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Chiari malformation: CSF flow dynamics in the craniocervical junction and syrinx

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Summary

Background. A CSF flow study in patients with Chiari malformation (ChM) who undergo craniocervical junction decompression (CCJD).

Methods. Using spatial modulation of magnetization (SPAMM), cerebrospinal fluid (CSF) flow velocities were measured at the prepontine (PP), anterior cervical (AC), and posterior cervical (PC) subarachnoid spaces (SAS) in healthy subjects (n = 11) and patients with Chiari malformation (ChM) before and/or after CCJD (n = 15). In the syringes, the intrasyrigeal pulsatile CSF motion was estimated qualitatively as present or absent.

Findings. In normal subjects, the mean CSF velocities were 2.4 ± 0.2 cm/s (PP), 2.8 ± 0.3 cm/s (AC), and 2.4 ± 0.2 cm/s (PC). Velocities were significantly lower than normal in patients with ChM prior to CCJD, reduced by 38%, 25%, and 79% in the 3 regions, respectively (P<0.001). Post-CCJD, velocities were 20% (PP), 100% (AC), and 40% (PC) greater than preoperatively (P<0.001).

Conclusions. In ChM, the posterior cervical CSF flow velocity was low, increased minimally after CCJD and, by itself, had limited predictive value. Post-CCJD, an increase of the sum of anterior and posterior cervical CSF flow velocities by more than 20% consistently preceded or coincided with marked headache improvement. After CCJD, the finding that the intrasyringeal CSF pulsatile motion had become absent was an earlier and more sensitive predictor of motor or sensory improvement than a reduction in syrinx’s size. SPAMM can be used to assess whether CCJD has restored CSF flow, predict outcome and provide pathophysiological insights in ChM and syringomyelia.

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References

  • J Aboulker (1979) ArticleTitleSyringomyelia and intra-rachidian fluids. V. Syringomyelic cavities with low power. Neurochirurgie 25 IssueID[Suppl] 1 38–54 Occurrence Handle481671

    PubMed  Google Scholar 

  • J Aboulker (1979) ArticleTitleSyringomyelia and intra-rachidian fluids. IX. The rachidian fluid: its relations with the spinal cord, its place in CSF, its movements. Neurochirurgie 25 IssueID[Suppl] 1 81–97 Occurrence Handle481675

    PubMed  Google Scholar 

  • RJ Armonda CM Citrin KT Foley RG Ellenbogen (1994) ArticleTitleQuantitative cine-mode magnetic resonance imaging in Chiari I malformations: an analysis of cerebrospinal fluid dynamics. Neurosurgery 35 214–223 Occurrence Handle7969828 Occurrence Handle1:STN:280:ByqD2MbosV0%3D

    PubMed  CAS  Google Scholar 

  • L Axel D Dougherty (1989) ArticleTitleMR imaging of motion with spatial modulation of magnetization. Radiology 171 841–845 Occurrence Handle2717762 Occurrence Handle1:STN:280:BiaB2c7itlc%3D

    PubMed  CAS  Google Scholar 

  • AJ Barkovich FJ Wippold JL Sherman CM Citrin (1986) ArticleTitleSignificance of cerebellar tonsillar position on MR. Am J Neuroradiology 7 795–799 Occurrence Handle1:STN:280:BiiD2crntVE%3D

    CAS  Google Scholar 

  • RA Bhadelia AR Bogdan SM Wolpert S Lev BA Appignani CB Heilman (1995) ArticleTitleCerebrospinal fluid flow waveforms: analysis in patients with Chiari I malformation by means of gated phase-contrast MR imaging velocity measurements. Radiology 196 195–202 Occurrence Handle7784567 Occurrence Handle1:STN:280:ByqA3cvgt1A%3D

    PubMed  CAS  Google Scholar 

  • AK Bindal SB Dunsker JM Tew SuffixJr (1995) ArticleTitleChiari I malformation: classification and management. Neurosurgery 37 1069–1074 Occurrence Handle8584146 Occurrence Handle1:STN:280:BymC2MbptlI%3D

    PubMed  CAS  Google Scholar 

  • AR Brodbelt MA Stoodley AM Watling J Tu NR Jones (2003) ArticleTitleFluid flow in an animal model of post-traumatic syringomyelia. Eur Spne J 12 300–306

    Google Scholar 

  • DR Enzmann NJ Pelc (1991) ArticleTitleNormal flow patterns of intracranial and spinal cerebrospinal fluid defined with phase-contrast cine MR imaging. Radiology 178 467–474 Occurrence Handle1987610 Occurrence Handle1:STN:280:By6C3c3isFY%3D

    PubMed  CAS  Google Scholar 

  • DR Enzmann NJ Pelc (1992) ArticleTitlePhase-contrast MR imaging in measurement of brain motion. Radiology 185 653–660 Occurrence Handle1438741 Occurrence Handle1:STN:280:ByyD28nps1U%3D

