Practical utility of quantitative CSF dynamics in type I Chiari malformation and syringomyelia. Report of 5 cases.
https://doi.org/10.59156/revista.v37i02.520
DOI:
https://doi.org/10.59156/revista.v37i02.520Keywords:
Chiari I malformation, CSF dynamics, phase contrast MRI, post-syringomyelic syndrome, primary spinal syringomyelia, syringomyeliaAbstract
Background: the treatment of Chiari malformation I (CMI) and/or syringomyelia (SM) is controversial. The quantitative dynamics of CSF at the craniospinal level is an alternative that could guide therapy. The objective of this publication is to describe 5 cases in which the use of CSF dynamics allowed guiding the treatment.Material: the medical records of 5 cases (mean age: 39 years / 3 women and 2 men) were reviewed. All were studied with MRI in phase contrast. The diagnosis was CMI (1 case) and SM (3 cases) or only SM (1 case). Only 2 cases with CMI+SM underwent surgery (decompression + duraplasty). All were followed between 1.5 and 6 years.Results: case 1 (CMI) the velocity of the CSF was normal, so his headache was treated medically with good results; case 2 (CMI+SM) the velocity was increased so it was intervened controlling the symptoms and the SM; case 3 (CMI +SM) the velocity was normal, its diagnosis being compatible with post-syringomyelic syndrome; case 4 (SM) the velocity was increased at the C5-C6 level, its diagnosis being compatible with a primary spinal SM; case 5 (CMI + SM) after the intervention it was observed that the velocities and the SM took 16 months to normalize.Conclusion: In the cases described, the CSF dynamics allowed the correct diagnosis to be made, to determine the advisability of performing surgery, to find the cause and to control the postoperative evolution.
Downloads
References
Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, Speer MC. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 1999;44(5):1005-17.
Tubbs RS, Iskandar BJ, Bartolucci AA, Oakes J. A critical analysis of the Chiari 1.5 malformation. J Neurosurg 2004; 101(2 Suppl):179-83.
Chern JJ, Gordon AJ, Mortazavi MM, Tubbs RS, Oakes WJ. Pediatric Chiari malformation Type 0: a 12-year institutional experience. Clinical article. J Neurosurg Pediatrics 2011; 8(1):1-5.
Meadows J, Kraut M, Guarnieri M, Haroun RI, Carson BS. Asymptomatic Chiari Type I malformation identified on magnetic resonance imaging. J Neurosurg 2000; 92(6):920
Milhorat TH, Nishikawa M, Kula RW, Dlugacz YD. Mechanisms of cerebellar tonsil herniation in patients with Chiari malformations as guide to clinical management. Acta Neurochir (Wien) 2010;152(7):1117-27.
Noudel R, Jovenin N, Eap C, Scherpercel B, Pierot I, Rousseaux P. Incidence of basioccipital hypoplasia in Chiari malformation type I: comparative morphometric study of the posterior cranial fossa. J Neurosurg 2009; 111(5):1046-52.
Urbizu A, Poca MA, Vidal X, Rovira A, Sahuquillo J, Macaya A. MRI-based morphometric analysis of posterior cranial fossa in the diagnosis of Chiari malformation type I. J Neuroimaging 2014; 24(3):250-6.
Elster AD, Chen MY. Chiari I malformations: clinical and radiologic reappraisal. Radiology 1992;183(2):347-53.
Hirano M, Haughton V, Muñoz del Río A. Tapering of the cervical spinal canal in patients with Chiari I malformations. AJNR Am J Neuroradiol 2012; 33:1326-30.
Taylor DG, Mastorakos P, Jane JA Jr, Oldfield EH. Two distinct populations of Chiari I malformation based on presence or absence of posterior fossa crowdedness on magnetic resonance imaging. J Neurosurg 2017; 126(6):1934-40.
Hofkes SK, Iskandar BJ, Turski PA, Gentry LR, McCue JB, Haughton VM. Differentiation between symptomatic Chiari I malformation and asymptomatic tonsillar ectopia by using cerebrospinal fluid flow imaging: initial estimate of imaging accuracy. Radiology 2007; 245(2):532-40.
Haughton V, Mardal KA. Spinal fluid biomechanics and imaging: an update for neuroradiologists. AJNR Am J Neuroradiol 2014; 35:1864-8.
Wymer DT, Patel KP, Burke WF3rd, Bhatia VK. Phase-contrast MRI: physics, techniques and clinical applications. Radiographics 2020; 40(1): 122-40.
Alves T, Ibrahim ES, Martin BA, Malyarenko D, Maher C, Muraszko KM et al. Principles, techniques and clinical applications of phase-contrast magnetic resonance cerebrospinal fluid imaging. Neurographics 2017;7(3):199-210.
Dolar MT, Haughton VM, Iskandar BJ, Quigley M. Effect of craniocervical decompression on peak CSF velocities in symptomatic patients with Chiari malformation. AJNR Am J Neuroradiol 2004; 25:142-5.
Headache classification committee of the International Headache Society (HIS): the international classification of headache disorders, 3rd edition. Cephalalgia 2018; 38:1-211.
Kinjo B, Mezzadri JJ, Molina L, Gestro D, Jalón P, Figuerola ML. Interdisciplinary approach of patients with Chiari type I malformation and headache – experience at Hospital de Clínicas José de San Martín. J Neurol Disord Stroke 2020; 7(4):1170-4.
McGirt MJ, Nimjee SN, Floyd J, Bulsara KR, George TM. Correlation of cerebrospinal fluid flow dynamics and headache in Chiari I malformation. Neurosurgery 2005; 56(4):716-21.
Mezzadri JJM. Siringomielia por malformación de Chiari: resolución espontánea. Revisión bibliográfica. Rev Argent Neuroc 2021; 35(3):216-23.
Langridge B, Phillips E, Choi D, Chiari Malformation type 1: a systematic review of natural history and conservative management. World Neurosurg 2017; 104:213-9.
Ciaramitaro P, Massimi L, Bertuccio A, Solari A, Farinotti M, Peretta P et al. Diagnosis and treatment of Chiari malformation and syringomyelia in adults: international consensus document. Neurol Sci 2022; 43(2):1327-42.
Bogdanov EI, Heiss JD, Mendelevich EG. The post-syrinx síndrome: stable central myelopathy and collapsed or absent syrinx. J Neurol 2006; 253(6):707-13.
Klekamp J. How should syringomyelia be defined and diagnosed? World Neurosurg 2018; 111: e729-45.
Mezzadri JJM. Espondiloartrosis. En: Mezzadri JJM, editor. Siringomielia Espinal Primaria. Ciudad Autónoma de Buenos Aires: Journal, 2023, pp. 59-67.
Spena G, Bernucci C, Garbossa D, Valfre W, Versari P. Clinical and radiological outcome of craniocervical osteo-dural decompression for Chiari I-associated syringomyelia. Neurosurg Rev 2010; 33(3):297-304.
Wetjen NM, Heiss JD, Oldfield EH. Time course of syringomyelia resolution following decompression of Chiari malformation type I. J Neurosurg Pediatr 2008; 1(2):118-23.
Heiss JD, Suffredini G, Smith R, DeVroom HL, Patronas NJ, Butman JA et al. Pathophysiology of persistent syringomyelia after decompressive craniocervical surgery. J Neurosurg Spine 2010; 13(6):729-42.
Krueguer KD, Haughton VM, Hetel S. Peak velocities in patients with symptomatic and asymptomatic Chiari I malformation. AJNR Am J Neuroradiol 2010; 31(10):1837-41.
