Cerebrospinal Fluid and Its Movement at the Upper Cervical Level in Healthy Volunteers and Patients with Chiari Malformation I before and after Operation

Arutyunov N., Fadeeva L., Kornienko V.

Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

The research goal was to study CSF movement in patients with Chiari malformation I before and after decompressive surgery, to estimate informative efficacy of phase-contrast MRI in a postoperative period and to compare its results with cardiosynchronization.

Material and Methods. Examination of patients with applying a high-field MR scanner (1.5 T) included T1- and T2- weighted imaging, MR cisternography and phase-contrast MRI (an axial section at the level of C1-C2, VENC of 10-15 cm/s, a sagittal section). A stroke volume (SV), mean linear velocity (MeanLV), maximum linear velocity (MLV), a volumetric velocity (VV) of liquor flow in an intradural space (Flow Analysis, GE) were calculated. SV was estimated as an area under a diagram of absolute values of liquor flow velocity. There were 8 cases with Chiari malformation I (3 females and 5 males, aged 21-56), examined before and after decompressive surgery, and 8 healthy volunteers (4 females and 4 males, aged 14-49).

Results. We visualized liquor movement in the aqueduct, the IVth ventricle, at level of cisterna magna, foramen magna (MR cisternography) and measured liquor flow velocity in an intradural space at the level of C1-C2 (phase-contrast MRI). SV values, characteristic of the upper cervical level of healthy volunteers and cases with Chiari malformation I before and after operation, were 1.06±0.47 ml, 0.31±0.24 ml and 0.64±0.29 respectively (p<0.03 and p< 0.1). Preoperative SV and liquor flow velocity of cases with Chiari malformation I differed greatly from those of healthy volunteers. However, this difference became insignificant after operation (p>0.1).

Conclusion. Phase-contrast MRI allows to visualize and to estimate a pulse movement of liquor. Values of SV, MeanLV and MLV make it possible to assess efficacy of surgical treatment of cases with Chiari malformation I.