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Author Notes:

Bryn A. Martin, PhD, Department of Biological Engineering, University of Idaho, 875 Perimeter Drive MS 0904, Moscow, ID 83844-0904, Phone: 208-885-6182, Fax: 208-885-7908, brynm@uidaho.edu.

The authors thank Michael Majcher; Nicholas Shaffer; Jennifer Chisko; Daniel McQuaide and Kyla Lowenkamp for assistance with data processing on this project.

The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Subjects:

Research Funding:

This work was supported by NIH NINDS grant 1R15NS071455-01; and NIH NIGMS grants P20GM103408; and 4U54GM104944-04; Conquer Chiari; and the University of Washington School of Medicine Medical Student Research Training Program (MSRTP).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Surgery
  • Neurosciences & Neurology
  • Cardiac-related brain deformation
  • Cerebrospinal fluid
  • Chiari malformation
  • Neurohydrodynamics
  • Phase-contrast MRI
  • Spinal cord motion
  • CEREBROSPINAL-FLUID HYDRODYNAMICS
  • PHASE-CONTRAST MRI
  • CLINICAL ARTICLE
  • CEREBELLAR TONSILS
  • NATURAL-HISTORY
  • SUBOCCIPITAL DECOMPRESSION
  • PRESSURE RECORDINGS
  • PEDIATRIC-PATIENTS
  • SURGICAL-TREATMENT
  • BRAIN-STEM

Cardiac-Related Spinal Cord Tissue Motion at the Foramen Magnum is Increased in Patients with Type I Chiari Malformation and Decreases Postdecompression Surgery

Tools:

Journal Title:

World Neurosurgery

Volume:

Volume 116

Publisher:

, Pages E298-E307

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objective: Type 1 Chiari malformation (CM-I) is a craniospinal disorder historically defined by cerebellar tonsillar position greater than 3–5 mm below the foramen magnum (FM). This definition has come under question because quantitative measurements of cerebellar herniation do not always correspond with symptom severity. Researchers have proposed several additional radiographic diagnostic criteria based on dynamic motion of fluids and/or tissues. The present study objective was to determine if cardiac-related craniocaudal spinal cord tissue displacement is an accurate indicator of the presence of CM-I and if tissue displacement is altered with decompression. Methods: A cohort of 20 symptomatic patients underwent decompression surgery. Fifteen healthy volunteers were recruited for comparison with the CM-I group. Axial phase-contrast magnetic resonance imaging (PC-MRI) measurements were collected before and after surgery at the FM with cranial-caudal velocity encoding and 20 frames per cardiac cycle with retrospective reconstruction. Spinal cord motion (SCM) at the FM was quantified based on the peak-to-peak integral of average spinal cord velocity. Results: Tissue motion for the presurgical group was significantly greater than controls (P = 0.0009). Motion decreased after surgery (P = 0.058) with an effect size of –0.151 mm and a standard error of 0.066 mm. Postoperatively, no statistical difference from controls in bulk displacement at the FM was found (P = 0.200) after post hoc testing using the Tukey adjustment for multiple comparisons. Conclusions: These results support SCM measurement by PC-MRI as a possible noninvasive radiographic diagnostic for CM-I. Dynamic measurement of SCM provides unique diagnostic information about CM-I alongside static quantification of tonsillar position and other intracranial morphometrics.

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© 2018 Elsevier Inc. All rights reserved.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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