Effect of Body Mass Index on Chiari Malformation 1 Tonsil Ectopia Length in Adults

Abstract

Diagnosis of Chiari I malformation (CM-1) is based on measurements of the inferior extension of the cerebellar tonsils into the foramen magnum on cranial or cervical spine magnetic resonance imaging. Imaging may be obtained before the patient is referred to the neurosurgical specialist. The length of time raises questions about the possibility that body mass index (BMI) fluctuations could affect the measurement of ectopia length. However, previous literature on BMI and CM-1 has reported conflicting findings on BMI. We conducted a retrospective chart review of 161 patients who were referred to a single neurosurgeon for CM-1 consultation. Patients with multiple recorded BMI values (n= 71) were compared to see if BMI changes correlated with changes in ectopia length. In addition, we compared and tested 154 recorded ectopia lengths from the patients (1 per patient) and patient BMI values with Pearson correlation and Welch t tests to determine if BMI changes either influenced or were associated with ectopia changes. For the 71 patients with multiple BMI values, change in ectopia length ranged from-4.6-9.8mm but was not statistically significant (r=0.019; P=0.88). For the 154 measured ectopia lengths, changes in BMI did not correlate with ectopia length (P>0.05). Likewise, differences in ectopia length between patients in normal, overweight, and obese categories were not statistically significant (|tstat|<|tcrit|, P>0.05). In individual patients, we found that BMI and changes in BMI were not accompanied by changes in tonsil ectopia length.