title: Evaluating the effect of decompression surgery on cerebrospinal fluid flow and intracranial compliance in patients with chiari malformation with magnetic resonance imaging flow studies.
abstract: OBJECTIVE
  To quantify the effect of decompression surgery on craniocervical junction hydrodynamics and on global intracranial compliance (ICC) in patients with Chiari I malformation by use of magnetic resonance measurements of cerebrospinal fluid and blood flow. Studying the effect of decompression surgery may improve our understanding of the pathophysiological characteristics of Chiari I malformation and aid in identifying patients who will benefit from the procedure.
  
  
  METHODS
  Twelve patients were studied with a 1.5-T magnetic resonance imaging scanner before and after decompression surgery. Cine phase contrast magnetic resonance images were used to quantify maximum cord displacement, maximum systolic cerebrospinal fluid velocity and volumetric flow rate, and overall ICC. ICC was derived by use of a previously reported method that measures small changes in intracranial volume and pressure that occur naturally with each cardiac cycle.
  
  
  RESULTS
  After surgery, changes were documented both in the local hydrodynamic parameters and in ICC. However, only the change in ICC, an average increase of more than 60%, was statistically significant. Increased ICC, which was associated with improved outcome, was measured in 10 of the 12 patients, no significant change was documented in 1 patient, and decreased ICC was measured in 1 patient whose symptoms persisted after surgery.
  
  
  CONCLUSIONS
  An increase in the overall compliance of the intracranial compartment is the most significant and consistent change measured after decompression surgery. Changes in cord displacement, cerebrospinal fluid velocities, and flow in the craniospinal junction were less consistent and less affected by the operation. Thus, ICC may play an important role in the outcome of decompression surgery related to improving symptoms and restoring normal neurological hydrodynamics in patients with Chiari I malformations.
authors.affiliation: Department of Radiology, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
authors.forename: Anusha
authors.initials: A
authors.lastname: Sivaramakrishnan
authors.forename: Noam
authors.initials: N
authors.lastname: Alperin
authors.forename: Sushma
authors.initials: S
authors.lastname: Surapaneni
authors.forename: Terry
authors.initials: T
authors.lastname: Lichtor
mesh_terms: D000328:Adult; D001139:Arnold-Chiari Malformation / Q000601:surgery*; D001933:Brain Stem / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D002555:Cerebrospinal Fluid / Q000378:metabolism; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology*; D003187:Compliance; D019299:Decompression, Surgical / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D012886:Skull / Q000378:metabolism; D013115:Spinal Canal / Q000378:metabolism