title: Relationship between pharyngitis and peri-odontoid pannus: A new etiology for some Chiari I malformations?
abstract: The pathophysiology underlying Chiari I malformations (CIMs) provides room for debate with several theories attempting to address this issue. We retrospectively reviewed many of our past patients with pediatric CIMs (specifically, those with peri-odontoid pannus), and present a hypothesis for the development of the malformation in some of said patients. Our experience with the pediatric CIM has shown that almost 1 in 20 patients who present with symptoms is found to have a peri-odontoid pannus. These masses ranged in size from 4 to 11 mm in diameter. Forty percent had a history of clinically significant pharyngitis or pharyngeal abscess. Pannus formation around the dens (odontoid) resulted in ventral compression of the craniocervical junction in each of these patients. Highlighting the hypermobility that causes such lesions, following fusion, the pannus and symptoms in several patients were diminished. Impairment of normal cerebrospinal fluid circulation out of the fourth ventricle and across the craniocervical junction appears to be a plausible endpoint in this discussion and a suitable explanation for some patients with CIM. Still, the mechanisms by which cerebrospinal fluid circulation is compromised may be variable and are not well understood. This is the first study dedicated to the evaluation of pannus formation in the CIM population. We hypothesize that pharyngeal inflammatory conditions contribute to the formation and progression of hindbrain herniation in a small subset of patients with CIMs.
authors.affiliation: Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama.|Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies.|Centre of Anatomy and Human Identification, University of Dundee, Scotland, United Kingdom.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama.
authors.forename: Philipp
authors.initials: P
authors.lastname: Hendrix
authors.affiliation: Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama.
authors.forename: Peter
authors.initials: P
authors.lastname: Oakes
authors.affiliation: Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies.
authors.forename: Marios
authors.initials: M
authors.lastname: Loukas
authors.affiliation: Department of Neurosurgery, Emory University, Atlanta, Georgia.|Pediatric Neurosurgery Associates, Atlanta, Georgia.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Chern
authors.affiliation: Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama.
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Rozzelle
authors.affiliation: Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama.
authors.forename: W Jerry
authors.initials: WJ
authors.lastname: Oakes
mesh_terms: D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008297:Male; D009809:Odontoid Process / Q000473:pathology*; D010612:Pharyngitis / Q000150:complications* / Q000473:pathology; D012189:Retrospective Studies
keywords: Chiari malformation; etiology; infection; inflammation; mechanism; pathophysiology; pharynx