scholarly journals Cerebrospinal fluid flow impairment in the patients with Chiari malformation: predictors of syringomyeliа cysts development and dynamics of postoperative regression

2021 ◽  
Vol 17 (6) ◽  
pp. 27-36
Author(s):  
L.A. Ktrakyan ◽  
T.S. Havryliv ◽  
V.I. Smolanka ◽  
A.V. Smolanka ◽  
M.M. Oros
Keyword(s):  
Cerebrospinal Fluid ◽  
Chiari Malformation ◽  
Brain Structures ◽  
Foramen Magnum ◽  
Csf Flow ◽  
Cerebrospinal Fluid Flow ◽  
Surgical Interventions ◽  
Clinical Center ◽  
The Central Nervous System ◽  
Clinical Records

Background. Chiari malformation (CM) is a defect in the development of the central nervous system, manifested by the mismatch between the size of the posterior cranial fossa and the brain structures located in this area, and, as a consequence, by the descent of the cerebellar tonsils (CM type 1), usually with a caudal dislocation of the lower parts of the brainstem into the foramen magnum (CM type 1.5). As a result of cerebrospinal fluid (CSF) flow disorders, 60–90 % of patients with CM have syringomyelia. Materials and methods. A retrospective analysis was performed of clinical records of 24 patients with Chiari malformation types 1 and 1.5, who had undergone surgeries at the Uzhhorod Regional Clinical Center of Neurosurgery and Neurology from December 2006 to December 2017, during which suboccipital decompressive craniectomy, C1 laminectomy, duraplasty were performed. The average follow-up period after the surgery was 5 years. Results. In patients whose symptoms lasted for more than 3 years, the frequency of formation of the associated syrinxes was 57 %. The dynamics of the regression of CSF flow disorders in the postoperative period varies considerably depending on age. Conclusions. The risk of syrinx formation within the spinal cord is higher in patients with CM types 1 and 1.5 who have been ill for more than 3 years. Surgical treatment is an effective method used to correct CSF circulation disturbances. The cyst puncture is not obligatory during surgical interventions.

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.

Association Between Resistance to Cerebrospinal Fluid Flow Near the Foramen Magnum and Cough-Associated Headache in Adult Chiari Malformation Type I

2021 ◽  
Author(s):  
Alaaddin Ibrahimy ◽  
Chi-Wen Christina Huang ◽  
Abraham F. Bezuidenhout ◽  
Phillip A. Allen ◽  
Rafeeque A. Bhadelia ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Roc Curve ◽  
Spinal Canal ◽  
Chiari Malformation ◽  
Foramen Magnum ◽  
Patient Specific ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Cerebrospinal Fluid Flow ◽  
Longitudinal Impedance

Abstract Background and Purpose: Cough-associated headaches (CAH) are thought to be distinctive for Chiari malformation type I (CMI) patients and have been shown to be related to the motion of cerebrospinal fluid (CSF) near the foramen magnum. We used computational fluid dynamics (CFD) to compute patient-specific resistance to CSF motion in the spinal canal for CMI patients to determine its accuracy in predicting CAH. Methods: 51 symptomatic CMI patients with cerebellar tonsillar position (CTP) = 5 mm were included in this study. The patients were divided into two groups based on their symptoms (CAH and non-CAH) by review of the neurosurgical records. CFD was utilized to simulate CSF motion and the integrated longitudinal impedance (ILI) was calculated for all patients. A receiver operating characteristic (ROC) curve was evaluated for its accuracy in predicting CAH. Results: The ILI for CMI patients with CAH (776 dyn/cm5, 288-1444 dyn/cm5; median, inter-quartile range) was significantly larger compared to non-CAH (285 dyn/cm5, 187-450 dyn/cm5; p = .001). The ILI was more accurate in predicting CAH in CMI patients than the CTP when the comparison was made using the area under the ROC curve (0.77 and 0.70, for ILI and CTP, respectively). ILI = 750 dyn/cm5 had a sensitivity of 50% and a specificity of 95% in predicting CAH. Conclusions: ILI is a parameter, used to assess CSF blockage in the spinal canal and can predict patients with and without CAH with greater accuracy than CTP.

