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Dynamic CSF MRI Findings in the Diagnosis and Follow-up of Arnold Chiari Type 1

Year 2021, Volume: 54 Issue: 3, 412 - 418, 01.01.2022
https://doi.org/10.20492/aeahtd.1014345

Abstract

Aim:
Chiari malformation is a spectrum of diseases that includes different subtypes, has a wide clinical presentation, and therefore has different follow-up and treatment methods. We aimed to compare clinical scoring systems and cerebrospinal fluid (CSF) dynamics obtained by magnetic resonance imaging (MRI) in Arnold Chiari Malformation Type-1 (CM-1) patients in the preoperative and postoperative periods.
Material and Method:
Twenty-one patients with a diagnosis of CM-1 who underwent CSF MRI between January 2016 and June 2020 were included. In addition, 21 healthy volunteers were evaluated. All the patients had undergone decompression surgery due to CM-1 related symptoms. The relationship between preoperative MRI findings and clinical findings of 21 patients was evaluated. Changes in clinical and imaging findings of 21 patients who underwent surgery were compared.
Results:
Measurements were made just below the level of the cerebellar tonsil. CM-1 patients had higher preoperative peak positive velocity anteriorly (PPV: 6.26±2.72 vs 3.89±1.74 cm/s; p=0.001) and peak negative velocity anteriorly (PNV: -7.45±3.36 vs -3.61±2.65 cm/s; p=0.001) than healthy volunteers. Preoperative net flow in the posterior subarachnoid space of CM-1 patients was lower than in healthy volunteers (p=0.017).
Aliasing of the reverse flow was seen in 13(62%) patients.
PPV and PNV were decreased after surgery (PPV: 6.26±2.72 vs 4.73±1.94 cm/s, p=0.017; PNV: -7.45±3.36 vs -4.97±1.97, p=0.005). Net Flow was increased posteriorly (0.32 vs 2.21 ml/min; p=0.053).
Postoperative response was inversely proportional to the degree of tonsillar herniation. As the Asgari score of the cases increases, the Peak Positive and Negative Velocity Anterior values also increase with a statistically significant correlation (p=0.003; p=0,032 respectively)
Conclusions:
Our findings suggest that the determination of flow dynamics and morphology using MR imaging correlates with clinical findings and may be a useful tool in determining the need and timing of surgery.

Supporting Institution

Yoktur

Project Number

Yoktur

Thanks

The authors received professional statistics service from Empiar Statistics.

