Chiari Type 1 malformation: CSF flow dynamics and morphology in the posterior fossa and craniocervical junction and correlation of these findings with syrinx formation

Yılmaz, Temel Fatih; Toprak, Hüseyin; Sarı, Lütfullah; Öz, İbrahim İlker; Kitiş, Serkan; Kaya, Ahmet Hilmi; Alkan, Alpay

doi:10.1016/j.neuchi.2022.06.001

Cited by 6 publications

(2 citation statements)

References 19 publications

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“…The current results showed that a narrower aqueduct of sylvius was associated with higher CCOS scores. The aqueduct area was larger, and the aqueduct stroke volume was higher in CMI patients with syrinx than in those without syrinx [ 34 ]. A wider aqueduct may indicate greater disturbances of CSF flow above the fourth ventricle.…”

Section: Discussionmentioning

confidence: 99%

“…The aqueduct area was larger, and the aqueduct stroke volume was higher in CMI patients with syrinx than in those without syrinx. 34 A wider aqueduct may indicate greater disturbances of CSF flow above the fourth ventricle. Interestingly, tonsillar herniation secondary to hydrocephalus is always associated with aqueduct stenosis, which results from the external compression of the mesencephalon.…”

Section: Decompressive Optionsmentioning

confidence: 99%

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Individualized Functional Decompression Options for Adult Chiari Malformation With Syringomyelia and A Novel Scale for Syringomyelia Resolution: A Single-Center Experience

Han,

Hou,

et al. 2023

Neurospine

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Objective: To compare outcomes of posterior fossa bony decompression alone (PFD) versus PFD with duraplasty (PFDD) versus PFDD with additional obex exploration (PFDDO) in patients with Chiari malformation type I (CMI) combining syringomyelia.Methods: Clinical records of adult patients who underwent decompressions from 2014 to 2022 were retrospectively analyzed. The decompression procedure was individualized based on the cerebrospinal fluid pulse in the surgical field. The Chicago Chiari Outcome Scale (CCOS) was used to assess the prognosis of the patients and a novel syringomyelia resolution scale, based on 3-dimensional volume, was introduced. The percentage change in the cervical syrinx volume was classified as follows by resolution: ≥ 70%, 30%–70%, and < 30%.Results: Seventy-eight individuals were enrolled, of which 22, 20, and 36 underwent PFD, PFDD, and PFDDO, respectively. The three decompression groups had no significant difference in the preoperative characteristics and postoperative prognosis. Multivariate analyses revealed that better CCOS was significantly correlated with younger age at surgery (p = 0.018), syrinx originated from lower cervical levels (p = 0.037), narrower preoperative cerebral aqueduct (p = 0.005), and better syrinx volume resolution (p = 0.004). Additionally, a better cervical syrinx volume resolution was significantly correlated with higher CCOS (p = 0.017), narrower cerebral aqueduct (p = 0.035), and better tonsillar descent resolution (p = 0.007).Conclusion: Individualized functional decompression induced an equal effect on CCOS and syrinx volume resolution for all CMI patients with syringomyelia. Our syringomyelia resolution scale facilitates communication and prediction of CMI prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Decompressive Optionsmentioning

confidence: 99%