Chiari malformation in nonsyndromal single craniosynostosis--much ado about nothing?
BACKGROUND
The significance of Chiari malformation in nonsyndromal-isolated craniosynostosis is still not well documented. Hence, in the present study we investigated the incidence of Chiari malformation in a larger series of patients with nonsyndromic-isolated single-suture craniosynostosis over a 9-year period using preoperative magnetic resonance imaging (MRI).


METHODS
Of 215 children who had undergone surgery for nonsyndromic-isolated craniosynostosis, 89 cases (41.4 %) had MRI prior to surgery. All MRIs were screened for Chiari malformation.


RESULTS
Only one patient (1.1 %) with isolated lambdoid synostosis showed Chiari malformation preoperatively, which was defined as a cerebellar tonsillar descent greater than 5 mm below the foramen magnum. However, no clinical symptoms were associated with Chiari malformation in this patient.


CONCLUSIONS
As Chiari malformation is more likely to be associated with syndromic craniosynostosis, nonsyndromic bilateral coronal synostosis, or synostosis of the lambdoid suture, a general use of MRI as a screening tool for Chiari malformation should not be recommended for patients with nonsyndromic-isolated craniosynostosis who lack clinical symptoms.
Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. michael.engel@med.uni-heidelberg.de
M
M
Engel
G
G
Castrillón-Oberndorfer
J
J
Hoffmann
B
B
Orakcioglu
S
S
Rohde
R
R
Seeberger
C
C
Freudlsperger
D001139:Arnold-Chiari Malformation / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003398:Craniosynostoses / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005539:Foramen Magnum / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging