Correlation of hindbrain CSF flow and outcome after surgical decompression for Chiari I malformation

Matthew J. McGirt, April Atiba, Frank J. Attenello, Bruce A Wasserman, Ghazala Datoo, Muraya Gathinji, Benjamin Solomon, Jon David Weingart, George Jallo

Research output: Contribution to journalArticle

Abstract

Objective: Many patients with symptomatic Chiari I malformation experience symptom recurrence after surgical decompression. Improved radiographic predictors of outcome are needed to better select patients most likely to benefit from surgical intervention. We examined whether ventral or dorsal cerebrospinal fluid (CSF) flow dynamics assessed by cine phase-contrast MRI scans could predict response to posterior fossa decompression for Chiari I malformation. Methods: Forty-four consecutive pediatric patients undergoing pre-operative cine phase-contrast MRI followed by posterior fossa decompression for Chiari I malformation were retrospectively reviewed. The association of pre-operative ventral or dorsal CSF flow abnormalities at the foramen magnum with symptom-free survival after surgical decompression was assessed via Kaplan-Meier plots and log-rank analysis. Results: Mean±SD age at time of surgery was 8±6 years. Sixteen (36%) patients demonstrated decreased CSF flow dorsal to the cervico-medullary brainstem alone. Fourteen (32%) patients demonstrated abnormal CSF flow both ventral and dorsal to the cervico-medullary brainstem. Fourteen (32%) had normal hindbrain CSF flow. Overall, 13 (30%) patients experienced some degree of symptom recurrence by last follow-up (mean of 27±16 months post-operatively). Symptom recurrence did not differ as a function of degree of tonsilar ectopia (p=0.55). Abnormal CSF flow dorsal to the cervico-medullary brainstem was not associated with symptom recurrence after surgical decompression (p=0.10). However, combined pre-operative ventral and dorsal CSF flow abnormality was associated with a significant reduction (2.6-fold) in the risk of post-operative symptom recurrence (p

Original languageEnglish (US)
Pages (from-to)833-840
Number of pages8
JournalChild's Nervous System
Volume24
Issue number7
DOIs
StatePublished - Jul 2008

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Surgical Decompression
Rhombencephalon
Cerebrospinal Fluid
Recurrence
Brain Stem
Decompression
Foramen Magnum
Hydrodynamics
Magnetic Resonance Imaging
Pediatrics
Survival

Keywords

  • Chiari malformation
  • Cinephase-contrast MRI
  • CSF flow
  • Outcome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Correlation of hindbrain CSF flow and outcome after surgical decompression for Chiari I malformation. / McGirt, Matthew J.; Atiba, April; Attenello, Frank J.; Wasserman, Bruce A; Datoo, Ghazala; Gathinji, Muraya; Solomon, Benjamin; Weingart, Jon David; Jallo, George.

In: Child's Nervous System, Vol. 24, No. 7, 07.2008, p. 833-840.

Research output: Contribution to journalArticle

McGirt, Matthew J. ; Atiba, April ; Attenello, Frank J. ; Wasserman, Bruce A ; Datoo, Ghazala ; Gathinji, Muraya ; Solomon, Benjamin ; Weingart, Jon David ; Jallo, George. / Correlation of hindbrain CSF flow and outcome after surgical decompression for Chiari I malformation. In: Child's Nervous System. 2008 ; Vol. 24, No. 7. pp. 833-840.
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abstract = "Objective: Many patients with symptomatic Chiari I malformation experience symptom recurrence after surgical decompression. Improved radiographic predictors of outcome are needed to better select patients most likely to benefit from surgical intervention. We examined whether ventral or dorsal cerebrospinal fluid (CSF) flow dynamics assessed by cine phase-contrast MRI scans could predict response to posterior fossa decompression for Chiari I malformation. Methods: Forty-four consecutive pediatric patients undergoing pre-operative cine phase-contrast MRI followed by posterior fossa decompression for Chiari I malformation were retrospectively reviewed. The association of pre-operative ventral or dorsal CSF flow abnormalities at the foramen magnum with symptom-free survival after surgical decompression was assessed via Kaplan-Meier plots and log-rank analysis. Results: Mean±SD age at time of surgery was 8±6 years. Sixteen (36{\%}) patients demonstrated decreased CSF flow dorsal to the cervico-medullary brainstem alone. Fourteen (32{\%}) patients demonstrated abnormal CSF flow both ventral and dorsal to the cervico-medullary brainstem. Fourteen (32{\%}) had normal hindbrain CSF flow. Overall, 13 (30{\%}) patients experienced some degree of symptom recurrence by last follow-up (mean of 27±16 months post-operatively). Symptom recurrence did not differ as a function of degree of tonsilar ectopia (p=0.55). Abnormal CSF flow dorsal to the cervico-medullary brainstem was not associated with symptom recurrence after surgical decompression (p=0.10). However, combined pre-operative ventral and dorsal CSF flow abnormality was associated with a significant reduction (2.6-fold) in the risk of post-operative symptom recurrence (p",
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AU - Atiba, April

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AU - Datoo, Ghazala

AU - Gathinji, Muraya

AU - Solomon, Benjamin

AU - Weingart, Jon David

AU - Jallo, George

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N2 - Objective: Many patients with symptomatic Chiari I malformation experience symptom recurrence after surgical decompression. Improved radiographic predictors of outcome are needed to better select patients most likely to benefit from surgical intervention. We examined whether ventral or dorsal cerebrospinal fluid (CSF) flow dynamics assessed by cine phase-contrast MRI scans could predict response to posterior fossa decompression for Chiari I malformation. Methods: Forty-four consecutive pediatric patients undergoing pre-operative cine phase-contrast MRI followed by posterior fossa decompression for Chiari I malformation were retrospectively reviewed. The association of pre-operative ventral or dorsal CSF flow abnormalities at the foramen magnum with symptom-free survival after surgical decompression was assessed via Kaplan-Meier plots and log-rank analysis. Results: Mean±SD age at time of surgery was 8±6 years. Sixteen (36%) patients demonstrated decreased CSF flow dorsal to the cervico-medullary brainstem alone. Fourteen (32%) patients demonstrated abnormal CSF flow both ventral and dorsal to the cervico-medullary brainstem. Fourteen (32%) had normal hindbrain CSF flow. Overall, 13 (30%) patients experienced some degree of symptom recurrence by last follow-up (mean of 27±16 months post-operatively). Symptom recurrence did not differ as a function of degree of tonsilar ectopia (p=0.55). Abnormal CSF flow dorsal to the cervico-medullary brainstem was not associated with symptom recurrence after surgical decompression (p=0.10). However, combined pre-operative ventral and dorsal CSF flow abnormality was associated with a significant reduction (2.6-fold) in the risk of post-operative symptom recurrence (p

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