Dolar Maria T, Haughton Victor M, Iskandar Bermans J, Quigley Mark
Department of Radiology, University of Wisconsin, Madison, WI, USA.
AJNR Am J Neuroradiol. 2004 Jan;25(1):142-5.
Peak CSF velocities detected in individual voxels in the subarachnoid space in patients with Chiari I malformations exceed those in similar locations in the subarachnoid space in healthy subjects. The purpose of this study was to test the hypothesis that the peak voxel velocities are decreased by craniocervical decompression.
A consecutive series of patients with symptomatic Chiari I malformations was studied before and after craniocervical decompression with cardiac-gated, phase contrast MR imaging. Velocities were calculated for each voxel within the foramen magnum at 14 time points throughout the cardiac cycle. The greatest velocities measured in a voxel during the cephalad and caudad phases of CSF flow through the foramen magnum were tabulated for each patient before and after surgery. The differences in these velocities between the preoperative and postoperative studies were tested for statistical significance by using a single-tailed Student's t test of paired samples.
Eight patients with a Chiari I malformation, including four with a syrinx, were studied. Peak caudad velocity diminished after craniocervical decompression in six of the eight patients, and the average diminished significantly from 3.4 cm/s preoperatively to 2.4 cm/s postoperatively (P =.01). Peak cephalad velocity diminished in six of the eight cases. The average diminished from 6.9 cm/s preoperatively to 3.9 cm/s postoperatively, a change that nearly reached the significance level of.05 (P =.055).
Craniocervical decompression in patients with Chiari I malformations decreases peak CSF velocities in the foramen magnum. The study supports the hypothesis that successful treatment of the Chiari I malformation is associated with improvement in CSF flow patterns.
Chiari I 型畸形患者蛛网膜下腔中各体素检测到的脑脊液峰值流速超过健康受试者蛛网膜下腔类似位置的流速。本研究的目的是检验颅骨减压术可降低体素峰值流速这一假设。
对一系列有症状的 Chiari I 型畸形患者在颅骨减压术前和术后采用心脏门控相位对比磁共振成像进行研究。在整个心动周期的 14 个时间点计算枕骨大孔内每个体素的流速。将脑脊液通过枕骨大孔的头向和尾向流动阶段每个体素测量到的最大流速记录在每位患者术前和术后的表格中。术前和术后研究中这些流速的差异通过配对样本单尾 Student t 检验进行统计学显著性检验。
研究了 8 例 Chiari I 型畸形患者，其中 4 例伴有脊髓空洞症。8 例患者中有 6 例在颅骨减压术后尾向峰值流速降低，平均流速从术前的 3.4 cm/s 显著降低至术后的 2.4 cm/s（P = 0.01）。8 例中有 6 例头向峰值流速降低。平均流速从术前的 6.9 cm/s 降至术后的 3.9 cm/s，这一变化几乎达到 0.05 的显著性水平（P = 0.055）。
Chiari I 型畸形患者的颅骨减压术可降低枕骨大孔处脑脊液的峰值流速。该研究支持 Chiari I 型畸形的成功治疗与脑脊液流动模式改善相关这一假设。
