Chiari 奇形に伴った脊髄空洞症における cine MRI を用いた髄液流通障害の定量的評価

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Most of the recent reports have suggested that cerebro-spinal fluid (CSF) flow disturbed by herniated cerebellar tonsils induces syringomyelia in adult type Chiari malformation. We investigated CSF flow dynamics at the foramen magnum using cine magnetic resonance imaging (cine MRI), to quatitatively estimate the improvement of CSF flow at the foramen magnum before and after decompressive surgery. Quantitative cine MRI was performed in 18 patients suffering from syringomyelia with Chiari malformation and 5 normal volunteers to evaluate CSF flow dynamics. As useful indices, we measured the maximum caudal flow velocity (max. flow velocity) and calculated the timescale of the maximum flow velocity to one cardiac cycle (% cardiac cycle). In all of the 18 cases who underwent expansive suboccipital cranioplasty, the neurological findings and syringomyelia improved after surgery. Before surgery the max. flow velocities in patients were significantly diminished in magnitude at the foramen magnum, compared with those in normal subjects. Before surgery the % cardiac cycles at the foramen magnum in patients were significantly diminished in quickness, compared with that in normal subjects. After surgery, the max. flow velocities and the % cardiac cycles approximated those of the normal controls. Thus, expansive suboccipital cranioplasty can effectively restore the disturbed CSF flow at the foramen magnum, and consequently result in reduction of the syrinx size. To-and-fro motion of the fluid in the syringomyelia before surgery diminished after surgery. We concluded that, to estimate the efficacy of surgical treatment, CSF flow dynamics at the foramen magnum should be evaluated. Cine MRI could be useful to study the progression of syringomyelia.
日本脊髄外科学会の論文
2000-02-29

Chiari 奇形に伴った脊髄空洞症における cine MRI を用いた髄液流通障害の定量的評価

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