Chiari malformation: CSF flow dynamics in the craniocervical junction and syrinx.
BACKGROUND
A CSF flow study in patients with Chiari malformation (ChM) who undergo craniocervical junction decompression (CCJD).


METHODS
Using spatial modulation of magnetization (SPAMM), cerebrospinal fluid (CSF) flow velocities were measured at the prepontine (PP), anterior cervical (AC), and posterior cervical (PC) subarachnoid spaces (SAS) in healthy subjects (n = 11) and patients with Chiari malformation (ChM) before and/or after CCJD (n = 15). In the syringes, the intrasyrigeal pulsatile CSF motion was estimated qualitatively as present or absent.


RESULTS
In normal subjects, the mean CSF velocities were 2.4 +/- 0.2 cm/s (PP), 2.8 +/- 0.3 cm/s (AC), and 2.4 +/- 0.2 cm/s (PC). Velocities were significantly lower than normal in patients with ChM prior to CCJD, reduced by 38%, 25%, and 79% in the 3 regions, respectively (P<0.001). Post-CCJD, velocities were 20% (PP), 100% (AC), and 40% (PC) greater than preoperatively (P<0.001).


CONCLUSIONS
In ChM, the posterior cervical CSF flow velocity was low, increased minimally after CCJD and, by itself, had limited predictive value. Post-CCJD, an increase of the sum of anterior and posterior cervical CSF flow velocities by more than 20% consistently preceded or coincided with marked headache improvement. After CCJD, the finding that the intrasyringeal CSF pulsatile motion had become absent was an earlier and more sensitive predictor of motor or sensory improvement than a reduction in syrinx's size. SPAMM can be used to assess whether CCJD has restored CSF flow, predict outcome and provide pathophysiological insights in ChM and syringomyelia.
Sakas
D E
DE
Department of Neurosurgery, University of Athens, Evangelismos General Hospital, Athens, Greece.
Korfias
S I
SI
Wayte
S C
SC
Beale
D J
DJ
Papapetrou
K P
KP
Stranjalis
G S
GS
Whittaker
K W
KW
Whitwell
H L
HL
D000293:Adolescent; D000328:Adult; D001139:Arnold-Chiari Malformation / Q000175:diagnosis / Q000503:physiopathology*; D001933:Brain Stem / Q000473:pathology / Q000503:physiopathology; D002531:Cerebellum / Q000473:pathology / Q000503:physiopathology; D002555:Cerebrospinal Fluid / Q000502:physiology*; D002574:Cervical Vertebrae / Q000473:pathology / Q000503:physiopathology; D002648:Child; D003388:Cranial Fossa, Posterior / Q000473:pathology / Q000503:physiopathology; D019299:Decompression, Surgical; D005260:Female; D006261:Headache / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011237:Predictive Value of Tests; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology; D013346:Subarachnoid Space / Q000473:pathology / Q000503:physiopathology*; D013595:Syringomyelia / Q000175:diagnosis / Q000503:physiopathology*; D000267:Tissue Adhesions / Q000150:complications / Q000517:prevention & control