Wang Shengxi, Zhang Dongao, Wu Kun, Fan Wayne, Fan Tao
Department of Spinal Spine Surgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Faculty of Science, University of British Columbia, Vancouver, BC, Canada.
Front Neurol. 2023 Feb 20;14:1069861. doi: 10.3389/fneur.2023.1069861. eCollection 2023.
The characteristic morphological parameters (bony posterior fossa volume (bony-PFV), posterior fossa crowdness, cerebellar tonsillar hernia, and syringomyelia) and CSF dynamics parameters at the craniocervical junction (CVJ) in Chiari malformation type I (CMI) were measured. The potential association between these characteristic morphologies and CSF dynamics at CVJ was analyzed.
A total of 46 cases of control subjects and 48 patients with CMI underwent computed tomography and phase-contrast magnetic resonance imaging. Seven morphovolumetric measures and four CSF dynamics at CVJ measures were performed. The CMI cohort was further divided into "syringomyelia" and "non-syringomyelia" subgroups. All the measured parameters were analyzed by the Pearson correlation.
Compared with the control, the posterior cranial fossa (PCF) area, bony-PFV, and CSF net flow were significantly smaller ( < 0.001) in the CMI group. Otherwise, the PCF crowdedness index (PCF CI, < 0.001) and the peak velocity of CSF ( < 0.05) were significantly larger in the CMI cohort. The mean velocity (MV) was faster in patients with CMI with syringomyelia ( < 0.05). In the correlation analysis, the degree of cerebellar tonsillar hernia was correlated with PCF CI ( = 0.319, < 0.05), MV ( = -0.303, < 0.05), and the net flow of CSF ( = -0.300, < 0.05). The Vaquero index was well correlated with the bony-PFV (= -0.384, < 0.05), MV ( = 0.326, < 0.05), and the net flow of CSF ( = 0.505, < 0.05).
The bony-PFV in patients with CMI was smaller, and the MV was faster in CMI with syringomyelia. Cerebellar subtonsillar hernia and syringomyelia are independent indicators for evaluating CMI. Subcerebellar tonsillar hernia was associated with PCF crowdedness, MV, and the net flow of CSF at CVJ, while syringomyelia was associated with bony-PFV, MV, and the net flow of CSF at the CVJ. Thus, the bony-PFV, PCF crowdedness, and the degree of CSF patency should also be one of the indicators of CMI evaluation.
测量Ⅰ型Chiari畸形（CMI）患者颅颈交界区（CVJ）的特征性形态学参数（骨性后颅窝容积（bony-PFV）、后颅窝拥挤程度、小脑扁桃体疝和脊髓空洞症）及脑脊液动力学参数。分析这些特征性形态与CVJ处脑脊液动力学之间的潜在关联。
46例对照者和48例CMI患者接受了计算机断层扫描和相位对比磁共振成像检查。进行了7项形态容积测量和4项CVJ处脑脊液动力学测量。CMI队列进一步分为“脊髓空洞症”和“非脊髓空洞症”亚组。所有测量参数采用Pearson相关性分析。
与对照组相比，CMI组后颅窝（PCF）面积、bony-PFV和脑脊液净流量显著减小（<0.001）。此外，CMI队列中PCF拥挤指数（PCF CI，<0.001）和脑脊液峰值速度（<0.05）显著增大。合并脊髓空洞症的CMI患者平均速度（MV）更快（<0.05）。在相关性分析中，小脑扁桃体疝程度与PCF CI（=0.319，<0.05）、MV（=-0.303，<0.05）和脑脊液净流量（=-0.300，<0.05）相关。Vaquero指数与bony-PFV（=-0.384，<0.05）、MV（=0.326，<0.05）和脑脊液净流量（=0.505，<0.05）相关性良好。
CMI患者的bony-PFV较小，合并脊髓空洞症的CMI患者MV更快。小脑扁桃体下疝和脊髓空洞症是评估CMI的独立指标。小脑扁桃体下疝与PCF拥挤程度、MV及CVJ处脑脊液净流量相关，而脊髓空洞症与bony-PFV、MV及CVJ处脑脊液净流量相关。因此，bony-PFV、PCF拥挤程度和脑脊液通畅程度也应作为CMI评估指标之一。
