scholarly journals Cough-Associated Changes in CSF Flow in Chiari I Malformation Evaluated by Real-Time MRI

2015 ◽  
Vol 37 (5) ◽  
pp. 825-830 ◽  
Author(s):  
R. A. Bhadelia ◽  
S. Patz ◽  
C. Heilman ◽  
D. Khatami ◽  
E. Kasper ◽  
...  
Keyword(s):  
Real Time ◽  
Chiari I Malformation ◽  
Csf Flow ◽  
Chiari I

scholarly journals Relationship between Cough-Associated Changes in CSF Flow and Disease Severity in Chiari I Malformation: An Exploratory Study Using Real-Time MRI

2018 ◽  
Vol 39 (7) ◽  
pp. 1267-1272 ◽  
Author(s):  
A.F. Bezuidenhout ◽  
D. Khatami ◽  
C.B. Heilman ◽  
E.M. Kasper ◽  
S. Patz ◽  
...  
Keyword(s):  
Real Time ◽  
Disease Severity ◽  
Exploratory Study ◽  
Chiari I Malformation ◽  
Csf Flow ◽  
Chiari I

scholarly journals Interpretation and value of MR CSF flow studies for paediatric neurosurgery

2013 ◽  
Vol 17 (1) ◽  
pp. 26-29 ◽  
Author(s):  
Samukelisiwe Sithembile Mbonane ◽  
Savvas Andronikou
Keyword(s):  
Imaging Techniques ◽  
Aqueductal Stenosis ◽  
Chiari I Malformation ◽  
Invasive Technique ◽  
Third Ventriculostomy ◽  
Csf Flow ◽  
Mechanical Coupling ◽  
Non Invasive ◽  
Technical Requirements ◽  
Chiari I

Imaging techniques may be underutilised when clinicians are unaware of the technique or do not recognise its potential. Phase-contrast MR imaging (PC-MRI) is a rapid, simple and non-invasive technique that is sensitive to CSF flow. It demonstrates a mechanical coupling between cerebral blood and CSF flow throughout the cardiac cycle. Neurosurgeons should be able to request this procedure routinely as part of an MRI request. This paper gives an overview of the indications, technical requirements, technique and interpretation, using image examples. Indications for CSF flow studies include assessment and functionality of shunt treatment in patients with hydrocephalus; hydrocephalus associated with achondroplasia; Chiari I malformation; confirmation of aqueductal stenosis; and determining patency of a third ventriculostomy.

Correlation of hindbrain CSF flow and outcome after surgical decompression for Chiari I malformation

2008 ◽  
Vol 24 (7) ◽  
pp. 833-840 ◽  
Author(s):  
Matthew J. McGirt ◽  
April Atiba ◽  
Frank J. Attenello ◽  
Bruce A. Wasserman ◽  
Ghazala Datoo ◽  
...  
Keyword(s):  
Chiari I Malformation ◽  
Surgical Decompression ◽  
Csf Flow ◽  
Chiari I

scholarly journals Analysis of magnetic resonance imaging–based blood and cerebrospinal fluid flow measurements in patients with Chiari I malformation: a system approach

2001 ◽  
Vol 11 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Noam Alperin ◽  
Kirti Kulkarni ◽  
Ben Roitberg ◽  
Francis Loth ◽  
Naren K. Pandian ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Cardiac Cycle ◽  
Chiari I Malformation ◽  
Intracranial Volume ◽  
Resonance Imaging ◽  
Csf Flow ◽  
Chiari I ◽  
Systolic Phase