    PubMed  CAS  Google Scholar 

  • DA Feinberg (1992) ArticleTitleModern concepts of brain motion and cerebrospinal fluid flow. Radiology 185 630–632 Occurrence Handle1438734 Occurrence Handle1:STN:280:ByyD28npsFA%3D

    PubMed  CAS  Google Scholar 

  • WJ Gardner (1965) ArticleTitleHydrodynamic mechanism of syringo-myelia: Its relationship to myelocele. J Neurol Neurosurg Psychiatry 28 247–259 Occurrence Handle14345682 Occurrence Handle1:STN:280:CCqC2M%2FlvV0%3D

    PubMed  CAS  Google Scholar 

  • VM Haughton FR Korosec JE Medow MT Dolar BJ Iskandar (2003) ArticleTitlePeak systolic and diastolic CSF velocity in the foramen magnum in adult patients with Chiari I malformations and in normal control participants. Am J Neuroradiol 24 165–166

    Google Scholar 

  • MC Henry-Feugeas I Idy-Peretti B Blanchet D Hassine G Zannoli E Schouman-Claeys (1993) ArticleTitleTemporal and spatial assessment of normal cerebrospinal fluid dynamics with MR imaging. Magn Res Imag 11 1107–1118 Occurrence Handle10.1016/0730-725X(93)90238-9 Occurrence Handle1:STN:280:ByuD1MjhsFw%3D

    Article  CAS  Google Scholar 

  • E Hofmann M Warmuth-Metz M Bendszus L Solymosi (2000) ArticleTitlePhase-Contrast MR imaging of the cervical CSF and spinal cord: Volumetric motion analysis in patients with Chiari I malformation. Am J Neuroradiology 21 151–158 Occurrence Handle1:STN:280:DC%2BD3c7jt1OhtA%3D%3D

    CAS  Google Scholar 

  • K Kyoshima T Kuroyanagi F Oya Y Kamijo H El-Noamany S Kobayashi (2002) ArticleTitleSyringomyelia without hindbrain herniation: tight cisterna magna. Report of four cases and a review of the literature. J Neurosurg 96 IssueID[Suppl] 2 239–249 Occurrence Handle12450289

    PubMed  Google Scholar 

  • MA Mazzola AH Fried (2003) ArticleTitleRevision surgery for Chiari malformation decompression. Neurosurg focus 15 E3 Occurrence Handle15347221 Occurrence Handle10.3171/foc.2003.15.3.3

    Article  PubMed  Google Scholar 

  • TH Milhorat JI Miller WD Johnson DE Adler IM Heger (1993) ArticleTitleAnatomical basis of syringomyelia occurring with hindbrain lesions. Neurosurgery 32 748–754 Occurrence Handle8492850 Occurrence Handle1:STN:280:ByyB287kvV0%3D

    PubMed  CAS  Google Scholar 

  • WR Nitz WG Bradley AS Watanabe (1992) ArticleTitleFlow dynamics of cerebrospinal fluid: Assessment with phase contrast velocity MR imaging performed with retrospective cardiac gating. Radiology 183 395–405 Occurrence Handle1561340 Occurrence Handle1:STN:280:By2B38%2Fps1M%3D

    PubMed  CAS  Google Scholar 

  • EH Oldfield K Murazko TH Shawker NJ Patronas (1994) ArticleTitlePathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. J Neurosurg 80 3–15 Occurrence Handle8271018 Occurrence Handle1:STN:280:ByuD1MnhtFc%3D

    PubMed  CAS  Google Scholar 

  • BP Poncelet VJ Weeden RM Weisskoff MS Cohen (1992) ArticleTitleBrain parenchyma motion: measurement with cine echo-planar MR imaging. Radiology 185 645–651 Occurrence Handle1438740 Occurrence Handle1:STN:280:ByyD28nps1Q%3D

    PubMed  CAS  Google Scholar 

  • J Pujol C Roig A Capdevila A Pou JL Marti-Vilalta J Kulisevsky A Escartin G Zannoli (1995) ArticleTitleMotion of the cerebellar tonsils in Chiari type I malformation studied by cine phase-contrast MRI. Neurology 45 1746–1753 Occurrence Handle7675239 Occurrence Handle1:STN:280:ByqH3crmtl0%3D

    PubMed  CAS  Google Scholar 

  • JP Ridgway LW Turnbull WA Smith (1987) ArticleTitleDemonstration of pulsatile cerebrospinal fluid flow using magnetic resonance phase imaging. Br J Radiol 60 423–427 Occurrence Handle3580751 Occurrence Handle1:STN:280:BiiB3MvosVc%3D

    PubMed  CAS  Google Scholar 

  • H Sakamoto M Nishikawa A Hakuba T Yasui S Kitano N Nakanishi Y Inoue (1999) ArticleTitleExpansive suboccipital cranioplasty for the treatment of syringomyelia associated with Chiari malformation. Acta Neurochir (Wien) 141 949–960 Occurrence Handle10.1007/s007010050401 Occurrence Handle1:STN:280:DyaK1Mvls1CksQ%3D%3D

