A Clinical Study on the Treatment of Recurrent Chiari (Type I) Malformation with Syringomyelia Based on the Dynamics of Cerebrospinal Fluid

Overview

Journal Biomed Res Int

Publisher Wiley

Specialties Biomedical Engineering
Biotechnology
General Medicine

Date 2022 Oct 24

PMID 36277900

Authors

Yongli Lou

Jichao Yang

Haoyuan Gu

Guanghua Xu

Shanfeng Ji

Chi Xu

Yong Liu

Affiliations

Soon will be listed here.

Abstract

Objective: Combining the dynamics of cerebrospinal fluid, our study investigates the clinical effects of syringomyelia after the combination of fourth ventricle-subarachnoid shunt (FVSS) for recurrent Chiari (type I) malformations after cranial fossa decompression (foramen magnum decompression (FMD)).

Methods: From December 2018 to December 2020, 15 patients with recurrent syringomyelia following posterior fossa decompression had FVSS surgery. Before and after the procedure, the clinical and imaging data of these individuals were retrospectively examined.

Results: Following FVSS, none of the 15 patients experienced infection, nerve injury, shunt loss, or obstruction. 13 patients improved dramatically after surgery, while 2 patients improved significantly in the early postoperative period, but the primary symptoms returned 2 months later. The Japanese Orthopedic Association (JOA) score was 12.67 ± 3.95, which was considerably better than preoperatively ( = 3.69, 0.001). The MRI results revealed that the cavities in 13 patients were reduced by at least 50% compared to the cavities measured preoperatively. The shrinkage rate of syringomyelia was 86.67% (13/15). One patient's cavities nearly vanished following syringomyelia. The size of the cavity in the patient remain unchanged, and the cavity's maximal diameter was significantly smaller than the size measured preoperatively ( < 0.001) PC-MRI results indicated that the peak flow rate of cerebrospinal fluid at the central segment of the midbrain aqueduct and the foramen magnum in patients during systole and diastole were significantly reduced after surgery ( < 0.05).

Conclusion: After posterior fossa decompression, FVSS can effectively restore the smooth circulation of cerebrospinal fluid and alleviate clinical symptoms in patients with recurrent Chiari (type I) malformation and syringomyelia. It is a highly effective way of treatment.

Citing Articles

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Ma L, Liu S, Yao Q, Wang X, Guan J, Jian F Fluids Barriers CNS. 2025; 22(1):21.

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Fourth ventricle to spinal subarachnoid space stenting in pediatric patients with refractory syringomyelia: case series and systematic review.

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References

Xu Q, Yu S, Zheng N, Yuan X, Chi Y, Liu C . Head movement, an important contributor to human cerebrospinal fluid circulation. Sci Rep. 2016; 6:31787. PMC: 4990938. DOI: 10.1038/srep31787. View

Mazzola C, Fried A . Revision surgery for Chiari malformation decompression. Neurosurg Focus. 2004; 15(3):E3. DOI: 10.3171/foc.2003.15.3.3. View

Phillips T, Kindt G . Syringoperitoneal shunt for syringomyelia: a preliminary report. Surg Neurol. 1981; 16(6):462-6. DOI: 10.1016/0090-3019(81)90248-2. View

Taylor D, Chatrath A, Mastorakos P, Paisan G, Chen C, Buell T . Cerebrospinal fluid area and syringogenesis in Chiari malformation type I. J Neurosurg. 2020; 134(3):825-830. DOI: 10.3171/2019.11.JNS191439. View

Tarumi T, Yamabe T, Fukuie M, Zhu D, Zhang R, Ogoh S . Brain blood and cerebrospinal fluid flow dynamics during rhythmic handgrip exercise in young healthy men and women. J Physiol. 2021; 599(6):1799-1813. DOI: 10.1113/JP281063. View

Luzzi S, Lucifero A, Elsawaf Y, Elbabaa S, Del Maestro M, Savioli G . Pulsatile cerebrospinal fluid dynamics in Chiari I malformation syringomyelia: Predictive value in posterior fossa decompression and insights into the syringogenesis. J Craniovertebr Junction Spine. 2021; 12(1):15-25. PMC: 8035583. DOI: 10.4103/jcvjs.JCVJS_42_20. View

