Panigrahi M, Reddy B Praveen, Reddy A K, Reddy J J M
Department of Neurosurgery, Nizam's Institute of Medical Sciences (NIMS), 500 082 Panjagutta, Hyderabad, India.
Childs Nerv Syst. 2004 May;20(5):336-40. doi: 10.1007/s00381-003-0881-3. Epub 2004 Apr 9.
The aim of this prospective study was to define the role of cardiac gated phase-contrast ciné magnetic resonance imaging in deciding the therapeutic strategy in patients with Chiari I malformation.
Twenty-one patients operated on between February 2000 and July 2002 were enrolled in the study. All patients underwent a detailed preoperative neurological examination. MRI of the craniovertebral junction and the whole spine was done, followed by cardiac gated phase contrast ciné magnetic resonance imaging.
Signs and symptoms of syringomyelia were noted in 15 patients and cerebellar signs in 11 patients. Three of them had trigeminal nerve involvement, and 4 had ninth and tenth cranial nerve involvement. The sixth and accessory nerves were involved in 1 patient each. Preoperative CSF flow studies revealed obstructive flow both anteriorly and posteriorly in 6 patients and only posterior block in 15 patients. One patient investigated for failed foramen magnum decompression revealed obstruction to CSF flow ventrally. Foramen magnum decompression with duroplasty was done in all these cases. The patient who had a persistent ventral flow block underwent odontoidectomy. Patients were followed up for a maximum of 36 months, with a mean of 18 months. MRI CSF flow studies revealed established flow dorsally in all cases. Seventeen patients showed clinical improvement and 2 of them did not show any neurological changes. Two patients deteriorated following an initial period with a shunt.
MRI CSF flow study is an effective tool for deciding the type of surgery to be performed and also for monitoring patients postoperatively.
这项前瞻性研究的目的是确定心脏门控相位对比电影磁共振成像在决定Chiari I型畸形患者治疗策略中的作用。
本研究纳入了2000年2月至2002年7月间接受手术的21例患者。所有患者均接受了详细的术前神经学检查。先对颅颈交界处和整个脊柱进行磁共振成像（MRI）检查，随后进行心脏门控相位对比电影磁共振成像检查。
15例患者出现脊髓空洞症的体征和症状，11例患者出现小脑体征。其中3例患者三叉神经受累，4例患者第九和第十颅神经受累。第六和副神经分别有1例患者受累。术前脑脊液流动研究显示，6例患者前后方均存在梗阻性流动，15例患者仅后方存在梗阻。1例因枕骨大孔减压失败接受检查的患者显示腹侧脑脊液流动受阻。所有这些病例均进行了枕骨大孔减压术加硬脑膜成形术。腹侧流动持续受阻的患者接受了齿状突切除术。对患者进行了最长36个月、平均18个月的随访。MRI脑脊液流动研究显示所有病例背侧均已建立流动。17例患者临床症状改善，其中2例未出现任何神经学变化。2例患者在初期使用分流器后病情恶化。
MRI脑脊液流动研究是决定手术类型以及术后监测患者的有效工具。
