{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T10:39:15Z","timestamp":1789123155116,"version":"build-2803163510"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,10]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Chiari malformation type I (CM-I) is a common condition characterized by the cerebellar tonsillar position below the foramen magnum. Radiographic measurements are important for diagnosing CM-I but have limited use in predicting the severity of the condition and the need for surgery. The fourth ventricle roof angle (FVRA), a measure of deformation or bowing of the roof of the fourth ventricle, has been presented as a tool for predicting brainstem dysfunction in patients with CM-I; however, this has not been validated. Utilizing a database of pediatric patients with CM-I from a large single center, this study aimed to validate the finding that the FVRA can serve as a predictor of brainstem dysfunction in pediatric CM-I and to present additional potential correlations of interest between the FVRA and symptoms and other radiographical measurements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Radiographic measurements were retrospectively reviewed for 388 pediatric patients evaluated for CM-I at Children\u2019s of Alabama from November 2010 to 2017. Fourth ventricle bowing was determined to be present if the FVRA was &gt; 65\u00b0. Univariate and multivariate logistic regression analyses were performed to identify significant associations with the FVRA, brainstem dysfunction, and surgery. Brainstem dysfunction was defined as the presence of lower cranial nerve dysfunction and\/or sleep apnea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Multivariate logistic regression showed significant association of lower brainstem dysfunction with tonsillar position (OR 1.17, 95% CI 1.06\u20131.29), basilar invagination (OR 0.66, 95% CI 0.47\u20130.91), supraoccipital length (OR 0.86, 95% CI 0.77\u20130.96), and tussive headache (OR 6.62, 95% CI 1.95\u201322.46). The presence of bowing did not show a significant association with brainstem dysfunction in the multivariable model (OR 1.02, 95% CI 0.27\u20133.81), and it was not significantly associated with undergoing surgery after controlling for symptoms that always resulted in surgery (p = 0.483).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Univariate logistic regression analysis demonstrated that an FVRA greater than 65\u00b0 is significantly associated with brainstem dysfunction. In a multivariate logistic regression model, however, the presence of bowing was not independently associated with brainstem dysfunction. As such, additional studies are needed before FVRA can be utilized clinically.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.5.peds24552","type":"journal-article","created":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:07:07Z","timestamp":1760148427000},"page":"694-701","source":"Crossref","is-referenced-by-count":3,"title":["Validation of fourth ventricle roof angle as a measure of brainstem dysfunction in pediatric Chiari malformation type I"],"prefix":"10.3171","volume":"36","author":[{"given":"Jana H.","family":"Badrani","sequence":"first","affiliation":[{"name":"Heersink School of Medicine, University of Alabama at Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Caudill","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham;"},{"name":"Division of Pediatric Neurosurgery, Children\u2019s of Alabama, Birmingham; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth S.","family":"Paik","sequence":"additional","affiliation":[{"name":"Heersink School of Medicine, University of Alabama at Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Anderson","sequence":"additional","affiliation":[{"name":"Heersink School of Medicine, University of Alabama at Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tofey J.","family":"Leon","sequence":"additional","affiliation":[{"name":"Heersink School of Medicine, University of Alabama at Birmingham;"},{"name":"Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon G.","family":"Rocque","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham;"},{"name":"Division of Pediatric Neurosurgery, Children\u2019s of Alabama, Birmingham; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis J.","family":"Rozzelle","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham;"},{"name":"Division of Pediatric Neurosurgery, Children\u2019s of Alabama, Birmingham; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Radiology","first-page":"347","article-title":"Chiari I malformations: clinical and radiologic reappraisal","volume":"183","author":"Elster AD","year":"1992","unstructured":"Elster AD, Chen MY. Chiari I malformations: clinical and radiologic reappraisal. Radiology. 1992;183(2):347\u2013353."},{"issue":"1","key":"b2","series-title":"Neurosurg Clin N Am","first-page":"9","article-title":"Epidemiology of Chiari I malformation and syringomyelia","volume":"34","author":"Holste KG","year":"2023","unstructured":"Holste KG, Muraszko KM, Maher CO. Epidemiology of Chiari I malformation and syringomyelia. Neurosurg Clin N Am. 2023;34(1):9\u201315."},{"issue":"11","key":"b3","series-title":"Childs Nerv Syst","first-page":"1239","article-title":"The pediatric Chiari I malformation: a review","volume":"23","author":"Tubbs RS","year":"2007","unstructured":"Tubbs RS, Lyerly MJ, Loukas M, Shoja MM, Oakes WJ. The pediatric Chiari I malformation: a review. Childs Nerv Syst. 2007;23(11):1239\u20131250."},{"issue":"6","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"620","article-title":"Imaging characteristics associated with surgery in Chiari malformation type I","volume":"27","author":"Alford EN","year":"2021","unstructured":"Alford EN, Atchley TJ, Leon TJ,  Imaging characteristics associated with surgery in Chiari malformation type I. J Neurosurg Pediatr. 2021;27(6):620\u2013628."},{"issue":"3","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"260","article-title":"Fourth ventricle roof angle as a measure of fourth ventricle bowing and a radiographic predictor of brainstem dysfunction in Chiari malformation type I","volume":"28","author":"Seaman SC","year":"2021","unstructured":"Seaman SC, Li L, Menezes AH, Dlouhy BJ. Fourth ventricle roof angle as a measure of fourth ventricle bowing and a radiographic predictor of brainstem dysfunction in Chiari malformation type I. J Neurosurg Pediatr. 