Arnold Chiari Tip 1 Tanı ve Takibinde Dinamik BOS MRG Bulguları

Öz

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.

Anahtar Kelimeler

• Chiari malformasyonu
• Beyin omurilik sıvısı
• Faz kontrast MRG
• Kranioservikal dekompresyon
• Asgari skoru

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

Öz

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.

Anahtar Kelimeler

• Chiari malformation
• cerebrospinal fluid
• phase-contrast MRI
• craniocervical decompression
• Asgari scoring

Kaynakça

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