A Hydrodynamic Model of Cerebrospinal Fluid Flow in Man

1980 ◽  
Vol 35 (3-4) ◽  
pp. 326-339
Author(s):  
Rolf Wüst ◽  
Trygve Kolberg ◽  
Alvaro Palma ◽  
Alfredo Palma
Keyword(s):  
Cerebrospinal Fluid ◽  
Radioactive Decay ◽  
Diagnostic Techniques ◽  
Diagnostic Methods ◽  
Csf Flow ◽  
Cerebrospinal Fluid Flow ◽  
Practical Applications ◽  
Decay Series ◽  
Flow Systems ◽  
The Central Nervous System

Abstract A hydrodynamic bi-compartmental model for the cerebrospinal fluid (CSF) flow in humans is presented which combines anatomical and physiological conditions in the central nervous system with results of special radioisotope diagnostic techniques. Normal and disturbed conditions, the diagnostic methods and the results are explained. A differential equation for the time behaviour of regional radioisotope concentrations is derived by applying to the model mathematical procedures which are familiar from the description of radioactive decay series, or reaction kinetics of chemical or pharmaceutical processes. The solutions are analysed and discussed with respect to findings of isotope diagnostics, and parameters for the complete and quantitative evaluation of CSF flow systems are derived. A system factor is introduced for classification purposes and, in conjunction with basic principles of hydrodynamics, is used to postulate a similarity law of CSF flow systems. The diagnostical and therapeutical value of the model for analysis and simulation of CSF flow systems is discussed. Practical applications to other disciplines are proposed.

scholarly journals Surgical Outcomes of C1-2 Posterior Stabilization in Patients With Chiari Malformation Type 1

2020 ◽  
pp. 219256822094529
Author(s):  
Ali Arslan ◽  
Semih Kivanc Olguner ◽  
Vedat Acik ◽  
İsmail İstemen ◽  
Barış Arslan ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Flow Rate ◽  
Surgical Outcomes ◽  
Chiari Malformation ◽  
Japanese Orthopaedic Association ◽  
Foramen Magnum ◽  
Posterior Fossa Decompression ◽  
Fluid Flow Rate ◽  
Cerebrospinal Fluid Flow

Study Design: Retrospective chart review. Objectives: Chiari malformation (CM) is characterized by a downward displacement of the cerebellar tonsils through the foramen magnum. This tonsillar herniation may sometimes be accompanied by syringomyelia and/or basilar invagination (BI). In this study, we examined the surgical outcomes of patients by underwent C1-2 reduction + fixation (C1-2RF), which is a new method defined by Goel, in the literature. Methods: Between 2015 and 2018, 21 patients (mean age and duration of follow-up: 39 years and 20 months, respectively) with CM were treated with atlantoaxial fixation. We found syringomyelia in all patients and BI in 9 of them. In all cases, radiography, computed tomography, and magnetic resonance imaging were performed radiologically. C1-2RF was performed in all patients. Preoperative and postoperative clinical Japanese Orthopaedic Association scores were obtained. Syrinx size and cerebrospinal fluid flow rate were compared radiologically. Results: All patients were treated with C1-2RF. None of the patients underwent foramen magnum decompression or intervention for the syrinx. Occipital bone and subaxial spinal structures were not included in the fixation. In addition to significant clinical improvement, significant improvement in syringomyelia and cerebrospinal fluid flow rate was seen on the radiographs of all patients. Conclusions: Although posterior fossa decompression and/or duraplasty is a common treatment modality in CM, we propose that the C1-2RF method described by Goel is a radiologically and clinically effective treatment method, whether or not BI and/or syringomyelia in CM are present. This article is the first article of central and axial atlantoaxial dislocation, except for Goel’s writings in the literature.

