Pulsatile cerebrospinal fluid dynamics in Chiari I malformation syringomyelia: Predictive value in posterior fossa decompression and insights into the syringogenesis.
Cerebrospinal fluid circulation
Chiari I malformation
cine magnetic resonance imaging
posterior fossa decompression
syringomyelia
Journal
Journal of craniovertebral junction & spine
ISSN: 0974-8237
Titre abrégé: J Craniovertebr Junction Spine
Pays: India
ID NLM: 101536746
Informations de publication
Date de publication:
Historique:
received:
08
04
2020
accepted:
26
12
2020
entrez:
14
4
2021
pubmed:
15
4
2021
medline:
15
4
2021
Statut:
ppublish
Résumé
Pathophysiological mechanisms underlying the syringomyelia associated with Chiari I malformation (CM-1) are still not completely understood, and reliable predictors of the outcome of posterior fossa decompression (PFD) are lacking accordingly. The reported prospective case-series study aimed to prove the existence of a pulsatile, biphasic systolic-diastolic cerebrospinal fluid (CSF) dynamics inside the syrinx associated with CM-1 and to assess its predictive value of patients' outcome after PFD. Insights into the syringogenesis are also reported. Fourteen patients with symptomatic CM-1 syringomyelia underwent to a preoperative neuroimaging study protocol involving conventional T1/T2 and cardiac-gated cine phase-contrast magnetic resonance imaging sequences. Peak systolic and diastolic velocities were acquired at four regions of interest (ROIs): syrinx, ventral, and dorsal cervical subarachnoid space and foramen magnum region. Data were reported as mean ± standard deviation. After PFD, the patients underwent a scheduled follow-up lasting 3 years. One-way analysis of variance with Bonferroni Post hoc test of multiple comparisons was performed All symptoms but atrophy and spasticity improved. PFD caused a significant velocity changing of each ROI. Syrinx and premedullary cistern velocities were found to be decreased within the 1 Syrinx and premedullary cistern velocities are related to an early improvement of symptoms in patients with CM-1 syringomyelia who underwent PFD. The existence of a biphasic pulsatile systolic-diastolic CSF pattern inside the syrinx validates the "transmedullary" theory about the syringogenesis.
Sections du résumé
BACKGROUND
BACKGROUND
Pathophysiological mechanisms underlying the syringomyelia associated with Chiari I malformation (CM-1) are still not completely understood, and reliable predictors of the outcome of posterior fossa decompression (PFD) are lacking accordingly. The reported prospective case-series study aimed to prove the existence of a pulsatile, biphasic systolic-diastolic cerebrospinal fluid (CSF) dynamics inside the syrinx associated with CM-1 and to assess its predictive value of patients' outcome after PFD. Insights into the syringogenesis are also reported.
METHODS
METHODS
Fourteen patients with symptomatic CM-1 syringomyelia underwent to a preoperative neuroimaging study protocol involving conventional T1/T2 and cardiac-gated cine phase-contrast magnetic resonance imaging sequences. Peak systolic and diastolic velocities were acquired at four regions of interest (ROIs): syrinx, ventral, and dorsal cervical subarachnoid space and foramen magnum region. Data were reported as mean ± standard deviation. After PFD, the patients underwent a scheduled follow-up lasting 3 years. One-way analysis of variance with Bonferroni Post hoc test of multiple comparisons was performed
RESULTS
RESULTS
All symptoms but atrophy and spasticity improved. PFD caused a significant velocity changing of each ROI. Syrinx and premedullary cistern velocities were found to be decreased within the 1
CONCLUSION
CONCLUSIONS
Syrinx and premedullary cistern velocities are related to an early improvement of symptoms in patients with CM-1 syringomyelia who underwent PFD. The existence of a biphasic pulsatile systolic-diastolic CSF pattern inside the syrinx validates the "transmedullary" theory about the syringogenesis.
Identifiants
pubmed: 33850377
doi: 10.4103/jcvjs.JCVJS_42_20
pii: JCVJS-12-15
pmc: PMC8035583
doi:
Types de publication
Journal Article
Langues
eng
Pagination
15-25Informations de copyright
Copyright: © 2021 Journal of Craniovertebral Junction and Spine.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
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