Object A pilot study was performed to assess noninvasively the change in intracranial compliance (ICC) and intracranial pressure (ICP) in patients with Chiari I malformation who undergo foramen magnum decompression. The working hypothesis was that the main effect of the decompressive surgery is a change in ICP. Noninvasive cine phase-contrast magnetic resonance (MR) imaging is a motion-sensitive dynamic MR imaging technique that allows for visualization and quantitation of tissue motion and flow. The authors' group has used dynamic phase-contrast MR imaging to visualize and quantify pulsatile blood and cerebrospinal fluid (CSF) flow in the craniospinal system. Methods A system approach has been used to characterize the hemodynamic–hydrodynamic coupling in the craniospinal system and to derive measures for ICC and ICP. Magnetic resonance imaging–based ICC and ICP values are derived from the ratio of the volume and pressure changes that occur naturally during each cardiac cycle. The authors conducted a prospective study of four patients, three of whom were studied before and after decompressive surgery; significant change in MR imaging–derived ICC and ICP values was documented in only one of the three surgically treated patients. A significant change in the dynamics of the intracranial volume change (ICVC) during the cardiac cycle, however, was observed in all three patients. In healthy individuals the ICVC waveform usually consists of the following sequence: monotonic increase in intracranial volume (ICV) during the systolic phase due to increased blood inflow, monotonic decrease in ICV caused by the onset of CSF outflow into the spinal canal, and increase in the venous outflow. A nonmonotonic decline in the ICVC waveform has been observed in all patients with headaches, and a relatively normal waveform was found in those without headaches or whose headaches were resolved or alleviated by the surgery. A “partial-valve” mechanism is proposed as an explanation for the abnormal ICVC dynamics. The monotonic decline in ICVC is interrupted by a “premature” reduction in the CSF outflow. This may be caused by a displacement of the hindbrain into the cervical spinal canal during the systolic phase. This obstructs the CSF flow at the later part of the systolic phase such that the ICV does not continue its gradual decline. Postsurgery, the ICVC waveforms presented a more normal-appearing ICVC dynamics profile. Conclusions Magnetic resonance imaging measurement of transcranial CSF and blood flow may lead to a better understanding of the pathophysiology of Chiari malformations and may prove to be an important diagnostic tool for guiding for the treatment of patients with Chiari I malformation.

scholarly journals Changes in cerebrospinal fluid flow assessed using intraoperative MRI during posterior fossa decompression for Chiari malformation

2015 ◽  
Vol 122 (5) ◽  
pp. 1068-1075 ◽  
Author(s):  
Aaron E. Bond ◽  
John A. Jane ◽  
Kenneth C. Liu ◽  
Edward H. Oldfield
Keyword(s):  
Posterior Fossa ◽  
Intraoperative Imaging ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Intraoperative Mri ◽  
Cine Mri ◽  
Posterior Fossa Decompression ◽  
Csf Flow ◽  
Chiari I ◽  
Adequate Decompression

OBJECT The authors completed a prospective, institutional review board–approved study using intraoperative MRI (iMRI) in patients undergoing posterior fossa decompression (PFD) for Chiari I malformation. The purpose of the study was to examine the utility of iMRI in determining when an adequate decompression had been performed. METHODS Patients with symptomatic Chiari I malformations with imaging findings of obstruction of the CSF space at the foramen magnum, with or without syringomyelia, were considered candidates for surgery. All patients underwent complete T1, T2, and cine MRI studies in the supine position preoperatively as a baseline. After the patient was placed prone with the neck flexed in position for surgery, iMRI was performed. The patient then underwent a bone decompression of the foramen magnum and arch of C-1, and the MRI was repeated. If obstruction was still present, then in a stepwise fashion the patient underwent dural splitting, duraplasty, and coagulation of the tonsils, with an iMRI study performed after each step guiding the decision to proceed further. RESULTS Eighteen patients underwent PFD for Chiari I malformations between November 2011 and February 2013; 15 prone preincision iMRIs were performed. Fourteen of these patients (93%) demonstrated significant improvement of CSF flow through the foramen magnum dorsal to the tonsils with positioning only. This improvement was so notable that changes in CSF flow as a result of the bone decompression were difficult to discern. CONCLUSIONS The authors observed significant CSF flow changes when simply positioning the patient for surgery. These results put into question intraoperative flow assessments that suggest adequate decompression by PFD, whether by iMRI or intraoperative ultrasound. The use of intraoperative imaging during PFD for Chiari I malformation, whether by ultrasound or iMRI, is limited by CSF flow dynamics across the foramen magnum that change significantly when the patient is positioned for surgery.

