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Comparison of pulsatile and static pressures within the intracranial and lumbar compartments in patients with Chiari malformation type 1: a prospective observational study

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Abstract

Background

In Chiari malformation type 1 (CMI), the obstruction of cerebrospinal fluid (CSF) flow through the foramen magnum is believed to cause alterations of intracranial pressure (ICP) pulsations. Foramen magnum decompression (FMD) is therefore considered a treatment of choice. However, the pathophysiology of CMI is poorly understood and it remains unknown how ICP alterations relate to symptoms and radiological findings. This study was undertaken to measure pulsatile pressure and its gradient between intracranial and lumbar compartments, and to determine its relationship to clinical and radiological findings.

Method

In patients with symptomatic CMI, we simultaneously measured ICP and lumbar CSF pressure, with particular focus on analysis of pulsatile pressure. Ventricular CSF volume (VV), intracranial volume (ICV) and posterior cranial fossa volume (PCFV) were calculated using volumetry software.

Results

In 26 patients (median 35 years), we found clearly abnormal or borderline values of pulsatile ICP in 18/26 patients (69 %; median 4.5 mmHg) and abnormal pulsatile pressure gradient in 17/24 patients (71 %; median 2.6 mmHg). The correlation between pulsatile ICP and the pulsatile pressure gradient was significantly positive (p < 0.001). We found no significant correlation between pulsatile or static pressure and extent of tonsillar ectopy, VV, ICV or PCFV. The pulsatile pressure gradient was significantly higher in patients with syringomyelia (p = 0.02).

Conclusions

In this cohort, the pulsatile ICP was elevated in 69 %. The intracranial-lumbar pulsatile pressure gradient was abnormal in 71 % and significantly higher in patients with syringomyelia. The elevated pulsatile ICP significantly correlated with pulsatile pressure gradient; no similar correlation was found for static ICP. We interpret the results as providing evidence of impaired intracranial compliance as an important pathophysiological mechanism in CMI.

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Conflicts of Interest

R. Frič discloses no conflicts of interests. The software used for analysis of the ICP recordings (Sensometrics Software) is manufactured by a software company (dPCom AS, Oslo, Norway) in which P.K. Eide has a financial interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Oslo University Hospital—Rikshospitalet, P.O.Box 4950, Nydalen, 0424, Oslo, Norway

    Radek Frič & Per Kristian Eide

  2. Faculty of Medicine, University of Oslo, Oslo, Norway

    Per Kristian Eide

Authors
  1. Radek Frič
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  2. Per Kristian Eide
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Correspondence to Radek Frič.

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Comments

This is a nicely performed prospective observational study comparing pulsatile and static pressures within the intracranial and lumbar compartments in 26 patients with Chiari 1 malformation. In my opinion, the most interesting aspect of this study is the analysis of pulsatile intracranial pressure and the pressure gradient to the lumbar CSF space, potentially providing new therapeutic aspects for Chiari 1 patients in the future.

Marcus Reinges

Giessen, Germany

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Frič, R., Eide, P.K. Comparison of pulsatile and static pressures within the intracranial and lumbar compartments in patients with Chiari malformation type 1: a prospective observational study. Acta Neurochir 157, 1411–1423 (2015). https://doi.org/10.1007/s00701-015-2465-x

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  • DOI: https://doi.org/10.1007/s00701-015-2465-x

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