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

Shah, Syed Omar; Haughton, Victor M.; Río, Alejandro Muñoz del

doi:10.3174/ajnr.a2460

Cited by 48 publications

(36 citation statements)

References 17 publications

(19 reference statements)

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“…The anteroposterior diameter of the cervical spinal canal from C1 to C7 was measured on the midline sagittal T2 images by a previously described method. 6,7 At each level, a line was placed perpendicular to the spinal axis at the midpoint of the vertebra, the points where it crossed from CSF to epidural tissue were identified, and the distances between them were measured. At C1, the midpoint of the anterior arch of C1 was defined, and the line was drawn transverse to the spinal axis at this level.…”

Section: Methodsmentioning

confidence: 99%

“…The C1-C7, C1-C4, and C4 -C7 taper ratios were calculated by least squares fitting of a line to the appropriate diameters, by using the LINE ST macro in Excel (Microsoft, Redmond, Washington) as in previous studies. 6,7 The length of the syringomyelia was calculated as the number of segments over which it extended. The readers measured the maximal anteroposterior diameter of the syrinx on the midsagittal T2-weighted image.…”

Section: Methodsmentioning

confidence: 99%

“…5 The tapering of the upper cervical spinal canal causes peak CSF velocities to increase from C1 to C4. 6,7 Taper ratios, the slope of a line fit to spinal canal diameters at multiple spinal levels, differ between patients with Chiari I and controls. 5,8 We designed this study to test the hypothesis that Chiari I patients with syringomyelia have different cervical spinal canal taper ratios than Chiari I patients without syringomyelia.…”

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confidence: 98%

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The Cervical Spinal Canal Tapers Differently in Patients with Chiari I with and without Syringomyelia

Thompson¹,

Madan

Hesselink

et al. 2015

AJNR Am J Neuroradiol

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 98%

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The Cervical Spinal Canal Tapers Differently in Patients with Chiari I with and without Syringomyelia

Thompson¹,

Madan

Hesselink

et al. 2015

AJNR Am J Neuroradiol

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“…The abnormal position of the cerebellar tonsils is thought to alter the CSF flow dynamic at foramen magnum level, possibly leading to spinal cord damage (Shah et al 2011). The latter presents usually with a progressive cavitation (syringomyelia) that might involve the entire length of the cord and/or the medulla oblongata.…”

Section: Discussionmentioning

confidence: 99%

“…CM1 is an uncommon condition (about 1 % in the pediatric population) (Aitken et al 2009) due to underdevelopment of mesenchymal structures forming the clivus and posterior cranial fossa bones (Milhorat et al 2010). The abnormal position of the cerebellar tonsils disrupts the normal CSF flow dynamics (Shah et al 2011) at the cranio-cervical junction and may result in spinal cord damage. The latter presents usually with a progressive cavitation (syringomyelia) that might involve the entire length of the cord and/or the medulla oblongata.…”

Section: Introductionmentioning

confidence: 99%

Chiari 1 Malformation and Holocord Syringomyelia in Hunter Syndrome

et al. 2013

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Compressive cervical myelopathy is a well-known life-threatening complication in mucopolysaccharidosis (MPS) patients. Glycosaminoglycan accumulation in the growing cartilage results in dens dysplasia, atlanto-axial instability, and subsequent periodontoid fibrocartilaginous tissue deposition with upper cervical stenosis.Chiari malformation type 1 (CM1) is a congenital downward cerebellar tonsil ectopia determined by clivus and posterior cranial fossa underdevelopment, possibly leading to progressive spinal cord cavitation (syringomyelia) and severe neurological impairment.We present a boy affected with Hunter syndrome (MPS II) and cerebellar tonsil ectopia who developed a holocord syringomyelia at the age of 6 years. The child underwent atlanto-occipital decompressive surgery with rapid clinical and neuroimaging improvement.Sharing a primary mesenchymal involvement of the cervical-occipital region, the coexistence of CM1 in MPS might be not unexpected and complicate further the disease course. In these patients, strict monitoring and prompt treatment might be of foremost importance for preventing major neurological complications.

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Intraoperative Phase Contrast MRI Analysis of Cerebrospinal Fluid Velocities During Posterior Fossa Decompression for Chiari I Malformation

Delavari

Wang

Bapuraj

et al. 2019

Magnetic Resonance Imaging

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Background: Cerebrospinal fluid (CSF) velocity at the craniovertebral junction (CVJ) is known to be altered in patients with Chiari I malformation (CMI), and normalization of CSF velocities is associated with symptom resolution. However, preoperative and intraoperative prediction methods have thus far failed to identify patients in whom CSF velocities can be normalized with posterior fossa decompression (PFD) without duraplasty. Phase contrast MRI (PC-MRI) may assist not only in diagnosis of CMI but also in guiding the intraoperative decision to perform duraplasty during PFD. Purpose: To use intraoperative MRI data to quantify changes in CSF hydrodynamics at the CVJ during each step of PFD with duraplasty (PFDD) in 12 consecutive patients. Study Type: Retrospective case series with all patients imaged before, during and after decompression, and all data analyzed postprocedure. Population/Subjects: Pediatric patients, mean age 14 years (range 4-18), undergoing PFD for CMI. Field Strength/Sequence: Intraoperative studies involved a dedicated 1.5T Siemens MRI imager. PC-MRI scans were in the axial plane at the CVJ. Assessment: Two observers assessed measurements. Statistical Test: The equality of matched pairs of observations was tested using the Wilcoxon matched-pairs signedranks test. Results: Data analyses of the PC-MRI demonstrated a marked and immediate increase in CSF velocity at the posterior CVJ during PFDD. Mean cranially-directed velocities increased by a mean of 1.049cm/s (P = 0.028) from preincision to postoperative measurement. There was a mean 0.45 cm/s (P = 0.022) increase in mean cranial velocity from preincision to bone decompression scans, and a mean 0.48 cm/s (P = 0.018) increase in mean velocity from preincision to duraplasty. Data Conclusion: In all subjects, significant increases in the mean and peak velocities of cranially-and caudally-directed velocities were observed from preincision to post-PFDD scans at the posterior CVJ. Level of Evidence: 2 Technical Efficacy: Stage 4

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

Abstract: BACKGROUND AND PURPOSE:Previous studies have quantified CSF flow in patients with Chiari I at the foramen magnum with single-axial or single-sagittal PCMR. The goal of this study was to measure CSF velocities at multiple cervical spinal levels in patients with Chiari I malformation.

Cited by 48 publications

References 17 publications

The Cervical Spinal Canal Tapers Differently in Patients with Chiari I with and without Syringomyelia

The Cervical Spinal Canal Tapers Differently in Patients with Chiari I with and without Syringomyelia

Chiari 1 Malformation and Holocord Syringomyelia in Hunter Syndrome

Intraoperative Phase Contrast MRI Analysis of Cerebrospinal Fluid Velocities During Posterior Fossa Decompression for Chiari I Malformation

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