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Analysis of cerebrospinal fluid flow dynamics and morphology in Chiari I malformation with cine phase-contrast magnetic resonance imaging

  • Clinical Article - Neurosurgical Techniques
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Abstract

Background

To determine cerebrospinal fluid (CSF) dynamics and morphology in Chiari I malformation (CMI) and assess the response to surgery of the posterior cranial fossa, we examined midsagittal imaging along with anterior cervical 2-3 (AC2-3), posterior cervical 2-3 (PC2-3), and aqueduct CSF flow hydrodynamics in axial imaging by using cine phase-contrast magnetic resonance imaging (PCMR).

Method

We examined 52 patients with CMI, both with and without syringomyelia (SM), pre-/post-surgery, and compared them to 17 healthy volunteers. Statistical analyses included paired t-tests, independent-samples t-tests, binary logistic regression, and crosstab with MedCalc software.

Results

Patients with CMI had significantly shorter clivus length and larger tentorial angle than the healthy controls (P = 0.004, P = 0.019, respectively). The AC2-3 cranial/caudal peak velocity (PV), PC2-3 cranial/caudal PV and aqueduct cranial peak PV of patients with CMI were significantly lower than healthy volunteers pre-surgery (P = 0.034 AC2-3 cranial PV, P = 0.000002 AC2-3 caudal PV; P = 0.046 PC2-3 cranial PV, P = 0.015 PC2-3 caudal PV; P = 0.022 aqueduct cranial PV) and increased after surgery (P = 0.024 AC2-3 cranial PV, P = 0.002 AC2-3 caudal PV; P = 0.001 PC2-3 cranial PV, P = 0.032 PC2-3 caudal PV; P = 0.003 aqueduct cranial PV). The aqueduct caudal PV of patients with CMI was higher than that of healthy controls (P = 0.004) and decreased post-surgery (P = 0.012). Patients with pre-surgery PC2-3 cranial PV >2.63 cm/s and aqueduct cranial PV >2.13 cm/s, respectively, experienced primary symptom improvement after surgery.

Conclusions

The innate bony dysontogenesis in patients with CMI contributes to tonsilar ectopia and exacerbates CSF flow obstruction. A pressure gradient that existed between SM and SAS supports the perivascular space theory that is used to explain SM formation. Our findings demonstrate that PCMR maybe a useful tool for predicting patient prognosis.

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Acknowledgments

This work was supported by grant SWH2013LC12 from the clinical innovation Foundation of Southwest hospital. The authors are grateful to the members of the neurosurgery and radiology departments of Southwest Hospital in Chongqing for permitting this study and for providing valuable advice.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Southwest Hospital, Third Military Medical University, No. 29, GaoTanYan Street, Chong-Qing, 400038, People’s Republic of China

    Cheng-Shi Wang, Chu-Hua Fu & Jiang-Kai Lin

  2. Department of Radiology, Southwest Hospital, Third Military Medical University, No. 29, GaoTanYan Street, Chong-Qing, 400038, People’s Republic of China

    Xing Wang, Lu-Qing Wei & Dai-Quan Zhou

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  1. Cheng-Shi Wang
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  2. Xing Wang
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  3. Chu-Hua Fu
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Correspondence to Jiang-Kai Lin.

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Cheng-Shi Wang and Xing Wang contributed equally to this work.

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Wang, CS., Wang, X., Fu, CH. et al. Analysis of cerebrospinal fluid flow dynamics and morphology in Chiari I malformation with cine phase-contrast magnetic resonance imaging. Acta Neurochir 156, 707–713 (2014). https://doi.org/10.1007/s00701-013-1958-8

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  • DOI: https://doi.org/10.1007/s00701-013-1958-8

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