Davidson K, Rogers J, Stoodley M . Syrinx to Subarachnoid Shunting for Syringomyelia. World Neurosurg. 2017; 110:e53-e59. DOI: 10.1016/j.wneu.2017.09.205. View

Sgouros S, Williams B . A critical appraisal of drainage in syringomyelia. J Neurosurg. 1995; 82(1):1-10. DOI: 10.3171/jns.1995.82.1.0001. View

Mozaffari K, Davidson L, Chalif E, Phan T, Sparks A, Myseros J . Long-term outcomes of posterior fossa decompression for Chiari malformation type 1: which patients are most prone to failure?. Childs Nerv Syst. 2021; 37(9):2891-2898. DOI: 10.1007/s00381-021-05280-y. View

10.

Soleman J, Bartoli A, Korn A, Constantini S, Roth J . Treatment failure of syringomyelia associated with Chiari I malformation following foramen magnum decompression: how should we proceed?. Neurosurg Rev. 2018; 42(3):705-714. DOI: 10.1007/s10143-018-01066-0. View

11.

Wan M, Zong R, Tong H, Zhang Z, Zhao B, Yu X . A morphometric study of the atlanto-occipital joint in adult patients with Chiari malformation type I. Br J Neurosurg. 2020; 38(1):12-15. DOI: 10.1080/02688697.2020.1823940. View

12.

Cacciola F, Capozza M, Perrini P, Benedetto N, Lorenzo N . Syringopleural shunt as a rescue procedure in patients with syringomyelia refractory to restoration of cerebrospinal fluid flow. Neurosurgery. 2009; 65(3):471-6. DOI: 10.1227/01.NEU.0000350871.47574.DE. View

13.

Wang D, Zhao R, Qu Y, Mei X, Zhang X, Zhou Q . Colonic Lysine Homocysteinylation Induced by High-Fat Diet Suppresses DNA Damage Repair. Cell Rep. 2018; 25(2):398-412.e6. DOI: 10.1016/j.celrep.2018.09.022. View

14.

Lin W, Duan G, Xie J, Shao J, Wang Z, Jiao B . Comparison of Results Between Posterior Fossa Decompression with and without Duraplasty for the Surgical Treatment of Chiari Malformation Type I: A Systematic Review and Meta-Analysis. World Neurosurg. 2017; 110:460-474.e5. DOI: 10.1016/j.wneu.2017.10.161. View

15.

Riordan C, Scott R . Fourth ventricle stent placement for treatment of recurrent syringomyelia in patients with type I Chiari malformations. J Neurosurg Pediatr. 2018; 23(2):164-170. DOI: 10.3171/2018.7.PEDS18312. View

16.

Takizawa K, Matsumae M, Sunohara S, Yatsushiro S, Kuroda K . Characterization of cardiac- and respiratory-driven cerebrospinal fluid motion based on asynchronous phase-contrast magnetic resonance imaging in volunteers. Fluids Barriers CNS. 2017; 14(1):25. PMC: 5615451. DOI: 10.1186/s12987-017-0074-1. View

17.

Arnautovic A, Splavski B, Boop F, Arnautovic K . Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr. 2014; 15(2):161-77. DOI: 10.3171/2014.10.PEDS14295. View

18.

Li Y, Yao C, Xu F, Qu Y, Li J, Lin Y . APC/C synchronizes ribose-5-phosphate levels and DNA synthesis to cell cycle progression. Nat Commun. 2019; 10(1):2502. PMC: 6555833. DOI: 10.1038/s41467-019-10375-x. View

19.

Qu Y, Zhao R, Zhang H, Zhou Q, Xu F, Zhang X . Inactivation of the AMPK-GATA3-ECHS1 Pathway Induces Fatty Acid Synthesis That Promotes Clear Cell Renal Cell Carcinoma Growth. Cancer Res. 2019; 80(2):319-333. DOI: 10.1158/0008-5472.CAN-19-1023. View

20.

Papaker M, Abdallah A, Cesme D, Gonen G, Asilturk M, Avyasov R . Clinical and radiological evaluation of treated Chiari I adult patients: retrospective study from two neurosurgical centers. Neurosurg Rev. 2020; 44(4):2261-2276. DOI: 10.1007/s10143-020-01414-z. View