Quantification of changes in brain morphology following posterior fossa decompression surgery in women treated for Chiari malformation type 1

Purpose While 84% of patients surgically treated for Chiari malformation type 1 (CM1) demonstrate improved quality of life after posterior fossa decompression surgery, there are many risks associated with this surgery. Surgical planning to identify candidates likely to improve postoperatively may benefit from an improved understanding of morphological changes after decompression surgery. To evaluate these changes, we quantified 59 morphological parameters on 42 CM1 adult female patients before and after CM1 decompression surgery. Methods Fifty-nine morphological parameters in the posterior cranial fossa, cranio-cervical, and intracranial regions in the midsagittal plane were evaluated using 42 T1-weighted magnetic resonance images of female CM1 patients before and after surgery, and 42 healthy female controls. Morphological differences before and after surgery were compared through the development of a technique to establish the opisthion location, a key reference point not present after surgery. Results In addition to the expected reduction of the cranio-caudal dimension of the cerebellum, objective analyses showed a significant increase in the area of the cerebrospinal fluid spaces, posterior (6x) and inferior (2.6x) to the cerebellum (+ 112 +/- 102 and + 140 +/- 127 mm(2), respectively). This increased area was primarily impacted by an average reduction in the occipital bone length of 24.5 +/- 7.3 mm following surgery. Based on multiple angles, results demonstrated a 2 degrees-4 degrees anterior rotation of the cerebellum after surgery. Conclusion Our results show that decompression surgery results in significant changes in the cerebellum and cerebrospinal fluid spaces. Further investigation should determine how these morphological changes impact clinical outcomes.