Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
Clinical and MRI morphometric characterization of symptomatic cerebellar tonsillar ectopia.
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Bogdanov Enver I, Faizutdinova Aisylu T, Heiss John D
Аннотация
BACKGROUND: Cerebellar tonsils normally extend up to 5 mm below the foramen magnum (FM). Some individuals with tonsillar ectopia (TE) measuring under 5 mm may present with symptoms of Chiari type 1 malformation (CM1). We analyzed MRI data of the posterior cranial fossa (PCF) in affected patients to assess TE's impact on clinical manifestations.
METHODS: The retrospective study examined 83 adults with 2-4 mm symptomatic cerebellar TE without syringomyelia (SM), 16 with syndromic CM1 without SM, and 19 controls. Participants with TE were divided into three groups: syndromic (TEs, n = 15), incomplete syndromic (TEis, n = 37), and non-syndromic (TEns, n = 31). Cranial MRIs assessed TE, obliterated cisterna magna (CM), and small PCF, along with clinical-radiological correlations.
RESULTS: TE and CM1 patients had a smaller PCF on MRI than controls, with obliterated CM found in 53% of TEs and 81% of CM1s. Both syndromic groups (TEs and CM1s) showed more abnormal MRI findings than TEis and TEns. All clinically syndromic cases reported exertion-induced occipital headaches. TEs group exhibited reduced PCF volume and reduced area surrounding the FM compared to TEns and had a smaller inferior outlet area FM than TEis. PCF width and FM inferior outlet area negatively correlated with Chiari-associated symptoms in TE cohort.
CONCLUSION: The study found that patients with TE without SM show clinical symptoms related to small PCF traits and congenital hypoplasia near the FM. In patients with TE under 4 mm, CM1-type symptoms are associated with TE at the FM, a constricted CM, and hypoplasia around the FM.
METHODS: The retrospective study examined 83 adults with 2-4 mm symptomatic cerebellar TE without syringomyelia (SM), 16 with syndromic CM1 without SM, and 19 controls. Participants with TE were divided into three groups: syndromic (TEs, n = 15), incomplete syndromic (TEis, n = 37), and non-syndromic (TEns, n = 31). Cranial MRIs assessed TE, obliterated cisterna magna (CM), and small PCF, along with clinical-radiological correlations.
RESULTS: TE and CM1 patients had a smaller PCF on MRI than controls, with obliterated CM found in 53% of TEs and 81% of CM1s. Both syndromic groups (TEs and CM1s) showed more abnormal MRI findings than TEis and TEns. All clinically syndromic cases reported exertion-induced occipital headaches. TEs group exhibited reduced PCF volume and reduced area surrounding the FM compared to TEns and had a smaller inferior outlet area FM than TEis. PCF width and FM inferior outlet area negatively correlated with Chiari-associated symptoms in TE cohort.
CONCLUSION: The study found that patients with TE without SM show clinical symptoms related to small PCF traits and congenital hypoplasia near the FM. In patients with TE under 4 mm, CM1-type symptoms are associated with TE at the FM, a constricted CM, and hypoplasia around the FM.