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.

scholarly journals Cerebrospinal Fluid Flow Impedance is Elevated in Type I Chiari Malformation

2014 ◽  
Vol 136 (2) ◽  
Author(s):  
Nicholas Shaffer ◽  
Bryn A. Martin ◽  
Brandon Rocque ◽  
Casey Madura ◽  
Oliver Wieben ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Chiari Malformation ◽  
Fluid Motion ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Type I ◽  
Cerebrospinal Fluid Flow ◽  
Spinal Subarachnoid Space ◽  
Flow Impedance ◽  
Magnetic Resonance Imaging Mri

Diagnosis of Type I Chiari malformation (CMI) is difficult because the most commonly used diagnostic criterion, cerebellar tonsillar herniation (CTH) greater than 3–5 mm past the foramen magnum, has been found to have little correlation with patient symptom severity. Thus, there is a need to identify new objective measurement(s) to help quantify CMI severity. This study investigated longitudinal impedance (LI) as a parameter to assess CMI in terms of impedance to cerebrospinal fluid motion near the craniovertebral junction. LI was assessed in CMI patients (N = 15) and age-matched healthy controls (N = 8) using computational fluid dynamics based on subject-specific magnetic resonance imaging (MRI) measurements of the cervical spinal subarachnoid space. In addition, CTH was measured for each subject. Mean LI in the CMI group (551 ± 66 dyn/cm5) was significantly higher than in controls (220 ± 17 dyn/cm5, p < 0.001). Mean CTH in the CMI group was 9.0 ± 1.1 mm compared to −0.4 ± 0.5 mm in controls. Regression analysis of LI versus CTH found a weak relationship (R2 = 0.46, p < 0.001), demonstrating that CTH was not a good indicator of the impedance to CSF motion caused by cerebellar herniation. These results showed that CSF flow impedance was elevated in CMI patients and that LI provides different information than a standard CTH measurement. Further research is necessary to determine if LI can be useful in CMI patient diagnosis.

Impedance to Cerebrospinal Fluid Flow in the Cervical Spinal Canal is Dominated by Geometric Complexity

2011 ◽  
Author(s):  
Nicholas Shaffer ◽  
Francis Loth ◽  
Oliver Wieben ◽  
Brandon Rocque ◽  
Bermans Iskandar ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Canal ◽  
Unit Length ◽  
Graft Patency ◽  
Foramen Magnum ◽  
Cerebellar Tonsil ◽  
Type I ◽  
Cerebrospinal Fluid Flow ◽  
Cervical Spinal Canal ◽  
Wide Range

In a fluid system, longitudinal impedance (LI) is the impedance per unit length of a conduit. Its magnitude depends on conduit geometry and the mechanical properties of both the fluid and conduit. In the context of vein grafts, LI has been shown to correlate with vein graft size and graft patency at one year from surgery [1]. More generally, LI has been shown to be consistent over a wide range of physiological flows [2]. Due to its ability to characterize the effect of geometry on flow in a conduit, LI may be useful in examining differences between a healthy spinal canal and one affected by Type I Chiari malformation (CMI). CMI is a complex disorder of the craniospinal system classically characterized by herniation of the cerebellar tonsils of 3–5 mm past the foramen magnum [3], which has proven difficult to properly diagnose as the associated neurological symptoms may overlap with the symptomatology of other disorders. Current methods of quantifying CMI severity, such as cerebellar tonsil herniation depth, do not necessarily correlate with symptom severity. Likewise, studies that have sought to hydrodynamically analyze CMI by measuring cerebrospinal fluid (CSF) velocity have yielded mixed results. We hypothesized that the severity of obstruction to CSF flow in the CMI-affected cervical spinal canal can be quantified and compared by calculation of LI.

Sign in / Sign up

Export Citation Format

Share Document