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

Sakas, Damianos E.; Korfias, Stefanos; Wayte, Sarah; Beale, David; Papapetrou, K. P.; Stranjalis, Georgios; Whittaker, Karl W; Whitwell, Helen

doi:10.1007/s00701-005-0645-9

Cited by 48 publications

(35 citation statements)

References 28 publications

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“…27 Second, the peak velocities and flow durations reported by us are consistent with results obtained by others using sagittal cine-PC imaging in different Chiari I populations. 13,14,25,26 Finally, long diastolic durations observed by us in patients with Chiari I with CAH with sagittal imaging are consistent with the phenomenon of anterior diastolic CSF flow jets reported in symptomatic patients with Chiari I by Quigley et al 19 by using axial cine-PC imaging. These investigators also observed simultaneous bidirectional flow at the foramen magnum.…”

Section: Discussionsupporting

confidence: 85%

“…13,14,25,26 Although it is difficult to directly compare these results with those of our observations (in the absence of the knowledge of how many of their patients had CAH), the reported CSF velocities and durations in these different Chiari I patient populations are similar to our results. 13,14,25,26 Because the differences in CSF flow between patients with Chiari I and healthy subjects has been thoroughly evaluated previously, in this study, we only sought to correlate cine-PC-demonstrated CSF flow abnormalities to the specific subjective symptom of CAH.…”

Section: Discussionsupporting

confidence: 75%

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Cough-Associated Headache in Patients with Chiari I Malformation: CSF Flow Analysis by Means of Cine Phase-Contrast MR Imaging

Bhadelia¹,

Frederick²,

Patz³

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY:The purpose of this study was to analyze the CSF flow in patients with Chiari I to determine differences between patients with and without CAH. Thirty patients with Chiari I malformation underwent cine-PC CSF flow imaging in the sagittal plane. CSF flow pulsations were analyzed by placing regions of interest in the anterior cervical subarachnoid space. Maximum CSF systolic (craniocaudal) and diastolic (caudocranial) velocities as well as the durations of CSF systole and diastole (measured in fractions of the cardiac cycle) were determined. In the region of interest just below the foramen magnum, patients with CAH had a significantly shorter CSF systole and longer diastole (P ϭ .02). A CSF diastolic length of Ն0.75 of the cardiac cycle was 67% sensitive and 86% specific for CAH. Our results indicate that Cine-PC imaging can show differences in CSF flow patterns in patients with Chiari I with and without CAH.ABBREVIATIONS: CAH ϭ cough-associated headache; Cine-PC ϭ cine phase-contrast; CSF diastole ϭ duration of CSF diastolic flow (fraction of the cardiac cycle); CSF systole ϭ duration of CSF systolic flow (fraction of the cardiac cycle); MSV ϭ maximum systolic velocity (millimeters/second); MDV ϭ maximum diastolic velocity (millimeters/second)

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 75%

Cough-Associated Headache in Patients with Chiari I Malformation: CSF Flow Analysis by Means of Cine Phase-Contrast MR Imaging

Bhadelia¹,

Frederick²,

Patz³

et al. 2011

AJNR Am J Neuroradiol

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“…[1][2][3][4][5][6][7][8][9][11][12][13][14][15][16][17][18][19][65][66][67]70,71,100,[102][103][104][105][106][107][108][109][110][111][113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128][129][130][132]…”

Section: General Informationunclassified

“…Combined series, which included both pediatric and adult patients, constituted 61 reports (42%). [5][6][7]9,11,12,[25][26][27]34,37,38,40,43,44,46,47,52,53,55,63,66,67,70,73,74,76,83,87,90,91,94,96,100,102,103,106,110,111,114,115,117,121,126,127,129,130,132,135,[138][139][140]…”

