Morphometric analysis of the craniocervical juncture in children with Chiari I malformation and concomitant syringobulbia

Abstract

Based on our study, the mechanism behind such cerebrospinal fluid distention into the brain stem remains elusive with no single morphometrical difference in patients with CIM and syringobulbia compared to other patients with CIM. Perhaps, future testing aimed at identifying pressure gradients across the foramen magnum in patients with and without syringobulbia and concomitant CIM may be useful.

Cerebrospinal Fluid Flow Impedance is Elevated in Type I Chiari Malformation

“…4(a)) and no clear stratification of symptomatic and asymptomatic CMI models. The two lowest values in the LI distribution for CMI patients fell within the range of values (157-303 dyn/cm 5 ) for the healthy volunteer group. These data points were from one symptomatic CMI model (290 dyn/cm [5]) and one asymptomatic CMI model (216 dyn/cm 5 ).…”

“…Intersite variability was assessed by comparing LI for the three models. Values of LI obtained from the three simulations were 246, 251, and 286 dyn/ cm [5] for SSS models from sites 1, 2, and 3, respectively. This showed that LI computed by the methods of this study may be as much as 16% different if a particular subject were imaged at a different site or on a different day.…”

“…Impedance modulus, Z L , was calculated by computing the ratio of Fourier coefficients of the pressure drop F DP t ð Þ ð Þ and flow waveforms F ðQðtÞÞ at each harmonic, where Z L ¼ FðDPðtÞÞ=F j ðQðtÞÞj. The resulting Z L (dyn-s/cm 5 ) values for each harmonic were integrated from 1-8 Hz to obtain integrated longitudinal impedance (LI) for each subject [29]. The range of 1-8 Hz was chosen because 90-100% of the signal power for all the flow waveforms used as inlet boundary conditions was contained between those frequencies.…”

“…Patients with CMI can have a variety of neurological symptoms and pain ranging from mild to severe [1]. It is thought that these symptoms result from abnormal pressure acting on the spinal cord, brain stem, and/or cerebellum due to crowding of the tissue in the posterior cranial fossa and craniovertebral junction (CVJ) [4][5][6]. However, large retrospective clinical studies have shown that CMI symptom severity does not always correlate with CTH depth [7].…”

Magnetic resonance 4D flow characteristics of cerebrospinal fluid at the craniocervical junction and the cervical spinal canal

“…Alterations in CSF dynamics have been associated with neurological symptoms and formation of syringomyelia in patients with Chiari malformations and spinal stenosis [5,[7][8][9][10]. In these patients, analysis of morphology alone has proved to be insufficient in explaining the absence or presence of symptoms [11,12]. Instead, dynamic imaging techniques such as cardiac gated steady-state free precession (SSFP) cine imaging have been suggested to analyse changes in bulk movement of the brain and spinal cord [13].…”