{
  "abstract": "BackgroundSagittal synostosis is increasingly recognized as a heterogeneous condition. Whether distinct anatomical phenotypes differ in Chiari type I malformation (CM-I) burden, and how posterior fossa morphology contributes to this heterogeneity, remains unclear.MethodsWe retrospectively studied 241 children with sagittal synostosis who underwent preoperative three-dimensional CT volumetry and MRI between January 2023 and December 2025. Patients were classified as anterior fossa–involved (Group A, n = 63), posterior fossa–involved (Group B, n = 53), or isolated sagittal synostosis (Group C, n = 125). Residualized posterior fossa volume (PFV_adj) was derived from PFV regressed on preoperative intracranial volume and age at surgery. ANCOVA and sequential logistic regression models were used, with Firth penalized regression as a sensitivity analysis.ResultsCM-I prevalence differed across subtypes (P = 0.012) and was highest in Group B (28.3%) versus Group A (11.1%) and Group C (12.0%). In the subtype-only model, Group B had higher CM-I odds than Group C (OR = 2.89, 95% CI 1.29–6.48; P = 0.010). Group B also showed significantly lower PFV_adj (P < 0.001). In morphology-adjusted analyses, greater tentorial angle (OR = 3.20 per 5°, 95% CI 2.10–4.88; P < 0.001) and lower PFV_adj (OR = 0.74 per 10 mL, 95% CI 0.62–0.89; P = 0.002) were associated with CM-I. Model AUC increased numerically from 0.869 to 0.885 after adding PFV_adj. Firth regression yielded consistent results.ConclusionsThe posterior fossa–involved phenotype carries the greatest overall CM-I burden and is characterized by relative posterior fossa deficiency and a steeper tentorial configuration. PFV_adj provides a developmentally adjusted measure that complements anatomical subtype classification.",
  "abstract_shown": true,
  "affiliations": [
    "Huaihe Hospital, Henan University, Kaifeng, China",
    "Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Chenxu Kong"
    },
    {
      "affs": [
        1
      ],
      "name": "Linzhao Min"
    },
    {
      "affs": [
        1
      ],
      "name": "Jiajia Wang"
    },
    {
      "affs": [
        1
      ],
      "name": "Jia Wei"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhenjiang Li"
    },
    {
      "affs": [
        1
      ],
      "name": "Xiaoqiang Wang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5kpg9gq1hqj46.bib",
  "cited_by": 0,
  "doi": "10.3389/fsurg.2026.1949189",
  "fulltext_url": "https://www.frontiersin.org/articles/10.3389/fsurg.2026.1949189/full",
  "id": "5kpg9gq1hqj46",
  "issns": [
    "2296-875X"
  ],
  "landing_url": "https://doi.org/10.3389/fsurg.2026.1949189",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RD1-811"
    ],
    [
      "openalex",
      "1311|Craniofacial Disorders and Treatments"
    ]
  ],
  "openalex": "W7223300287",
  "pdf_url": "https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1949189/pdf",
  "pmcid": "PMC13739670",
  "pmid": "42996582",
  "published": "2026-10-23",
  "publisher": "Frontiers Media S.A.",
  "ris": "https://research.draconitic.com/paper/5kpg9gq1hqj46.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:43:47Z",
      "native_id": "5985fed71de24fb199b750b55a5129f8",
      "source": "doaj",
      "url": "https://doi.org/10.3389/fsurg.2026.1949189"
    },
    {
      "first_seen": "2026-11-09T15:20:41Z",
      "native_id": "MED:42996582",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42996582"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "openalex:1311|Craniofacial Disorders and Treatments",
      "subfield": "genetics-genomics"
    }
  ],
  "title": "Chiari I malformation risk across anatomical subtypes of sagittal synostosis",
  "title_text": "Chiari I malformation risk across anatomical subtypes of sagittal synostosis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:41Z",
  "url": "https://research.draconitic.com/paper/5kpg9gq1hqj46",
  "venue": "Frontiers in Surgery",
  "versions": []
}