. Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine 2004;1:281-6. [DOI:10.3171/spi.2004.1.3.0281] [PMID]
5. Goel A. Is Chiari malformation nature's protective "air-bag"? Is its presence diagnostic of atlantoaxial instability? J Craniovertebr Junction Spine. 2014; 5(3):107-9. [DOI:10.4103/0974-8237.142302] [PMID] [PMCID]
6. Goel A. Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation. J Neurosurg Spine. 2015; 22(2):116-27. [DOI:10.3171/2014.10.SPINE14176] [PMID]
7. Goel A. Is Chiari a "formation" or a "malformation". J Craniovertebr Junction Spine. 2017; 8 (1): 1-2.
https://doi.org/10.4103/0974-8237.65474
https://doi.org/10.4103/0974-8237.121615
https://doi.org/10.4103/0974-8237.85306
https://doi.org/10.4103/0974-8237.199881
https://doi.org/10.4103/0974-8237.151575
https://doi.org/10.4103/0974-8237.176602
https://doi.org/10.4103/0974-8237.135205 [DOI:10.4103/0974-8237.110115]
8. Goel A: Goel's classification of atlantoaxial "facetal" dislocation. J Craniovertbr Junction Spine. 2014; 5 (1): 15-9.
https://doi.org/10.4103/0974-8237.135210
https://doi.org/10.4103/0974-8237.199878 [DOI:10.4103/0974-8237.135206]
9. Goel A. Central or axial atlantoaxial instability: Expanding understanding of craniovertebral junction. J Craniovertebr Junction Spine. 2016; 7(1): 1-3.
https://doi.org/10.4103/0974-8237.65474
https://doi.org/10.4103/0974-8237.121615
https://doi.org/10.4103/0974-8237.85306
https://doi.org/10.4103/0974-8237.199881
https://doi.org/10.4103/0974-8237.176602
https://doi.org/10.4103/0974-8237.151575
https://doi.org/10.4103/0974-8237.135205 [DOI:10.4103/0974-8237.110115]
10. Goel A, Shah A. Reversal of longstanding musculoskeletal changes in basilar invagination after surgical decompression and stabilization. J Neurosurg Spine. 2009; 10(3):220-7. [DOI:10.3171/2008.12.SPINE08499]
11. Goel A, Desai K, Muzumdar DP. Atlantoaxial fixation using plate and screw method: A report of 160 treated patients. Neurosurgery. 2002; 51(6): 1351-1357.
https://doi.org/10.1097/00006123-200212000-00004 [DOI:10.1227/01.NEU.0000309110.78968.F5]
12. Goel A, Laheri VK. Plate and screw fixation for atlanto-axial dislocation (Technical report). Acta Neurochir (Wien). 1994; 129: 47-53. [DOI:10.1007/BF01400872]
13. Goel A, Nadkarni T, Shah A, Sathe P, Patil M. Radiological evaluation of Basilar invagination without obvious atlantoaxial instability (Group B-basilar invagination): An analysis based on a study of 75 patients. World Neurosurg. 2016; 95: 375-382. [DOI:10.1016/j.wneu.2016.08.026]
14. Goel A, Sathe P, Shah A. Atlantoaxial fixation for Basilar invagination without obvious atlantoaxial instability (Group B-basilar invagination): Outcome analysis of 63 surgically treated cases. World Neurosurg. 2017; 99: 164-170. [DOI:10.1016/j.wneu.2016.11.093]
15. Goel A, Jain S, Shah A. Radiological evaluation of 510 cases of basilar invagination with evidence of atlantoaxial instability (Group A). World Neurosurg. In press 2017.
16. Goel A, Desai K, Bhatjiwale M, Muzumdar DP. Basilar invagination and Chiari malformation associated with cerebellar atrophy: report of two treated cases. J Clin Neurosciences. 2002; 9:194-196. [DOI:10.1054/jocn.2001.0958]
17. Goel A. Short neck, short head, short spine, and short body height – hallmarks of basilar invagination. J Craniovertebr Junction Spine 2017 Jul 1;8(3):165. DOI:10.4103/jcvjs.JCVJS_101_17. [DOI:10.4103/jcvjs.JCVJS_101_17]
Send email to the article author
| Rights and Permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Copyright © The Author(s);
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Contact Information
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Contact Information