References

  • Chiari H. Concerning alterations in the cerebellum resulting from cerebral hydrocephalus. Pediat Neurosci. 1987; 13: 3-8. https://doi.org/10.1159/000120293
  • Meadows J, Kraut M, Guarnieri M, et al. Asymptomatic Chiari Type I malformations identified on magnetic resonance imaging. J Neurosurg. 2000; 92: 920-6. https://doi.org/10.3171/jns.2000.92.6.0920
  • Milhorat TH, Chou MW, Trinidad EM, et al. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 1999; 44: 1005-17. https://doi.org/10.1097/00006123-199905000-00042
  • Iskandar BJ, Quigley M, Haughton VM. Foramen magnum cerebrospinal fluid flow characteristics in children with Chiari I malformation before and after craniocervical decompression. J Neurosurg. 2004; 101: 169-78. https://doi.org/10.3171/ped.2004.101.2.0169
  • Gholampour S, Gholampour H. Correlation of a new hydrodynamic index with other effective indexes in Chiari I malformation patients with different associations. Sci Rep. 2020; 10: 15907. https://doi.org/10.1038/s41598-020-72961-0
  • Wang CS, Wang X, Fu CH, et al. Analysis of cerebrospinal fluid flow dynamics and morphology in Chiari I malformation with cine phase-contrast magnetic resonance imaging. Acta Neurochir. 2014;1 56: 707-13. https://doi.org/10.1007/s00701-013-1958-8
  • Gholampour S, Taher M. Relationship of Morphologic Changes in the Brain and Spinal Cord and Disease Symptoms with Cerebrospinal Fluid Hydrodynamic Changes in Patients with Chiari Malformation Type I. World Neurosurg. 2018; 116: e830-9. https://doi.org/10.1016/j.wneu.2018.05.108
  • Sadique SI, Pandey P, Chaudhuri AK. Cerebrospinal Fluid Flowmetry in Pediatric Patients with Chiari Malformation I with Surgical Implications. World Neurosurg. 2020; 135: e83-6. https://doi.org/10.1016/j.wneu.2019.10.184
  • Asgari S, Engelhorn TM, Bschor M, et al. Surgical prognosis in hindbrain related syringomyelia. Acta Neurol Scand. 2003; 107: 12-21. https://doi.org/10.1034/j.1600-0404.2003.01357.x
  • McGirt MJ, Attenello FJ, Atiba A, et al. Symptom recurrence after suboccipital decompression for pediatric Chiari I malformation: analysis of 256 consecutive cases. Childs Nerv Syst. 2008; 24: 1333-9. https://doi.org/10.1007/s00381-008-0651-3
  • Leon TJ, Kuhn EN, Arynchyna AA, et al. Patients with "benign" Chiari I malformations require surgical decompression at a low rate. J Neurosurg Pediatr. 2019; 23: 498-506. https://doi.org/10.3171/2018.10.PEDS18407
  • Aliaga L, Hekman KE, Yassari R, et al. A novel scoring system for assessing Chiari malformation type I treatment outcomes. Neurosurgery. 2012; 70: 656-64. https://doi.org/10.1227/NEU.0b013e31823200a6
  • Yarbrough CK, Greenberg JK, Smyth MD, et al. External validation of the Chicago Chiari Outcome Scale. J Neurosurg Pediatr. 2014; 13: 679-84. https://doi.org/10.3171/2014.3.PEDS13503
  • Yilmaz A, Kanat A, Musluman AM, et al. When is duraplasty required in the surgical treatment of Chiari malformation type I based on tonsillar descending grading scale? World Neurosurg. 2011; 75: 307-13. https://doi.org/10.1016/j.wneu.2010.09.005
  • Clarke EC, Stoodle MA, Bilston LE. Changes in temporal flow characteristics of CSF in Chiari malformation Type I with and without syringomyelia: implications for theory of syrinx development. J Neurosurg. 2013; 118: 1135-40. https://doi.org/10.3171/2013.2.JNS12759
  • Dolar MT, Haughton VM, Iskandar BJ, et al. Effect of craniocervical decompression on peak CSF velocities in symptomatic patients with Chiari I malformation. Am J Neuroradiol. 2004; 25: 142-5.
  • Haughton VM, Korosec FR, Medow JE, et al. Peak systolic and diastolic CSF velocity in the foramen magnum in adult patients with Chiari I malformations and in normal control participants. Am J Neuroradiol. 2003; 24: 169-76.
  • Linge SO, Mardal KA, Helgeland A, et al. Effect of craniovertebral decompression on CSF dynamics in Chiari malformation type I studied with computational fluid dynamics: Laboratory investigation. J Neurosurg Spine. 2014; 21: 559-64. https://doi.org/10.3171/2014.6.SPINE13950
  • Liu B, Wang ZY, Xie JC, et al. Cerebrospinal fluid dynamics in Chiari malformation associated with syringomyelia. Chin Med J. 2007; 120: 219-23.

Arnold Chiari Tip 1 Tanı ve Takibinde Dinamik BOS MRG Bulguları

Year 2021, Volume: 54 Issue: 3, 412 - 418, 01.01.2022
https://doi.org/10.20492/aeahtd.1014345

