The Effect Of Reconstruction Of The Cisterna Magna On CSF Dynamics In Patients With Chiari Malformation Type I And Syringomyelia

Objective: The aim of the study is to explore the effect of reconstruction of the cisterna magna(posterior vertebral column resection and cerebellar tonsillectomy and reconstruction of the cisterna magna by artificial dura) on CSF dynamics in Chiari malformation type I with syringomyelia by Magnetic Resonance Imaging cine PC and evaluate its efficacy. Methods : There are 40 cases of in-patients with Chiari malformation type I with syringomyelia that diagnosed by MRI were selected. They have been therapied by reconstruction of the cisterna magna. Phase-contrast MR imaging using Philips 3.0T superconductive MRI machine was performed and cerebrospinal fluid dynamics indicators of cerebral aqueduct, pons’ ventral side, the third cervical vertebra’s(C3) ventral side were detected and compared when preoperative and 12 months postoperative. The cerebrospinal fluid dynamics indicators include: ①Stroke volume(SV), ②Mean flux(MF), ③Regurgitant Fraction(%), ④Peak velocity(Vmax), ⑤RR Interval(ms), To evaluate the efficacy of surgery by JOA criteria. Results: Preoperative qualitative observations indicate that two-way flow of cerebrospinal fluid was associated with cardiac systolic and diastolic. Cerebrospinal fluid was flowing from the head to end side at systolic. Cerebrospinal fluid was flowing from the tail to the head side at diastolic. Magnum pool disappeared, cerebrospinal fluid flow signal almost disappeared when Chiari malformation type Ⅰpatients with syringomyelia had serious obstruction on the foramen magnum dorsal. There are 10 patients, syringomyelia fluid signal changes Synchronized with subarachnoid cerebrospinal fluid, it confirmed syringomyelia and the spinal subarachnoid were interlinked. There was no one’s neurological function deterioration or death. The cisterna magna formed well, spinal subarachnoid space was clear, cerebrospinal fluid signal on the foramen magnum dorsal was recovery, there were 30 patients’ syringomyelia significantly reduced after pc-MRI. All patients’ JOA score, Stroke volume and mean flux were increased, but maximum peak velocity was reduced, especially C3 ventral side more obvious. The differences in comparison were statistically significant of(P <0.05). Conclusion: Reconstruction of the cisterna magna can reduce syringomyelia, increased cerebrospinal fluid flow, reduce peak flow of cerebrospinal fluid, improve patient outcomes which is effective surgical procedures of Chiari malformation type Ⅰwith syringomyelia.