University of Oulu

Jussila, MP., Nissilä, J., Vakkuri, M. et al. Preoperative measurements on MRI in Chiari 1 patients fail to predict outcome after decompressive surgery. Acta Neurochir 163, 2005–2014 (2021).

Preoperative measurements on MRI in Chiari 1 patients fail to predict outcome after decompressive surgery

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Author: Jussila, Miro-Pekka1; Nissilä, Juho1; Vakkuri, Minna2;
Organizations: 1Department of Diagnostic Radiology, Oulu University Hospital, Oulu and Research Unit of Medical Imaging, Physics, and Technology, Oulu University Hospital and University of Oulu, Kajaanintie 50, OYS, P.O. Box 50, 90029, Oulu, Finland
2Department of Neurosurgery, Oulu University Hospital, Oulu and Research Unit of Clinical Neuroscience, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
3Department of Children and Adolescents, Oulu University Hospital, Oulu and PEDEGO Research Unit, University of Oulu and Medical Research Center Oulu (MRC Oulu), Oulu, Finland
4Department of Neurosurgery, Kuopio University Hospital, Kuopio and Institute of Clinical Medicine-Neurosurgery, University of Eastern Finland, Kuopio, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Springer Nature, 2021
Publish Date: 2021-09-03


Background: The purpose of our study was to research the parameters of magnetic resonance imaging (MRI) that would predict the outcome of surgery in patients with Chiari 1 malformation (CM1) and to evaluate changes in MRI parameters after surgery.

Methods: Fifty-one patients (19 children, 13 adolescents, and 19 adults) operated on due to CM1 in Oulu University Hospital between 2004 and 2018 were evaluated. Seventeen parameters were measured from the preoperative MRI and 11 from the postoperative MRI. The correlations between the MRI parameters and the clinical variables before and after surgery were analyzed.

Results: The majority (88.2%) of the patients had favorable surgical outcomes. Postoperatively, subjective symptoms improved in 88.6% of the patients and syringomyelia in 81.8%. The location of the cerebellar tonsils, when measured in relation to the C2 synchondrosis or the end plate, postoperatively moved cranially in 51.0% (n = 26), did not change in 27.4% (n = 14), and moved caudally in 21.6% (n = 11) of the patients. However, neither the location of the tonsils nor any other parameters measured from pre- or postoperative MRI correlated with the patients’ symptoms or surgical outcomes.

Conclusions: No specific parameters on preoperative MRI evaluation were predictive of the outcome of surgery, emphasizing clinical examination in surgical decision-making. Furthermore, the postoperative MRI parameters did not correlate with the surgical outcomes. Thus, routine postoperative imaging is suggested only for patients with preoperatively diagnosed syringomyelia or worsening of symptoms.

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Series: Acta neurochirurgica
ISSN: 0001-6268
ISSN-E: 0942-0940
ISSN-L: 0001-6268
Volume: 163
Issue: 7
Pages: 2005 - 2014
DOI: 10.1007/s00701-021-04842-y
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3124 Neurology and psychiatry
Funding: Open access funding provided University of Oulu including Oulu University Hospital. MPJ received a research grant from the Radiological Society of Finland and the Arvo and Lea Ylppö Foundation for this study. The sponsors had no role in the design or conduct of this research.
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