Abstract

Amaç:
Chiari malformasyonu farklı alt tipleri barındıran, geniş bir klinik prezentasyona sahip ve bu nedenle farklı takip ve tedavi yöntemleri olan bir hastalık yelpazesidir. Bu çalışmada Arnold Chiari Malformasyonu Tip-1 (CM-1) tanılı hastalarda preoperatif ve postoperatif dönemde manyetik rezonans görüntüleme (MRG) ile elde edilen beyin omurilik sıvısı (BOS) dinamikleri ve klinik skorlama sistemlerinin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem:
Ocak 2016 ile Haziran 2020 tarihleri arasında BOS MRG yapılan CM-1 tanılı 21 hasta dâhil edildi. Ayrıca 21 sağlıklı gönüllü değerlendirildi. Tüm hastalara CM-1 ile ilişkili semptomlar nedeniyle dekompresyon cerrahisi uygulanmıştı. 21 hastanın preoperatif MRG bulguları ile klinik bulguları arasındaki ilişki değerlendirildi. Cerrahi uygulanan 21 hastanın klinik ve görüntüleme bulgularındaki değişiklikler karşılaştırıldı.
Bulgular:
Ölçümler serebellar tonsil seviyesinin hemen altından yapıldı. CM-1 hastalarının ameliyat öncesi pik pozitif ve negatif hızları (PPV-PNV) sağlıklı gönüllülerden daha yüksekti (PPV: 6,26±2,72 vs 3,89±1,74 cm/s, p=0.001; PNV: -7,45±3,36 vs -3,61±2,65 cm/s, p=0.001). CM-1 hastalarının posterior subaraknoid alandan yapılan ölçümde net debi değeri sağlıklı gönüllülere göre daha düşüktü (p=0.017).
Hastaların 13’ünde (%62) ters akıma bağlı ‘aliasing’ görüldü.
Ameliyat sonrası PPV ve PNV değerleri azaldı (PPV: 6,26±2,72’ye karşı 4,73±1,94 cm/s, p=0.017; PNV: -7,45±3,36’ya karşı -4,97±1,97, p=0.005). Net Akış ise arttı (0.32’ye karşı 2.21 ml/dak; p=0.053).
Postoperatif yanıt, tonsiller herniasyon derecesi ile ters orantılı idi. Hastalarda Asgari skoru arttıkça, PPV ve PNV değerleri de artmaktadır (sırasıyla p=0.003 ve p=0,032)
Sonuç:
Bulgularımız, MR görüntüleme kullanılarak elde edilen akış dinamikleri ve morfolojinin klinik bulgularla ilişkili olduğunu, cerrahi ihtiyacı ve zamanlamasını belirlemede yararlı bir araç olabileceğini düşündürmektedir.

