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.

Relation of Cerebrospinal Fluid Flow Impedance and Cerebellar Herniation in Type I Chiari Malformation

2013 ◽  
Author(s):  
Nicholas Shaffer ◽  
Bryn Martin ◽  
Brandon Rocque ◽  
Casey Madura ◽  
Bermans Iskandar ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Healthy Volunteers ◽  
Chiari Malformation ◽  
Cerebellar Tonsil ◽  
Type I ◽  
Cerebrospinal Fluid Flow ◽  
Asymptomatic Patients ◽  
Longitudinal Impedance ◽  
Spinal Subarachnoid Space ◽  
Flow Impedance

This study investigates the use of longitudinal impedance (LI) as a means to quantify the severity of Type I Chiari Malformation (CMI). LI was analyzed in image-based models of the cervical spinal subarachnoid space of 22 CMI patients and 10 healthy volunteers. LI was then compared with the cerebellar tonsil herniation (CTH) measured by two neurosurgeons. Results showed that both LI and CTH differentiated CMI patients from healthy volunteers, but lacked the specificity to differentiate symptomatic and asymptomatic patients.

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.

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.

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.

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 Breaking Barriers for Cerebrospinal Fluid Flow in Chiari Malformation Type I: “What and How Much Is Enough?” A Retrospective Analysis of 74 Cases

2018 ◽  
Vol 07 (03) ◽  
pp. 196-208
Author(s):  
Manish Jaiswal ◽  
Amit Patil ◽  
Radhey Mittal
Keyword(s):  
Cerebrospinal Fluid ◽  
Natural History ◽  
Retrospective Analysis ◽  
Chiari Malformation ◽  
Foramen Magnum ◽  
Common Finding ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Compression Syndrome ◽  
History Of

Abstract Introduction: Chiari malformation type I is a collection of hindbrain abnormalities, for which natural history of the disease process is not clear. The challenge is to identify which patients will benefit most from posterior fossa decompression. Objectives: To identify important surgical implications that most likely benefit patients with Chiari malformation type I by analyzing and reviewing various operative interventions in these patients with appropriate symptoms and then following their course. Subjects & Methods: Retrospective analysis of 74 operated Chiari malformation type I with syrinx adult patients was done. Results: No definite pattern of progression in natural history of disease was noted. Most of the patients who were symptomatically stable for months to years presented with recent rapid progression. The most common symptom was suboccipital pain. The most common finding was lower extremity weakness. On clinical presentation basis, patients were divided into three categories: foramen magnum compression syndrome, central cord syndrome, and cerebellar syndrome. Most patients in our study fall in first category. Foramen magnum decompression with atlas posterior arch removal and sometimes partial C2 laminectomy depending on extent of tonsillar descent as well as augmentation duraplasty was done in most patients. Improvement was seen in foramen magnum compression syndrome group more significantly. Conclusions: Individualized surgical techniques for breaking the barriers of cerebrospinal fluid (CSF) flow in Chiari malformation type I with syrinx to restore normal CSF dynamics across craniocervical junction provide the pragmatic solution. The trend is toward balance between optimum wide decompression as compared with long craniocaudal decompression and preserving normal integrity.

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.

Prognostic significance of C1–C2 facet malalignment after surgical decompression in adult Chiari malformation type I: a pilot study based on the Chicago Chiari Outcome Scale

2020 ◽  
pp. 1-7
Author(s):  
Michael Lumintang Loe ◽  
Tito Vivas-Buitrago ◽  
Ricardo A. Domingo ◽  
Johan Heemskerk ◽  
Shashwat Tripathi ◽  
...  
Keyword(s):  
Pilot Study ◽  
Chiari Malformation ◽  
Prognostic Significance ◽  
Foramen Magnum ◽  
Bivariate Analysis ◽  
Type I ◽  
Foramen Magnum Decompression ◽  
Swallowing Function ◽  
Chiari Malformation Type I

OBJECTIVEThe authors assessed the prognostic significance of various clinical and radiographic characteristics, including C1–C2 facet malalignment, in terms of surgical outcomes after foramen magnum decompression of adult Chiari malformation type I.METHODSThe electronic medical records of 273 symptomatic patients with Chiari malformation type I who were treated with foramen magnum decompression, C1 laminectomy, and duraplasty at Mayo Clinic were retrospectively reviewed. Preoperative and postoperative Neurological Scoring System scores were compared using the Friedman test. Bivariate analysis was conducted to identify the preoperative variables that correlated with the patient Chicago Chiari Outcome Scale (CCOS) scores. Multiple linear regression analysis was subsequently performed using the variables with p < 0.05 on the bivariate analysis to check for independent associations with the outcome measures. Statistical software SPSS version 25.0 was used for the data analysis. Significance was defined as p < 0.05 for all analyses.RESULTSFifty-two adult patients with preoperative clinical and radiological data and a minimum follow-up of 12 months were included. Motor deficits, syrinx, and C1–C2 facet malalignment were found to have significant negative associations with the CCOS score at the 1- to 3-month follow-up (p < 0.05), while at the 9- to 12-month follow-up only swallowing function and C1–C2 facet malalignment were significantly associated with the CCOS score (p < 0.05). Multivariate analysis showed that syrinx presence and C1–C2 facet malalignment were independently associated with the CCOS score at the 1- to 3-month follow-up. Swallowing function and C1–C2 facet malalignment were found to be independently associated with the CCOS score at the 9- to 12-month follow-up.CONCLUSIONSThe observed results in this pilot study suggest a significant negative correlation between C1–C2 facet malalignment and clinical outcomes evaluated by the CCOS score at 1–3 months and 9–12 months postoperatively. Prospective studies are needed to further validate the prognostic value of C1–C2 facet malalignment and the potential role of atlantoaxial fixation as part of the treatment.

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