Section: General Informationmentioning

confidence: 99%

Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Arnautovic

Splavski

Boop

et al. 2015

PED

205

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OBJECT Chiari malformation Type I (CM-I) is a hindbrain disorder associated with elongation of the cerebellar tonsils, which descend below the foramen magnum into the spinal canal. It occurs in children and adults. Clinical symptoms mainly develop from alterations in CSF flow at the foramen magnum and the common subsequent development of syringomyelia. METHODS The authors reviewed English-language reports of pediatric, adult, and combined (adult and pediatric) surgical series of patients with CM-I published from 1965 through August 31, 2013, to investigate the following: 1) geographical distribution of reports; 2) demographics of patients; 3) follow-up lengths; 4) study durations; 5) spectrum and frequency of surgical techniques; 6) outcomes for neurological status, syrinx, and headache; 7) frequency and scope of complications; 8) mortality rates; and 9) differences between pediatric and adult populations. Research and inclusion criteria were defined, and all series that contained at least 4 cases and all publications with sufficient data for analysis were included. RESULTS The authors identified 145 operative series of patients with CM-I, primarily from the United States and Europe, and divided patient ages into 1 of 3 categories: adult (> 18 years of age; 27% of the cases), pediatric (≤ 18 years of age; 30%), or unknown (43%). Most series (76%) were published in the previous 21 years. The median number of patients in the series was 31. The mean duration of the studies was 10 years, and the mean follow-up time was 43 months. The peak ages of presentation in the pediatric studies were 8 years, followed by 9 years, and in the adult series, 41 years, followed by 46 years. The incidence of syringomyelia was 65%. Most of the studies (99%) reported the use of posterior fossa/foramen magnum decompression. In 92%, the dura was opened, and in 65% of these cases, the arachnoid was opened and dissected; tonsillar resection was performed in 27% of these patients. Postoperatively, syringomyelia improved or resolved in 78% of the patients. Most series (80%) reported postoperative neurological outcomes as follows: 75% improved, 17% showed no change, and 9% experienced worsening. Postoperative headaches improved or resolved in 81% of the patients, with a statistical difference in favor of the pediatric series. Postoperative complications were reported for 41% of the series, most commonly with CSF leak, pseudomeningocele, aseptic meningitis, wound infection, meningitis, and neurological deficit, with a mean complication rate of 4.5%. Complications were reported for 37% of pediatric, 20% of adult, and 43% of combined series. Mortality was reported for 11% of the series. No difference in mortality rates was seen between the pediatric and adult series. CONCLUSIONS Before undergoing surgical treatment for CM-I, symptomatic patients and their families should be given clear information about the success of treatment and potential complications. Furthermore, surgeons may benefit from comparing published data with their own. In the future, operative CM-I reports should provide all details of each case for the purpose of comparison.

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“…At present, MRI techniques are being developed to measure CSF pressure gradients noninvasively [14], but these methods are not in standard use and have not been validated. In principle, changes in CSF pressure gradients are related to alterations in impedance to CSF motion, CSF velocities [15][16][17][18][19][20][21][22], neural tissue motion [23][24][25], and craniospinal compliance [26][27][28]. We suspect that alterations in each of these biomechanical parameters could prove useful to quantify the biomechanical environment near the CVJ in CMI.…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal Fluid Flow Impedance is Elevated in Type I Chiari Malformation

Shaffer

Martin

Rocque

et al. 2014

Journal of Biomechanical Engineering

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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 ¼ 15) and age-matched healthy controls (N ¼ 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 6 66 dyn/cm 5 ) was significantly higher than in controls (220 6 17 dyn/cm 5 , p < 0.001). Mean CTH in the CMI group was 9.0 6 1.1 mm compared to À0.4 6 0.5 mm in controls. Regression analysis of LI versus CTH found a weak relationship (R 2 ¼ 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.

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

Cited by 48 publications

References 28 publications

Cough-Associated Headache in Patients with Chiari I Malformation: CSF Flow Analysis by Means of Cine Phase-Contrast MR Imaging

Cough-Associated Headache in Patients with Chiari I Malformation: CSF Flow Analysis by Means of Cine Phase-Contrast MR Imaging

Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Cerebrospinal Fluid Flow Impedance is Elevated in Type I Chiari Malformation

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