title: Monitoring of cerebrospinal fluid flow by intraoperative ultrasound in patients with Chiari I malformation.
abstract: OBJECTIVE
  To investigate the feasibility of intraoperative ultrasound (IOUS) for monitoring cerebrospinal fluid (CSF) flow in patients with Chiari I malformation.
  
  
  METHODS
  Twenty patients with Chiari I were scanned by IOUS with color Doppler flow imaging (CDFI). CSF flow status and flow velocity were monitored at different times during the surgery.
  
  
  RESULTS
  CSF flow was detected in all 20 cases by IOUS-CDFI in real time. CSF flow was extremely slow or even ceased following bony decompression (craniectomy+laminectomy) in 19 patients; however, bi-directional flow was observed in the systolic phase and cranially directed flow in the diastolic phase. The maximum flow rate ranged from 4 to 13cm/s after duraplasty, and this varied with respiratory rhythm. Only 1 patient showed typical CSF flow after craniectomy, suggesting sufficient decompression, and without further duraplasty. All surgeries were terminated when bi-directional CSF flow was observed using IOUS-CDFI. With the exception of 1 patient, all the patients' symptoms were significantly relieved.
  
  
  CONCLUSIONS
  IOUS-CDFI can monitor CSF flow during posterior fossa decompression, provide information about the re-circulation of CSF flow, and objectively evaluate the efficacy of surgery.
authors.affiliation: Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Li-Gang
authors.initials: LG
authors.lastname: Cui
authors.forename: Ling
authors.initials: L
authors.lastname: Jiang
authors.forename: Hua-Bin
authors.initials: HB
authors.lastname: Zhang
authors.forename: Bin
authors.initials: B
authors.lastname: Liu
authors.forename: Jin-Rui
authors.initials: JR
authors.lastname: Wang
authors.forename: Jian-Wen
authors.initials: JW
authors.lastname: Jia
authors.forename: Wen
authors.initials: W
authors.lastname: Chen
mesh_terms: D000368:Aged; D001139:Arnold-Chiari Malformation / Q000134:cerebrospinal fluid* / Q000000981:diagnostic imaging* / Q000601:surgery; D002531:Cerebellum / Q000473:pathology; D002555:Cerebrospinal Fluid; D019299:Decompression, Surgical; D004244:Dizziness / Q000209:etiology; D004388:Dura Mater / Q000473:pathology; D018618:Echocardiography, Doppler, Color; D005260:Female; D020233:Gait Disorders, Neurologic / Q000503:physiopathology; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000379:methods*; D013116:Spinal Cord / Q000473:pathology; D016896:Treatment Outcome