Toward a rational treatment of Chiari I malformation and syringomyelia

2000 ◽  
Vol 8 (3) ◽  
pp. 1-10 ◽  
Author(s):  
Richard G. Ellenbogen ◽  
Rocco A. Armonda ◽  
Dennis W. W. Shaw ◽  
H. Richard Winn
Keyword(s):  
Mr Imaging ◽  
Posterior Fossa ◽  
Phase Contrast ◽  
Chiari I Malformation ◽  
Pathological Findings ◽  
Csf Flow ◽  
Rational Treatment ◽  
Flow Profiles ◽  
Cine Mr ◽  
Chiari I

In patients with Chiari I malformation with and without associated syringomyelia, aberrant cerebrospinal fluid (CSF) dynamics and a spectrum of posterior fossa pathological findings are demonstrated. In this study, the authors test the validity of using prospective cardiac-gated phase-contrast cine-mode magnetic resonance (MR) imaging to define the malformation, delineate its pathophysiology, and assist in implementing a rational treatment plan. Eighty-five cases were prospectively analyzed using cine MR imaging. Sixty-five patients, adults and children, with symptomatic Chiari malformation, with and without syringomyelia, were surgically treated from 1990 to 1999. All patients underwent pre- and postoperative cine MR evaluation. Ten patients were treated after a previous surgical procedure had failed. To establish CSF flow characteristics and normative CSF profiles, 20 healthy volunteers were examined. Compared with normal volunteers, in Chiari I malformation patients with and without syringomyelia, uniformly abnormal craniocervical junction CSF flow profiles were revealed. After intradural exploration, nearly all patients with Chiari I malformation experienced clinical improvement and CSF flow profiles, paralleling those of normal volunteers, were shown. In all patients in whom treatment had failed, abnormal preoperative CSF flow profiles, which correlated with suspected physiological abnormalities and the pathological findings noted at reoperation, were demonstrated. Symptomatic Chiari I malformation is a dynamic process characterized by the impaction of the hindbrain in an abnormal posterior fossa. This compression obstructs the normal venting of CSF in and out of the craniocervical sub-arachnoid space, throughout the cardiac cycle. Therefore, decompression or enlargement of the posterior fossa to establish normal CSF pathways should be the primary goal of surgical intervention. Aberrant CSF flow appears to be only one aspect of the pathological condition found in patients with Chiari I malformation. Arachnoid scarring in the posterior fossa and selective vulnerability of the spinal cord may also be factors in the pathogenesis and maintenance of associated syringomyelia. Phase-contrast cine MR imaging is a useful tool in defining physiological and anatomical problems in patients with Chiari I and syringomyelia, and it can help guide an appropriate primary or salvage surgical therapy.

scholarly journals CSF Flow through the Upper Cervical Spinal Canal in Chiari I Malformation

2011 ◽  
Vol 32 (6) ◽  
pp. 1149-1153 ◽  
Author(s):  
S. Shah ◽  
V. Haughton ◽  
A. Muñoz del Río
Keyword(s):  
Spinal Canal ◽  
Chiari I Malformation ◽  
Csf Flow ◽  
Cervical Spinal Canal ◽  
Upper Cervical ◽  
Chiari I ◽  
Flow Through

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.

CSF flow study in Chiari I malformation

2004 ◽  
Vol 20 (5) ◽  
pp. 336-340 ◽  
Author(s):  
M. Panigrahi ◽  
B. Praveen Reddy ◽  
A. K. Reddy ◽  
J. J. M. Reddy
Keyword(s):  
Chiari I Malformation ◽  
Csf Flow ◽  
Chiari I ◽  
Flow Study
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