Project Number

Yoktur

References

  • Chiari H. Concerning alterations in the cerebellum resulting from cerebral hydrocephalus. Pediat Neurosci. 1987; 13: 3-8. https://doi.org/10.1159/000120293
  • Meadows J, Kraut M, Guarnieri M, et al. Asymptomatic Chiari Type I malformations identified on magnetic resonance imaging. J Neurosurg. 2000; 92: 920-6. https://doi.org/10.3171/jns.2000.92.6.0920
  • Milhorat TH, Chou MW, Trinidad EM, et al. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 1999; 44: 1005-17. https://doi.org/10.1097/00006123-199905000-00042
  • Iskandar BJ, Quigley M, Haughton VM. Foramen magnum cerebrospinal fluid flow characteristics in children with Chiari I malformation before and after craniocervical decompression. J Neurosurg. 2004; 101: 169-78. https://doi.org/10.3171/ped.2004.101.2.0169
  • Gholampour S, Gholampour H. Correlation of a new hydrodynamic index with other effective indexes in Chiari I malformation patients with different associations. Sci Rep. 2020; 10: 15907. https://doi.org/10.1038/s41598-020-72961-0
  • Wang CS, Wang X, Fu CH, et al. Analysis of cerebrospinal fluid flow dynamics and morphology in Chiari I malformation with cine phase-contrast magnetic resonance imaging. Acta Neurochir. 2014;1 56: 707-13. https://doi.org/10.1007/s00701-013-1958-8
  • Gholampour S, Taher M. Relationship of Morphologic Changes in the Brain and Spinal Cord and Disease Symptoms with Cerebrospinal Fluid Hydrodynamic Changes in Patients with Chiari Malformation Type I. World Neurosurg. 2018; 116: e830-9. https://doi.org/10.1016/j.wneu.2018.05.108
  • Sadique SI, Pandey P, Chaudhuri AK. Cerebrospinal Fluid Flowmetry in Pediatric Patients with Chiari Malformation I with Surgical Implications. World Neurosurg. 2020; 135: e83-6. https://doi.org/10.1016/j.wneu.2019.10.184
  • Asgari S, Engelhorn TM, Bschor M, et al. Surgical prognosis in hindbrain related syringomyelia. Acta Neurol Scand. 2003; 107: 12-21. https://doi.org/10.1034/j.1600-0404.2003.01357.x
  • McGirt MJ, Attenello FJ, Atiba A, et al. Symptom recurrence after suboccipital decompression for pediatric Chiari I malformation: analysis of 256 consecutive cases. Childs Nerv Syst. 2008; 24: 1333-9. https://doi.org/10.1007/s00381-008-0651-3
  • Leon TJ, Kuhn EN, Arynchyna AA, et al. Patients with "benign" Chiari I malformations require surgical decompression at a low rate. J Neurosurg Pediatr. 2019; 23: 498-506. https://doi.org/10.3171/2018.10.PEDS18407
  • Aliaga L, Hekman KE, Yassari R, et al. A novel scoring system for assessing Chiari malformation type I treatment outcomes. Neurosurgery. 2012; 70: 656-64. https://doi.org/10.1227/NEU.0b013e31823200a6
  • Yarbrough CK, Greenberg JK, Smyth MD, et al. External validation of the Chicago Chiari Outcome Scale. J Neurosurg Pediatr. 2014; 13: 679-84. https://doi.org/10.3171/2014.3.PEDS13503
  • Yilmaz A, Kanat A, Musluman AM, et al. When is duraplasty required in the surgical treatment of Chiari malformation type I based on tonsillar descending grading scale? World Neurosurg. 2011; 75: 307-13. https://doi.org/10.1016/j.wneu.2010.09.005
  • Clarke EC, Stoodle MA, Bilston LE. Changes in temporal flow characteristics of CSF in Chiari malformation Type I with and without syringomyelia: implications for theory of syrinx development. J Neurosurg. 2013; 118: 1135-40. https://doi.org/10.3171/2013.2.JNS12759
  • Dolar MT, Haughton VM, Iskandar BJ, et al. Effect of craniocervical decompression on peak CSF velocities in symptomatic patients with Chiari I malformation. Am J Neuroradiol. 2004; 25: 142-5.
  • Haughton VM, Korosec FR, Medow JE, et al. Peak systolic and diastolic CSF velocity in the foramen magnum in adult patients with Chiari I malformations and in normal control participants. Am J Neuroradiol. 2003; 24: 169-76.
  • Linge SO, Mardal KA, Helgeland A, et al. Effect of craniovertebral decompression on CSF dynamics in Chiari malformation type I studied with computational fluid dynamics: Laboratory investigation. J Neurosurg Spine. 2014; 21: 559-64. https://doi.org/10.3171/2014.6.SPINE13950
  • Liu B, Wang ZY, Xie JC, et al. Cerebrospinal fluid dynamics in Chiari malformation associated with syringomyelia. Chin Med J. 2007; 120: 219-23.
There are 19 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original research article
Authors

Begumhan Baysal 0000-0003-0470-1683

Mahmut Bilal Dogan This is me 0000-0001-7063-7371

Ercan Bosnak This is me 0000-0001-5026-6884

Mehmet Sabri Gürbüz 0000-0002-3764-389X

Nejat Isik 0000-0002-6809-4969

Project Number Yoktur
Publication Date January 1, 2022
Submission Date October 27, 2021
Published in Issue Year 2021 Volume: 54 Issue: 3

Cite

AMA Baysal B, Dogan MB, Bosnak E, Gürbüz MS, Isik N. Dynamic CSF MRI Findings in the Diagnosis and Follow-up of Arnold Chiari Type 1. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. January 2022;54(3):412-418. doi:10.20492/aeahtd.1014345