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Relationship of cine phase-contrast magnetic resonance imaging with outcome after decompression for Chiari I malformations.
Neurosurgery. 2006 Jul; 59(1):140-6; discussion 140-6.N

Abstract

OBJECTIVE

Many patients with symptomatic Chiari I malformations experience symptom recurrence after surgical decompression. Identification of predictors of outcome is needed to better select patients most likely to benefit from surgical intervention. We examined whether or not cerebrospinal fluid (CSF) flow dynamics assessed by cine phase contrast magnetic resonance imaging could independently predict response to posterior fossa decompression for Chiari I malformations.

METHODS

Pre- and postoperative CSF flow dynamics were assessed by cine phase-contrast magnetic resonance imaging in 130 consecutive patients receiving posterior fossa decompression for a Chiari I malformation between 1997 and 2003. CSF flow was classified as "abnormal" if biphasic flow was either absent or decreased through the aqueduct, fourth ventricle and its outlets, the foramen magnum, or ventral or dorsal to the cervical spinal cord. If no evidence of decreased flow was noted, CSF flow was classified as "normal." The association between preoperative CSF flow dynamics, all recorded variables, and long-term outcome was assessed using multivariate proportional hazards regression analysis.

RESULTS

All patients had tonsil herniation more than 5 mm below the foramen magnum (average, 11 +/- 5 mm). Abnormal hindbrain CSF flow was observed in 81% of patients (43% complete obstruction, 38% reduced flow). Normal CSF flow was observed in 19% of patients. In multivariate analysis, patients with normal preoperative hindbrain CSF flow were 4.8-fold more likely to experience symptom recurrence after surgery (relative risk, 4.85; 95% confidence interval, 1.88-12.5; P < 0.001) regardless of degree of tonsillar ectopia or presence of syringomyelia. Isolated frontal headache (relative risk, 4.16; 95% confidence interval, 1.7-9.8; P < 0.05) and scoliosis (relative risk, 9.2; 95% confidence interval, 1.7-10.5; P < 0.001) also were independent risk factors for symptom recurrence.

CONCLUSION

Normal preoperative hindbrain CSF flow was an independent risk factor for treatment failure after decompression for Chiari I malformation regardless of the degree of tonsillar ectopia. Cine phase-contrast magnetic resonance imaging may be a valuable tool in identifying patients who are less likely to respond to surgical decompression for Chiari I malformation.

Authors+Show Affiliations

Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16823310

Citation

McGirt, Matthew J., et al. "Relationship of Cine Phase-contrast Magnetic Resonance Imaging With Outcome After Decompression for Chiari I Malformations." Neurosurgery, vol. 59, no. 1, 2006, pp. 140-6; discussion 140-6.
McGirt MJ, Nimjee SM, Fuchs HE, et al. Relationship of cine phase-contrast magnetic resonance imaging with outcome after decompression for Chiari I malformations. Neurosurgery. 2006;59(1):140-6; discussion 140-6.
McGirt, M. J., Nimjee, S. M., Fuchs, H. E., & George, T. M. (2006). Relationship of cine phase-contrast magnetic resonance imaging with outcome after decompression for Chiari I malformations. Neurosurgery, 59(1), 140-6; discussion 140-6.
McGirt MJ, et al. Relationship of Cine Phase-contrast Magnetic Resonance Imaging With Outcome After Decompression for Chiari I Malformations. Neurosurgery. 2006;59(1):140-6; discussion 140-6. PubMed PMID: 16823310.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship of cine phase-contrast magnetic resonance imaging with outcome after decompression for Chiari I malformations. AU - McGirt,Matthew J, AU - Nimjee,Shahid M, AU - Fuchs,Herbert E, AU - George,Timothy M, PY - 2006/7/11/pubmed PY - 2006/8/2/medline PY - 2006/7/11/entrez SP - 140-6; discussion 140-6 JF - Neurosurgery JO - Neurosurgery VL - 59 IS - 1 N2 - OBJECTIVE: Many patients with symptomatic Chiari I malformations experience symptom recurrence after surgical decompression. Identification of predictors of outcome is needed to better select patients most likely to benefit from surgical intervention. We examined whether or not cerebrospinal fluid (CSF) flow dynamics assessed by cine phase contrast magnetic resonance imaging could independently predict response to posterior fossa decompression for Chiari I malformations. METHODS: Pre- and postoperative CSF flow dynamics were assessed by cine phase-contrast magnetic resonance imaging in 130 consecutive patients receiving posterior fossa decompression for a Chiari I malformation between 1997 and 2003. CSF flow was classified as "abnormal" if biphasic flow was either absent or decreased through the aqueduct, fourth ventricle and its outlets, the foramen magnum, or ventral or dorsal to the cervical spinal cord. If no evidence of decreased flow was noted, CSF flow was classified as "normal." The association between preoperative CSF flow dynamics, all recorded variables, and long-term outcome was assessed using multivariate proportional hazards regression analysis. RESULTS: All patients had tonsil herniation more than 5 mm below the foramen magnum (average, 11 +/- 5 mm). Abnormal hindbrain CSF flow was observed in 81% of patients (43% complete obstruction, 38% reduced flow). Normal CSF flow was observed in 19% of patients. In multivariate analysis, patients with normal preoperative hindbrain CSF flow were 4.8-fold more likely to experience symptom recurrence after surgery (relative risk, 4.85; 95% confidence interval, 1.88-12.5; P < 0.001) regardless of degree of tonsillar ectopia or presence of syringomyelia. Isolated frontal headache (relative risk, 4.16; 95% confidence interval, 1.7-9.8; P < 0.05) and scoliosis (relative risk, 9.2; 95% confidence interval, 1.7-10.5; P < 0.001) also were independent risk factors for symptom recurrence. CONCLUSION: Normal preoperative hindbrain CSF flow was an independent risk factor for treatment failure after decompression for Chiari I malformation regardless of the degree of tonsillar ectopia. Cine phase-contrast magnetic resonance imaging may be a valuable tool in identifying patients who are less likely to respond to surgical decompression for Chiari I malformation. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/16823310/Relationship_of_cine_phase_contrast_magnetic_resonance_imaging_with_outcome_after_decompression_for_Chiari_I_malformations_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/01.NEU.0000219841.73999.B3 DB - PRIME DP - Unbound Medicine ER -