title: Posterior fossa volume increase after surgery for Chiari malformation Type I: a quantitative assessment using magnetic resonance imaging and correlations with the treatment response.
abstract: OBJECTIVE
  The aim of this paper was to measure the posterior fossa (PF) volume increase resulting from a given-sized occipital craniectomy in Chiari malformation Type I surgery and to analyze its correlations with the PF size and the treatment response, with the perspective of tailoring the amount of bone removal to the patient-specific PF dimensions.
  
  
  METHODS
  Between January 2005 and June 2006, 11 adult patients with symptomatic Chiari malformation Type I underwent a standardized PF decompression. A prospective evaluation with clinical examination, functional grading, and MR imaging measurement protocols was performed pre- and postoperatively. A method is reported for the measurement of PF volume (PFV) after surgery. The degree of PFV increase was compared with the preoperative size of the PF and with the clinical outcome.
  
  
  RESULTS
  All 11 patients improved postoperatively, with complete and partial recovery in 4 and 7 patients, respectively. No postoperative complication occurred after a mean follow-up period of 45 months. The mean relative increase in PFV accounted for 10% (range 1.5%-19.7%) of the initial PFV; the increase was greater in cases in which the PF was small (r = -0.52, p = 0.09) and the basiocciput was short (r = -0.37, p = 0.2). A statistically significant positive correlation was found between the degree of PFV increase and the treatment response (p = 0.014); complete recovery was observed with a PFV increase of 15% and partial recovery with an increase of 7%.
  
  
  CONCLUSIONS
  The treatment response is significantly influenced by the degree of PFV increase, which is dependent on the size of the PF and the extent of the craniectomy, suggesting that the optimal patient-specific PFV increase could be predicted on the basis of preoperative MR imaging and enhancing the perspective that the craniectomy size could be tailored to the individual PFV.
authors.affiliation: Department of Neurosurgery, Maison Blanche Hospital, University of Reims, France. remynoudel@yahoo.fr
authors.forename: Rémy
authors.initials: R
authors.lastname: Noudel
authors.forename: Philippe
authors.initials: P
authors.lastname: Gomis
authors.forename: Gustavo
authors.initials: G
authors.lastname: Sotoares
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bazin
authors.forename: Laurent
authors.initials: L
authors.lastname: Pierot
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Pruvo
authors.forename: Régis
authors.initials: R
authors.lastname: Bordet
authors.forename: Pierre-Hugues
authors.initials: PH
authors.lastname: Roche
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001139:Arnold-Chiari Malformation / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000473:pathology / Q000601:surgery*; D056424:Decompressive Craniectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013595:Syringomyelia / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome