scholarly journals SCIDOT-37. ASSESSING CEREBROSPINAL FLUID FLOW DYNAMICS IN PEDIATRIC PATIENTS WITH CENTRAL NERVOUS SYSTEM TUMORS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi279-vi279
Author(s):  
Kim Kramer ◽  
Maria Donzellie ◽  
Emmanuela Nwora ◽  
Neeta Pandit-Taskar
Keyword(s):  
Pediatric Population ◽  
Flow Dynamics ◽  
Cns Tumors ◽  
Nuclear Medicine Imaging ◽  
Csf Flow ◽  
Single Institution ◽  
Cerebrospinal Fluid Flow ◽  
Diethylene Triamine ◽  
Diethylene Triamine Pentaacetic Acid ◽  
Neurosurgical Intervention

Abstract BACKGROUND The incidence of abnormal CSF flow dynamics in the pediatric population with CNS tumors prior to intraventricular therapy has not been described. METHODS We performed a single-institution, retrospective review of patients with primary or metastatic CNS tumors treated between 2003–2018 (15 years).. Patients underwent 111-indium diethylene triamine pentaacetic acid injection into the CSF intraventricular space followed by nuclear medicine imaging at 90 minutes, 4, 24, and 48 hours (if required). CSF flow was classified as normal, delayed, asymmetric or obstructed. RESULTS 278 CSF flow studies were performed in 224 patients, 202(90%) <18 years of age. 116(52%) patients had metastatic CNS neuroblastoma, 57(25%) had medulloblastoma, and 51(23%) had other CNS histologies. Of the 278 studies, 237(85%) were normal, 9(3%) required neurosurgical intervention, 25(9%) were delayed, and 7(3%) were asymmetric. CONCLUSIONS Abnormal CSF flow and necessity of neurosurgical intervention must be considered when attempting to ensure appropriate intraventricular therapy in the pediatric population.

scholarly journals Cerebrospinal fluid flow dynamics study in Chiari I malformation: implications for syrinx formation

2000 ◽  
Vol 8 (3) ◽  
pp. 1-8 ◽  
Author(s):  
Giampietro Pinna ◽  
Franco Alessandrini ◽  
Alex Alfieri ◽  
Marcella Rossi ◽  
Albino Bricolo
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Statistical Significance ◽  
Flow Patterns ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Flow Dynamics ◽  
Csf Flow ◽  
Cerebrospinal Fluid Flow ◽  
Chiari I

Cerebrospinal fluid (CSF) flow abnormalities are known to be present in Chiari I malformation and to underlie the origin and progression of associated syringomyelia. The incidence of syrinx formation, however, is variable for unknown reasons. The aim of this study was to investigate whether differences in CSF flow dynamics in patients with Chiari I malformation may account for the different clinical and radiological presentation. Presurgical and postsurgical phase-contrast magnetic resonance imaging investigations were prospectively conducted in 47 adult patients with symptomatic Chiari I malformation. Patients were divided into two groups according to the presence (32 cases) or absence (15 cases) of syrinx. Cerebrospinal fluid flow patterns were evaluated at four regions of interest: prebulbar cistern, foramen magnum, and the ventral and dorsal spinal subarachnoid spaces at the C-5 level. A temporal analysis of CSF flow waveforms was performed with measurement of cranial- and caudal-directed flow durations. All patients underwent a craniocervical decompressive procedure. Preoperatively, a prolonged caudal-directed (systolic) flow pattern was observed in patients with syringomyelia, as compared with normal control values obtained in 15 healthy volunteers. Conversely, a decreased systolic duration was observed in Chiari I patients who had malformation without syrinx. These trends were not statistically significant because of the considerable degree of overlap with the control values recorded in both groups. Additional comparison of the observed preoperative values obtained in patients with and those without syringomyelia indicated that the difference in systolic flow duration was significant at the ventral spinal subarachnoid space level (p = 0.003) and remarkable at the other levels, although not reaching statistical significance. Cerebrospinal fluid flow was minimal or absent at the foramen magnum (dorsal aspect) due to tonsillar herniation, precluding reliable quantitative measurement at this level. There was no evidence of communication between the fourth ventricle and syrinx in any case. Postoperatively, unobstructed CSF flow was recorded across the enlarged foramen magnum and into the artificial cisterna magna in all patients. A gradual restoration of near-normal flow patterns was observed in both groups. Inside the syrinx, fluid motion gradually tapered, no longer being detectable in 12 patients (37.5%) 1 year postsurgery. In patients with Chiari I malformation and associated syringomyelia different CSF flow patterns were demonstrated as compared with patients in whom syrinx was absent. Analysis of this study's findings supports the hypothesis that in Chiari I malformation an elongated systolic flow may prolong the condition of increased spinal subarachnoid pressure caused by the junctional obstruction, thus favoring CSF penetration into the spinal cord. It may be also proposed that a shortened systolic flow may be insufficient to maintain a hypertensive condition for enough time to induce syrinx formation.

The impact of fluorescein-guided technique in the surgical removal of CNS tumors in a pediatric population: results from a multicentric observational study

2020 ◽  
Vol 63 (6) ◽  
Author(s):  
Camilla de Laurentis ◽  
Julius Höhne ◽  
Claudio Cavallo ◽  
Francesco Restelli ◽  
Jacopo Falco ◽  
...  
Keyword(s):  
Observational Study ◽  
Pediatric Population ◽  
Cns Tumors ◽  
Surgical Removal ◽  
The Impact

scholarly journals Assessment of Cerebrospinal Fluid Hydrodynamics Using Magnetic Resonance Imaging in Postcraniospinal Surgery Patients

2021 ◽  
Author(s):  
Pankaj Arora ◽  
Kanica Rawat ◽  
Rajiv Azad ◽  
Kehkashan Chouhan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Clinical Outcome ◽  
Phase Contrast ◽  
Flow Dynamics ◽  
Resonance Imaging ◽  
Csf Flow ◽  
Group I ◽  
Group Ii

Abstract Objective Aim of this study is to evaluate the effect of craniospinal interventions on cerebrospinal fluid (CSF) flow hydrodynamics and study the correlation of postoperative changes in flow alteration with clinical outcome. Materials and Methods Fifty patients who underwent various craniospinal procedures were studied using conventional and phase-contrast magnetic resonance imaging (PCMRI) protocol. CSF flow quantification was performed at cerebral aqueduct, foramen magnum, C2–3, and D12–L1 vertebral levels with site showing maximal alteration of CSF flow dynamics considered as the region of interest. Velocity encoding was kept at 20 cm/s. Patients with pathology atcraniovertebral junction were considered separately (group I) from others (group II) due to different flow dynamics. Follow-up scans were performed after an interval of 1 month for temporal evaluation of changes in CSF flow dynamics. Results Patients in both groups showed a significant change in peak CSF velocity postoperatively (mean change of 1.34 cm/s in group I and 0.28 cm/s in group II) with bidirectional improvement in flow on cine-phase-contrast qualitative images. Regional pain (82%) and headache (46%) were seen in most of the patients preoperatively. Postoperatively clinical symptoms improved in 59.5%, static in 26.2%, and worsened in 14.3%. In both the groups, an improvement in clinical symptomatology had significant correlation with mean changes in peak CSF velocity postoperatively (p = 0.04 in both groups). Conclusion PCMRI can effectively evaluate changes in CSF flow noninvasively both pre- and postoperatively. This may have potential role in determining clinical outcome and prognosis of patients undergoing procedures in craniospinal axis.

scholarly journals Standard and cardiac-gated phase-contrast magnetic resonance imaging in the clinical course of patients with Chiari malformation Type I

2011 ◽  
Vol 31 (3) ◽  
pp. E5 ◽  
Author(s):  
Uwe Max Mauer ◽  
Andreas Gottschalk ◽  
Carolin Mueller ◽  
Linda Weselek ◽  
Ulrich Kunz ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Chiari Malformation ◽  
Phase Contrast ◽  
Foramen Magnum ◽  
Central Canal ◽  
Type I ◽  
Csf Flow ◽  
Chiari Malformation Type I ◽  
Cerebrospinal Fluid Flow ◽  
Contrast Magnetic Resonance

Object The causal treatment of Chiari malformation Type I (CM-I) consists of removing the obstruction of CSF flow at the level of the foramen magnum. Cerebrospinal fluid flow can be visualized using dynamic phase-contrast MR imaging. Because there is only a paucity of studies evaluating CSF dynamics in the region of the spinal canal on the basis of preoperative and postoperative measurements, the authors investigated the clinical usefulness of cardiacgated phase-contrast MR imaging in patients with CM-I. Methods Ninety patients with CM-I underwent preoperative MR imaging of CSF pulsation. Syringomyelia was present in 59 patients and absent in 31 patients. Phase-contrast MR imaging of the entire CNS was used to investigate 22 patients with CM-I before surgery and after a mean postoperative period of 12 months (median 12 months, range 3–33 months). In addition to the dynamic studies, absolute flow velocities, the extension of the syrinx, and tonsillar descent were also measured. Results The changes in pulsation were highly significant in the region of the (enlarged) cistern (p = 0.0005). Maximum and minimum velocities (the pulsation amplitude) increased considerably in the region where the syrinx was largest in diameter. The changes of pulsation in these patients were significant in the subarachnoid space in all spinal segments but not in the syrinx itself and in the central canal. Conclusions The demonstration of CSF flow pulsation can contribute to assessments of surgical outcomes. The results presented here, however, raise doubts about current theories on the pathogenesis of syringomyelia.

scholarly journals Risks, costs, and outcomes of cerebrospinal fluid leaks after pediatric skull fractures: a MarketScan analysis between 2007 and 2015

2019 ◽  
Vol 47 (5) ◽  
pp. E10
Author(s):  
Kunal Varshneya ◽  
Adrian J. Rodrigues ◽  
Zachary A. Medress ◽  
Martin N. Stienen ◽  
Gerald A. Grant ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Neurological Deficits ◽  
Csf Leak ◽  
Skull Fractures ◽  
Pediatric Head Trauma ◽  
Cerebrospinal Fluid Leaks ◽  
Neurosurgical Intervention ◽  
Csf Leaks

OBJECTIVESkull fractures are common after blunt pediatric head trauma. CSF leaks are a rare but serious complication of skull fractures; however, little evidence exists on the risk of developing a CSF leak following skull fracture in the pediatric population. In this epidemiological study, the authors investigated the risk factors of CSF leaks and their impact on pediatric skull fracture outcomes.METHODSThe authors queried the MarketScan database (2007–2015), identifying pediatric patients (age < 18 years) with a diagnosis of skull fracture and CSF leak. Skull fractures were disaggregated by location (base, vault, facial) and severity (open, closed, multiple, concomitant cerebral or vascular injury). Descriptive statistics and hypothesis testing were used to compare baseline characteristics, complications, quality metrics, and costs.RESULTSThe authors identified 13,861 pediatric patients admitted with a skull fracture, of whom 1.46% (n = 202) developed a CSF leak. Among patients with a skull fracture and a CSF leak, 118 (58.4%) presented with otorrhea and 84 (41.6%) presented with rhinorrhea. Patients who developed CSF leaks were older (10.4 years vs 8.7 years, p < 0.0001) and more commonly had skull base (n = 183) and multiple (n = 22) skull fractures (p < 0.05). These patients also more frequently underwent a neurosurgical intervention (24.8% vs 9.6%, p < 0.0001). Compared with the non–CSF leak population, patients with a CSF leak had longer average hospitalizations (9.6 days vs 3.7 days, p < 0.0001) and higher rates of neurological deficits (5.0% vs 0.7%, p < 0.0001; OR 7.0; 95% CI 3.6–13.6), meningitis (5.5% vs 0.3%, p < 0.0001; OR 22.4; 95% CI 11.2–44.9), nonroutine discharge (6.9% vs 2.5%, p < 0.0001; OR 2.9; 95% CI 1.7–5.0), and readmission (24.7% vs 8.5%, p < 0.0001; OR 3.4; 95% CI 2.5–4.7). Total costs at 90 days for patients with a CSF leak averaged $81,206, compared with $32,831 for patients without a CSF leak (p < 0.0001).CONCLUSIONSThe authors found that CSF leaks occurred in 1.46% of pediatric patients with skull fractures and that skull fractures were associated with significantly increased rates of neurosurgical intervention and risks of meningitis, hospital readmission, and neurological deficits at 90 days. Pediatric patients with skull fractures also experienced longer average hospitalizations and greater healthcare costs at presentation and at 90 days.

