{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:24:18Z","timestamp":1794324258999,"version":"4.9.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2016,11]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The diagnosis of Chiari malformation Type I (CM-I) is primarily based on the degree of cerebellar tonsillar herniation even though it does not always correlate with symptoms. Neurological dysfunction in CM-I presumably results from brainstem compression. With the premise that conventional MRI does not reveal brain microstructural changes, this study examined both structural and microstructural neuroimaging metrics to distinguish patients with CM-I from age- and sex-matched healthy control subjects.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Eight patients with CM-I and 16 controls were analyzed. Image postprocessing involved coregistration of anatomical T1-weighted with diffusion tensor images using 3D Slicer software. The structural parameters included volumes of the posterior fossa, fourth ventricle, and tentorial angle. Fractional anisotropy (FA) was calculated separately in the anterior and posterior compartments of the lower brainstem.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The mean age of patients in the CM-I cohort was 42.6 \u00b1 10.4 years with mean tonsillar herniation of 12 mm (SD 0.7 mm). There were no significant differences in the posterior fossa volume (p = 0.06) or fourth ventricular volume between the 2 groups (p = 0.11). However, the FA in the anterior brainstem compartment was significantly higher in patients with CM-I preoperatively (p = 0.001). The FA values normalized after Chiari decompression except for persistently elevated FA in the posterior brainstem compartment in patients with CM-I and syrinx.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n In this case-control study, microstructural alterations appear to be reliably associated with the diagnosis of CM-I, with a significantly elevated FA in the lower brainstem in patients with CM-I compared with controls. More importantly, the FA values normalized after decompressive surgery. These findings should be validated in future studies to determine the significance of diffusion tensor imaging\u2013based assessment of brainstem microstructural integrity as an adjunct to the clinical assessment in patients with CM-I.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.9.jns151196","type":"journal-article","created":{"date-parts":[[2016,2,5]],"date-time":"2016-02-05T10:01:06Z","timestamp":1454666466000},"page":"1112-1119","source":"Crossref","is-referenced-by-count":39,"title":["Diffusion tensor imaging assessment of microstructural brainstem integrity in Chiari malformation Type I"],"prefix":"10.3171","volume":"125","author":[{"given":"Vibhor","family":"Krishna","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery,"},{"name":"Center for Neuromodulation, Department of Neurosurgery, Ohio State University, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Sammartino","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Yee","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mikulis","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery,"},{"name":"Division of Brain Imaging, Behaviour Systems Neuroscience, Toronto Western Research Institute; and"},{"name":"Institute of Medical Science, and"},{"name":"Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada; and"},{"name":"Department of Medical Imaging, University of Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Walker","sequence":"additional","affiliation":[{"name":"Division of Brain Imaging, Behaviour Systems Neuroscience, Toronto Western Research Institute; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Elias","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mojgan","family":"Hodaie","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery,"},{"name":"Division of Brain Imaging, Behaviour Systems Neuroscience, Toronto Western Research Institute; and"},{"name":"Institute of Medical Science, and"},{"name":"Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns151196","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"E578","DOI":"10.1227\/01.neu.0000417804.07223.5d","article-title":"Diffusion tensor imaging changes with decompression of Chiari I malformation","volume":"71","author":"Abeshaus","year":"2012"},{"key":"b2-jns151196","series-title":"Functional Neuroanatomy: Text and Atlas","author":"Afifi","year":"1998"},{"key":"b3-jns151196","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1227\/NEU.0b013e31823200a6","article-title":"A novel scoring system for assessing Chiari malformation type I treatment outcomes","volume":"70","author":"Aliaga","year":"2012"},{"key":"b4-jns151196","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"459","DOI":"10.3171\/jns.2003.98.3.0459","article-title":"Improvement in brainstem auditory evoked potentials after suboccipital decompression in patients with Chiari I malformations","volume":"98","author":"Anderson","year":"2003"},{"key":"b5-jns151196","series-title":"AJNR Am J Neuroradiol","first-page":"1717","article-title":"Diffusion tensor imaging in hydrocephalus: initial experience","volume":"27","author":"Assaf","year":"2006"},{"key":"b6-jns151196","series-title":"NMR Biomed","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1002\/nbm.782","article-title":"The basis of anisotropic water diffusion in the nervous system - a technical review","volume":"15","author":"Beaulieu","year":"2002"},{"key":"b7-jns151196","series-title":"Neuroscience","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.neuroscience.2013.09.004","article-title":"A macroscopic view of microstructure: using diffusion-weighted images to infer damage, repair, and plasticity of white matter","volume":"276","author":"Concha","year":"2014"},{"key":"b8-jns151196","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"159","DOI":"10.3171\/jns.1989.71.2.0159","article-title":"Symptomatic Chiari malformations. 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