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Chiari malformation: CSF flow dynamics in the craniocervical junction and syrinx.
Acta Neurochir (Wien). 2005 Dec; 147(12):1223-33.AN

Abstract

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.

FINDINGS

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.

Authors+Show Affiliations

Department of Neurosurgery, University of Athens, Evangelismos General Hospital, Athens, Greece.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16228125

Citation

Sakas, D E., et al. "Chiari Malformation: CSF Flow Dynamics in the Craniocervical Junction and Syrinx." Acta Neurochirurgica, vol. 147, no. 12, 2005, pp. 1223-33.
Sakas DE, Korfias SI, Wayte SC, et al. Chiari malformation: CSF flow dynamics in the craniocervical junction and syrinx. Acta Neurochir (Wien). 2005;147(12):1223-33.
Sakas, D. E., Korfias, S. I., Wayte, S. C., Beale, D. J., Papapetrou, K. P., Stranjalis, G. S., Whittaker, K. W., & Whitwell, H. L. (2005). Chiari malformation: CSF flow dynamics in the craniocervical junction and syrinx. Acta Neurochirurgica, 147(12), 1223-33.
Sakas DE, et al. Chiari Malformation: CSF Flow Dynamics in the Craniocervical Junction and Syrinx. Acta Neurochir (Wien). 2005;147(12):1223-33. PubMed PMID: 16228125.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chiari malformation: CSF flow dynamics in the craniocervical junction and syrinx. AU - Sakas,D E, AU - Korfias,S I, AU - Wayte,S C, AU - Beale,D J, AU - Papapetrou,K P, AU - Stranjalis,G S, AU - Whittaker,K W, AU - Whitwell,H L, Y1 - 2005/10/17/ PY - 2005/03/03/received PY - 2005/08/16/accepted PY - 2005/10/18/pubmed PY - 2006/4/20/medline PY - 2005/10/18/entrez SP - 1223 EP - 33 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 147 IS - 12 N2 - 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. FINDINGS: 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. SN - 0001-6268 UR - https://www.unboundmedicine.com/medline/citation/16228125/Chiari_malformation:_CSF_flow_dynamics_in_the_craniocervical_junction_and_syrinx_ L2 - https://dx.doi.org/10.1007/s00701-005-0645-9 DB - PRIME DP - Unbound Medicine ER -