scholarly journals Brain blood and cerebrospinal fluid flow dynamics during rhythmic handgrip exercise in young healthy men and women

2021 ◽  
Author(s):  
Takashi Tarumi ◽  
Takayuki Yamabe ◽  
Marina Fukuie ◽  
David C. Zhu ◽  
Rong Zhang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Flow Dynamics ◽  
Handgrip Exercise ◽  
Men And Women ◽  
Cerebrospinal Fluid Flow ◽  
Healthy Men

scholarly journals Analysis of Intracranial CSF Flow Dynamics in Phase-Contrast Cine MRI

1996 ◽  
Vol 52 (9) ◽  
pp. 1191
Author(s):  
Harumasa Kasai ◽  
Toshiaki Miyati ◽  
Tatsuo Banno ◽  
Kazuya Ohashi ◽  
Takahiro Sakurai ◽  
...  
Keyword(s):  
Phase Contrast ◽  
Flow Dynamics ◽  
Cine Mri ◽  
Csf Flow

In vitro experiment for verification of the tandem shunt valve system: a novel method for treating hydrocephalus by flexibly controlling cerebrospinal fluid flow and intracranial pressure

2013 ◽  
Vol 11 (1) ◽  
pp. 43-47
Author(s):  
Yasuo Aihara ◽  
Ichiro Shoji ◽  
Yoshikazu Okada
Keyword(s):  
Intracranial Pressure ◽  
Flow Rate ◽  
Csf Shunt ◽  
Main Function ◽  
Csf Flow ◽  
Shunt Valve ◽  
Cerebrospinal Fluid Flow ◽  
Valve System ◽  
Programmable Valve

Object The CSF shunt valve is a medical device whose main function is to regulate intracranial pressure and drain excess CSF. The authors have developed a new therapeutic method for treating hydrocephalus, namely the tandem shunt valve system, which has the potential of flexibly controlling the CSF flow rate and intracranial pressure in patients. Methods The properties of the tandem system were verified by performing in vitro experiments. An in vitro system with a manometer was built to measure pressure and flow rates of water in open systems using the Codman Hakim Programmable Valve and the Strata adjustable pressure programmable valve. A single valve and 2 single shunt valves connected in series (the tandem shunt valve system) were connected to the manometer to check the final pressure. Results Conventional single shunt valve systems require valve pressures to be set higher to slow down the CSF flow rate, which inevitably results in a higher final pressure. On the other hand, the tandem shunt valve system uses the combination of 2 valves to slow the CSF flow rate without increasing the final pressure. Conclusions The authors succeeded in experimentally demonstrating in vitro results of tandem systems and their effectiveness by applying a model to show that the valve with the higher pressure setting determined the final pressure of the entire system and the flow rate became slower than single shunt valve systems.

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