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. 2022 Oct 13:2022:9770323.
doi: 10.1155/2022/9770323. eCollection 2022.

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

Yongli Lou  1 , Jichao Yang  1 , Haoyuan Gu  2 , Guanghua Xu  2 , Shanfeng Ji  1 , Chi Xu  2 , Yong Liu  3
Affiliations

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

Yongli Lou et al. Biomed Res Int. .

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 (t = 3.69, P0.001). 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 (P < 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 (P < 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.

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Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1
PC-MRI images ((a) high signal indicates downward movement of systolic CSF (as indicated by the red arrow); (b) low signal indicates headward movement of diastolic CSF (as indicated by the red arrow)).
Figure 2
Figure 2
FVSS intraoperative pictures.
Figure 3
Figure 3
Preoperative and postoperative imaging data of CMI patients ((a–c) preoperative MRI; CMI patients after FMD (arrow in (b)), sagittal position, and cross section indicate large syringo in cervicothoracic junction; (d–f) MRI in the 6th month after FVSS (arrow in (d) indicates shunt position) found a significantly reduced syringo; (g–i) the 2nd MRI of patients in the 24th month after FVSS found a smaller and almost disappeared syringo than that observed in the 6th month after FVSS. (c, f, and i) represent the maximum cross-section of syringo).
Figure 4
Figure 4
PC-MRI scans.
Figure 5
Figure 5
Curves of systolic peak flow of CSF in central segment of mesencephalic aqueduct before and after FVSS and curves of diastolic peak flow velocities of CSF in foramen magnum before and after FVSS.
Figure 6
Figure 6
Diagram of shunt tube fixation.
See this image and copyright information in PMC

References

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