Cerebellar tonsillar position

Cerebellar tonsillar position (TP) is the vertical distance from the tip of the cerebellar tonsils to a line drawn between the anterior and posterior margins of the foramen magnum (McRae line).

As is to be expected, values used vary somewhat from author to author :

  • above foramen magnum: normal
  • <3 mm: also normal but the term low-lying tonsils can be used
  • 3 to 6 mm: indeterminate, and needs to be correlated with symptoms and presence of syrinx, etc
  • >6 mm: Chiari 1 malformation

Some authors advocate a simpler rule :

To make matters worse the 'normal' position of the cerebellar tonsils varies with age. In neonates, the tonsils are located just below the foramen magnum and descend further during childhood, reaching their lowest point somewhere between 5 and 15 years of age. As the individual ages further the tonsils usually ascend coming to rest at the level of the foramen magnum . As such although 5 mm descent in an adult should be viewed with suspicion, in a child it is most likely normal .

Related pathology