• Anshul Ratnaparkhi, Azim N Laiwalla, Bilwaj Gaonkar, David Zarrin, Kirstin Cook, Elliot Berdy, Ien Li, Bayard Wilson, Mark Attiah, Langston Holly, Luke Macyszyn, Joel Beckett, and Ulrich Batzdorf.
• Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
• World Neurosurg. 2022 Dec 1; 168: e621e625e621-e625.

ObjectiveTo assess volumetric changes in the spinal cord at the cervicomedullary junction, diameter of the cervicomedullary cord, and width of the brainstem following posterior fossa decompression (PFD).MethodsA retrospective analysis of adult patients with Chiari malformation who underwent PFD was performed. Segmentations were done on clinical quality T2-weighted cervical magnetic resonance images obtained before and after decompression using ITK-SNAP. Volumes of neural tissue within the cervicomedullary junction were evaluated from 10 mm cranial to the medullary beak to the cervical spinal cord at the level of the caudal endplate of the second cervical vertebra. The diameter of the cervicomedullary cord was calculated perpendicular to the spinal cord. The width of the brainstem was measured perpendicular to the clivus at the level of the basion.ResultsTwenty adult patients, a mean age of 49.55 years, were included. The cervical cord increased in volume by 13 mm3 to 338 mm3, with an average increase of 155 mm3 (P-value of 0.00002). The diameter of the cervicomedullary cord increased 10.30% 7 mm superior to the beak (P-value of 0.00074), 11.49% at the apex of the beak (P-value of 0.00082), 8.29% 7 mm inferior to the beak (P-value of 0.00075), and the brainstem increased 14.46% perpendicular to the clivus (P-value of 0.00109). The spinal cord at the inferior aspect of the C3 vertebra changed insignificantly (P-value of 0.10580).ConclusionThe volume of the cervical cord at the cervical-medullary junction, width of the cervicomedullary cord, and diameter of the brainstem increase following PFD.Copyright © 2022. Published by Elsevier Inc.

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