2021;28(3):260\u2013267."},{"issue":"4","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"498","article-title":"Patients with \"benign\" Chiari I malformations require surgical decompression at a low rate","volume":"23","author":"Leon TJ","year":"2019","unstructured":"Leon TJ, Kuhn EN, Arynchyna AA,  Patients with \"benign\" Chiari I malformations require surgical decompression at a low rate. J Neurosurg Pediatr. 2019;23(4):498\u2013506."},{"issue":"4","key":"b7","series-title":"J Neurosurg Pediatr","first-page":"393","article-title":"Sleep-disordered breathing in children with Chiari type I malformation","volume":"34","author":"Jarrell M","year":"2024","unstructured":"Jarrell M, Caudill C, Haji F,  Sleep-disordered breathing in children with Chiari type I malformation. J Neurosurg Pediatr. 2024;34(4):393\u2013401."},{"issue":"9","key":"b8","series-title":"Childs Nerv Syst","first-page":"2865","article-title":"Predicting the presence of 4th ventricular outlet obstruction in Chiari I malformation","volume":"40","author":"Paik KS","year":"2024","unstructured":"Paik KS, Caudill C, Arynchyna-Smith A, Rocque BG, Rozzelle CJ. Predicting the presence of 4th ventricular outlet obstruction in Chiari I malformation. Childs Nerv Syst. 2024;40(9):2865\u20132870."},{"issue":"6","key":"b9","series-title":"Neurosurgery","first-page":"854","article-title":"Development of common data elements for use in Chiari malformation type I clinical research: an NIH\/NINDS project","volume":"85","author":"Luciano MG","year":"2019","unstructured":"Luciano MG, Batzdorf U, Kula RW,  Development of common data elements for use in Chiari malformation type I clinical research: an NIH\/NINDS project. Neurosurgery. 2019;85(6):854\u2013860."},{"issue":"2","key":"b1","series-title":"Radiology","first-page":"347","article-title":"Chiari I malformations: clinical and radiologic reappraisal","volume":"183","author":"Elster AD","year":"1992","unstructured":"Elster AD, Chen MY. Chiari I malformations: clinical and radiologic reappraisal. Radiology. 1992;183(2):347\u2013353."},{"issue":"1","key":"b2","series-title":"Neurosurg Clin N Am","first-page":"9","article-title":"Epidemiology of Chiari I malformation and syringomyelia","volume":"34","author":"Holste KG","year":"2023","unstructured":"Holste KG, Muraszko KM, Maher CO. Epidemiology of Chiari I malformation and syringomyelia. Neurosurg Clin N Am. 2023;34(1):9\u201315."},{"issue":"11","key":"b3","series-title":"Childs Nerv Syst","first-page":"1239","article-title":"The pediatric Chiari I malformation: a review","volume":"23","author":"Tubbs RS","year":"2007","unstructured":"Tubbs RS, Lyerly MJ, Loukas M, Shoja MM, Oakes WJ. The pediatric Chiari I malformation: a review. Childs Nerv Syst. 2007;23(11):1239\u20131250."},{"issue":"6","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"620","article-title":"Imaging characteristics associated with surgery in Chiari malformation type I","volume":"27","author":"Alford EN","year":"2021","unstructured":"Alford EN, Atchley TJ, Leon TJ,  Imaging characteristics associated with surgery in Chiari malformation type I. J Neurosurg Pediatr. 2021;27(6):620\u2013628."},{"issue":"3","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"260","article-title":"Fourth ventricle roof angle as a measure of fourth ventricle bowing and a radiographic predictor of brainstem dysfunction in Chiari malformation type I","volume":"28","author":"Seaman SC","year":"2021","unstructured":"Seaman SC, Li L, Menezes AH, Dlouhy BJ. Fourth ventricle roof angle as a measure of fourth ventricle bowing and a radiographic predictor of brainstem dysfunction in Chiari malformation type I. J Neurosurg Pediatr. 2021;28(3):260\u2013267."},{"issue":"4","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"498","article-title":"Patients with \"benign\" Chiari I malformations require surgical decompression at a low rate","volume":"23","author":"Leon TJ","year":"2019","unstructured":"Leon TJ, Kuhn EN, Arynchyna AA,  Patients with \"benign\" Chiari I malformations require surgical decompression at a low rate. J Neurosurg Pediatr. 2019;23(4):498\u2013506."},{"issue":"4","key":"b7","series-title":"J Neurosurg Pediatr","first-page":"393","article-title":"Sleep-disordered breathing in children with Chiari type I malformation","volume":"34","author":"Jarrell M","year":"2024","unstructured":"Jarrell M, Caudill C, Haji F,  Sleep-disordered breathing in children with Chiari type I malformation. J Neurosurg Pediatr. 2024;34(4):393\u2013401."},{"issue":"9","key":"b8","series-title":"Childs Nerv Syst","first-page":"2865","article-title":"Predicting the presence of 4th ventricular outlet obstruction in Chiari I malformation","volume":"40","author":"Paik KS","year":"2024","unstructured":"Paik KS, Caudill C, Arynchyna-Smith A, Rocque BG, Rozzelle CJ. Predicting the presence of 4th ventricular outlet obstruction in Chiari I malformation. Childs Nerv Syst. 2024;40(9):2865\u20132870."},{"issue":"6","key":"b9","series-title":"Neurosurgery","first-page":"854","article-title":"Development of common data elements for use in Chiari malformation type I clinical research: an NIH\/NINDS project","volume":"85","author":"Luciano MG","year":"2019","unstructured":"Luciano MG, Batzdorf U, Kula RW,  Development of common data elements for use in Chiari malformation type I clinical research: an NIH\/NINDS project. Neurosurgery. 2019;85(6):854\u2013860."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/36\/6\/article-p694.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/36\/6\/article-p694.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/36\/6\/article-p694.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:46:13Z","timestamp":1772804773000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/36\/6\/article-p694.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,10]]},"references-count":18,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2025.5.peds24552","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,10]]}}}