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.

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.

CEREBROSPINAL FLUID FLOW IN THE CERVICAL SPINAL CANAL IN PATIENTS WITH CHRONIC NECK PAIN

2000 ◽  
Vol 41 (6) ◽  
pp. 578-583
Author(s):  
R. K. Parkkola ◽  
U. M. Rytokoski ◽  
M. E. S. Komu ◽  
C. Thomsen
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Neck Pain ◽  
Spinal Canal ◽  
Chronic Neck Pain ◽  
Cerebrospinal Fluid Flow ◽  
Cervical Spinal Canal

Numerical simulations of the pulsating flow of cerebrospinal fluid flow in the cervical spinal canal of a Chiari patient

2014 ◽  
Vol 47 (5) ◽  
pp. 1082-1090 ◽  
Author(s):  
Anders Helgeland ◽  
Kent-Andre Mardal ◽  
Victor Haughton ◽  
Bjørn Anders Pettersson Reif
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Numerical Simulations ◽  
Spinal Canal ◽  
Pulsating Flow ◽  
Cerebrospinal Fluid Flow ◽  
Cervical Spinal Canal

CEREBROSPINAL FLUID FLOW IN CERVICAL SPINAL CANAL

2008 ◽  
Vol 41 ◽  
pp. S359
Author(s):  
Agnieszka Kaczmarská ◽  
Zbyšek Štěpáník ◽  
Hana Jeřábková ◽  
Petr Vaněk ◽  
Vítězslav Štembera ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Spinal Canal ◽  
Cerebrospinal Fluid Flow ◽  
Cervical Spinal Canal

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.

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.

Cerebrospinal fluid flow in the cervical spinal canal in patients with chronic neck pain

2000 ◽  
Vol 41 (6) ◽  
pp. 578-583 ◽  
Author(s):  
R.K. Parkkola ◽  
U.M. Rytökoski ◽  
M.E.S. Komu ◽  
C. Thomsen
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Neck Pain ◽  
Spinal Canal ◽  
Chronic Neck Pain ◽  
Cerebrospinal Fluid Flow ◽  
Cervical Spinal Canal

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.

CFD Modeling for Patient-Specific Analysis of Cerebrospinal Fluid Flow

2007 ◽  
Author(s):  
Alejandro Roldán ◽  
Andrew Wentland ◽  
Oliver Wieben ◽  
Victor Haughton ◽  
Tim Osswald ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Canal ◽  
Chiari Malformation ◽  
Cfd Modeling ◽  
Patient Specific ◽  
Variable Response ◽  
Cervical Spinal Canal ◽  
Upper Cervical ◽  
The Impact ◽  
Cerebellar Tonsils

Chiari malformations are characterized by the cerebellar tonsils extending into the upper cervical spinal canal. Many patients with Chiari malformation experience headaches or develop a cyst in the spinal cord inferior to the cerebellar tonsils. Some symptomatic patients benefit from a surgical procedure to enlarge the foramen magnum and others do not. The causes of symptoms and variable response to surgery remain unknown. Imaging studies have shown that patients with a Chiari malformation exhibit increased cerebrospinal fluid (CSF) velocities compared to subjects without the malformation. Improved methods of analyzing the CSF fluid dynamics are needed to evaluate the impact of increased fluid velocities on pressure differentials in the upper cervical spinal canal and the potential impact of surgery on flow dynamics in patient specific geometries.

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