Capel Cyrille, Lantonkpode Romaric, Metanbou Serge, Peltier Johann, Balédent Olivier
Department of Neurosurgery, Hospital University Center of Amiens-Picardie, 80054 Amiens, France.
Chimère UR 7516, Jules Verne University, 80000 Amiens, France.
J Clin Med. 2023 Sep 13;12(18):5954. doi: 10.3390/jcm12185954.
The pathophysiology of this association of type 1 Chiari malformation (CM1) and syrinxes is still unknown. There is an alteration in the dynamics of neurofluids (cerebrospinal fluid, arterial and venous blood) during the cardiac cycle in CM1. Our objective is to quantify CSF or arterial blood or venous blood flow in patients with Chiari syndrome (CS) with and without syrinxes using phase-contrast MRI (PCMRI).
We included 28 patients with CM1 (9 with syrinxes, 19 without). Morphological MRI with complementary PCMRI sequences was performed. We analyzed intraventricular CSF, subarachnoid spaces CSF, blood, and tonsillar pulsatility.
There is a highly significant correlation ( < 0.001) between cerebral blood flow, cerebral vascular expansion volume and venous drainage distribution. Venous drainage distribution is significantly inversely correlated with oscillatory CSF volume at the level of the foramen magnum plane [-0.37 (0.04)] and not significantly correlated at the C2C3 level [-0.37 (0.05)] over our entire population. This correlation maintained the same trend in patients with syrinxes [-0.80 (<0.01)] and disappeared in patients without a syrinx [-0.05 (0.81)].
The distribution of venous drainage is an important factor in intracranial homeostasis. Impaired venous drainage would lead to greater involvement of the CSF in compensating for arterial blood influx, thus contributing to syrinx genesis.
1型Chiari畸形（CM1）与脊髓空洞症这种关联的病理生理学仍不清楚。在CM1患者的心动周期中，神经流体（脑脊液、动脉血和静脉血）的动力学存在改变。我们的目的是使用相位对比磁共振成像（PCMRI）对伴有和不伴有脊髓空洞症的Chiari综合征（CS）患者的脑脊液、动脉血或静脉血流动进行量化。
我们纳入了28例CM1患者（9例伴有脊髓空洞症，19例不伴有）。进行了带有补充PCMRI序列的形态学磁共振成像检查。我们分析了脑室内脑脊液、蛛网膜下腔脑脊液、血液以及扁桃体搏动情况。
脑血流量、脑血管扩张容积和静脉引流分布之间存在高度显著的相关性（<0.001）。在我们的全部研究对象中，静脉引流分布与枕大孔平面的振荡性脑脊液容积呈显著负相关[-0.37（0.04）]，而在C2C3水平则无显著相关性[-0.37（0.05）]。这种相关性在伴有脊髓空洞症的患者中保持相同趋势[-0.80（<0.01）]，而在不伴有脊髓空洞症的患者中则消失[-0.05（0.81）]。
静脉引流分布是颅内稳态的一个重要因素。静脉引流受损会导致脑脊液更多地参与代偿动脉血流入，从而促成脊髓空洞症的发生。
