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Cerebrospinal fluid dynamics in Chiari malformation associated with syringomyelia
Liu Bin1; Wang Zhen-yu1; Xie Jing-cheng1; Han Hong-bin1; Pei Xin-long1
关键词Arnold-chiari Malformation Syringomyelia Cerebrospinal Fluid
刊名CHINESE MEDICAL JOURNAL
2007-02-05
120期:3页:219-223
收录类别SCI
文章类型Article
WOS标题词Science & Technology
类目[WOS]Medicine, General & Internal
研究领域[WOS]General & Internal Medicine
关键词[WOS]I MALFORMATION ; SYMPTOMATIC PATIENTS ; CEREBELLAR TONSILS ; FLOW ; MR ; DECOMPRESSION ; PATHOPHYSIOLOGY ; PATHOGENESIS ; DIAGNOSIS ; VELOCITY
英文摘要

Background About 50%-70% of patients with Chiari malformation I (CMI) presented with syringomyelia (SM), which is supposed to be related to abnormal cerebrospinal fluid (CSF) flow around the foramen magnum. The aim of this study was to investigate the cerebrospinal fluid dynamics at levels of the aqueduct and upper cervical spine in patients with CMI associated with SM, and to discuss the possible mechanism of formation of SM.

Methods From January to April 2004, we examined 10 adult patients with symptomatic CMI associated with SM and 10 healthy volunteers by phase-contrast MRI. CSF flow patterns were evaluated at seven regions of interest (RCI): the aqueduct and ventral and dorsal subarachnoid spaces of the spine at levels of the cerebellar tonsil, C2-3, and C5-6. The CSF flow waveforms were analyzed by measuring CSF circulation time, durations and maximum velocities of cranial- and caudal-directed flows, and the ratio between the two maximum velocities. Data were analyzed by t test using SPSS 11.5.

Results We found no definite communication between the fourth ventricle and syringomyelia by MRI in the 10 patients. In both the groups, we observed cranial-directed flow of CSF in the early cardiac systolic phase, which changed the direction from cranial to caudal from the middle systolic phase to the early diastolic phase, and then turned back in cranial direction in the late diastolic phase. The CSF flow disappeared at the dorsal ROI at the level of C2-3 in 3 patients and 1 volunteer, and at the level of C5-6 in 6 patients and 3 volunteers. The durations of CSF circulation at all the ROIs were significantly shorter in the patients than those in the healthy volunteers (P = 0.014 at the midbrain aqueduct, P = 0.019 at the inferior margin of the cerebellar tonsil, P = 0.014 at the level of C2-3, and P = 0.022 at the level of C5-6). No significant difference existed between the two groups in the initial point and duration of the caudal-directed CSF flow during a cardiac cycle at all the ROIs. The maximum velocities of both cranial- and caudal-directed CSF flows were significantly higher in the patients than those in the volunteers at the aqueduct (P = 0.018 and P = 0.007) and ventral ROI at the inferior margin of the cerebellar tonsil (P < 0.001 and P = 0.002), as so did the maximum velocities of the caudal-directed flow in the ventral and dorsal ROIs at the level of C2-3 (P = 0.004; P = 0.007).

Conclusions The direction of CSF flow changes in accordance with cardiac cycle. The syringomyelia in patients with CMI may be due to the decreased circulation time and abnormal dynamics of the CSF in the upper cervical segment. The decompression of the foramen magnum with dural plasty is an alternative for patients with CMI associated with SM.

语种英语
WOS记录号WOS:000244222200009
引用统计
被引频次:15[WOS]   [WOS记录]     [WOS相关记录]
文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/52135
专题北京大学第三临床医学院_神经外科
北京大学医学部管理机构_北京大学医学部校医院
北京大学第三临床医学院_放射科
作者单位1.Peking Univ Third Hosp, Dept Neurosurg, Beijing 100083, Peoples R China
2.Peking Univ Third Hosp, Dept Radiol, Beijing 100083, Peoples R China
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GB/T 7714
Liu Bin,Wang Zhen-yu,Xie Jing-cheng,et al. Cerebrospinal fluid dynamics in Chiari malformation associated with syringomyelia[J]. CHINESE MEDICAL JOURNAL,2007,120(3):219-223.
APA Liu Bin,Wang Zhen-yu,Xie Jing-cheng,Han Hong-bin,&Pei Xin-long.(2007).Cerebrospinal fluid dynamics in Chiari malformation associated with syringomyelia.CHINESE MEDICAL JOURNAL,120(3),219-223.
MLA Liu Bin,et al."Cerebrospinal fluid dynamics in Chiari malformation associated with syringomyelia".CHINESE MEDICAL JOURNAL 120.3(2007):219-223.
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