Pulsatile cerebrospinal fluid dynamics in Chiari i malformation syringomyelia: Predictive value in posterior fossa decompression and insights into the syringogenesis

Sabino Luzzi, Alice Giotta Lucifero, Yasmeen Elsawaf, Samer Elbabaa, Mattia Del Maestro, Gabriele Savioli, Renato Galzio, Cristian Gragnaniello

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

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: 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 P was <0.001. 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 1stmonth after PFD (<0.001). A caudad and cephalad CSF jet flow was found inside the syrinx during systole and diastole, respectively. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)15-25
Number of pages11
JournalJournal of Craniovertebral Junction and Spine
Volume12
Issue number1
DOIs
StatePublished - Jan 1 2021
Externally publishedYes

Keywords

  • Cerebrospinal fluid circulation
  • Chiari I malformation
  • cine magnetic resonance imaging
  • posterior fossa decompression
  • syringomyelia

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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