    Article  CAS  Google Scholar 

  • DE Sakas K Charnvises LF Borges NT Zervas (1990) ArticleTitleBiologically inert synthetic dural substitutes. Appraisal of a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer. J Neurosurg 73 936–941 Occurrence Handle2230977 Occurrence Handle1:CAS:528:DyaK3MXhtVyruro%3D

    PubMed  CAS  Google Scholar 

  • G Scroth U Klose (1992) ArticleTitleCerebrospinal fluid flow. I. Physiology of cardiac-related pulsation. Neuroradiology 35 1–9

    Google Scholar 

  • R Shibuya K Yonenobu T Koizumi Y Kato M Mitta H Yoshikawa (2002) ArticleTitlePulsatile cerebrospinal fluid flow measurement using phase-contrast magnetic resonance imaging in patients with cervical myelopathy. Spine 27 1087–1093 Occurrence Handle10.1097/00007632-200205150-00015 Occurrence Handle12004177

    Article  PubMed  Google Scholar 

  • MA Stoodley B Gutschmidt NR Jones (1999) ArticleTitleCerebrospinal fluid flow in an animal model of noncommunicating syringomyelia. Neurosurgery 44 1065–1075 Occurrence Handle10232540 Occurrence Handle1:STN:280:DyaK1M3kslGjsg%3D%3D

    PubMed  CAS  Google Scholar 

  • RS Tubbs DB Webb WJ Oakes (2004) ArticleTitlePersistent syringomyelia following pediatric Chiari I decompression: radiological and surgical findings. J Neurosurg 100 IssueID5 Suppl Pediatrics 460–464 Occurrence Handle15287455

    PubMed  Google Scholar 

  • EC Ventureyra HA Aziz M Vassilyadi (2003) ArticleTitleThe role of cine flow MRI in children with Chiari I malformation. Childs Nerv Syst 2003, 19 109–113

    Google Scholar 

  • SC Wayte TW Redpath DJ Beale (1992) ArticleTitleMagnetic resonance imaging of pulsatile cerebrospinal fluid flow by spatial modulation magnetization. Br J Radiol 65 495–501 Occurrence Handle1628181 Occurrence Handle1:STN:280:By2A3s%2FptVU%3D

    PubMed  CAS  Google Scholar 

  • SC Wayte TW Redpath DJ Beale (1993) ArticleTitleA cine-SPAMM sequence for NMR of pulsatile cerebrospinal fluid flow. Phys Med Biol 38 455–463 Occurrence Handle10.1088/0031-9155/38/3/011 Occurrence Handle8451284 Occurrence Handle1:STN:280:ByyC1MjjsFU%3D

    Article  PubMed  CAS  Google Scholar 

  • B Williams (1980) ArticleTitleOn the pathogenesis of syringomyelia. A review. J R Soc Med 73 798–806 Occurrence Handle7017117 Occurrence Handle1:CAS:528:DyaL3MXktF2lt74%3D

    PubMed  CAS  Google Scholar 

  • B Williams (1981) ArticleTitleSimultaneous cerebral and spinal fluid pressure recordings: II: cerebrospinal dissociation with lesions at the foramen magnum. Acta Neurochir (Wien) 59 123–142 Occurrence Handle10.1007/BF01411198 Occurrence Handle1:STN:280:Bi2D1cfgs1c%3D

    Article  CAS  Google Scholar 

  • SM Wolpert RA Bhadelia AR Bogdan AR Cohen (1994) ArticleTitleChiari I malformations: assessment with phase-contrast velocity MRI. Am J Neuroradiol 15 1299–1308 Occurrence Handle7976942 Occurrence Handle1:STN:280:ByqD28jlt1I%3D

    PubMed  CAS  Google Scholar 

  • YW Wu CT Chin KM Chan AJ Barkovich DM Ferriero (1999) ArticleTitlePediatric Chiari malformations. Do clinical and radiologic features correlate? Neurology 53 1271–1276 Occurrence Handle10522884 Occurrence Handle1:STN:280:DyaK1MvltVOiuw%3D%3D

    PubMed  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Neurosurgery, University of Athens, Evangelismos General Hospital, Athens, Greece

    D. E. Sakas, S. I. Korfias, K. P. Papapetrou & G. S. Stranjalis

  2. Departments of Neurosurgery, Radiology, Clinical Physics and Bioengineering, University Hospital Coventry and Warwickshire, Coventry, UK

    S. C. Wayte, D. J. Beale, K. W. Whittaker & H. L. Whitwell

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  1. D. E. Sakas
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  2. S. I. Korfias
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  3. S. C. Wayte
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  4. D. J. Beale
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  5. K. P. Papapetrou
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  6. G. S. Stranjalis
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  7. K. W. Whittaker
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  8. H. L. Whitwell
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Sakas, D., Korfias, S., Wayte, S. et al. Chiari malformation: CSF flow dynamics in the craniocervical junction and syrinx. Acta Neurochir (Wien) 147, 1223–1233 (2005). https://doi.org/10.1007/s00701-005-0645-9

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  • DOI: https://doi.org/10.1007/s00701-005-0645-9

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