Changes in CSF flow after one-stage posterior vertebral column resection in scoliosis patients with syringomyelia and Chiari malformation Type I
Changes in CSF flow after one-stage posterior vertebral column resection in scoliosis patients with syringomyelia and Chiari malformation Type I
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DOI：
10.3171/2013.1.spine12366
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发表时间：
2013-05-01
影响因子：
2.8
通讯作者：
Si, Yongyu
中科院分区：
文献类型：
--
作者：
Wang, Yingsong;Xie, Jingming;Si, Yongyu
物体。脊髓空洞症和Chiari畸形I型(CM-I)患者的相位对比电影MRI(PC-Cine MRI)研究显示，脑脊液异常流过枕骨大孔区，在伴有脊髓空洞缩小的颅颈减压后可恢复正常。为探讨脊髓空洞术后脊髓空洞缩小的机制，对脊柱侧弯合并脊髓空洞症患者一期脊柱后路切除术后颅颈交界区和椎管内脑脊液的血流变化进行了研究。采用同步心电门控PC-Cine磁共振成像技术，对8例重度脊柱侧凸合并脊髓空洞症和CM-I青少年脊柱侧凸患者(脊柱侧弯组)行后路脊柱切除手术前后枕大孔、C-7、T-7(或心尖)和L-1水平的脑脊液血流动力学变化进行了研究。另选择8例脊髓空洞症和无脊柱畸形的CM-I患者(空洞组)和8例健康志愿者(对照组)。获得以下参数的平均值：一个脑脊液周期的持续时间、尾部脑脊液持续时间(脑脊液向下流动的持续时间[df])和头端脑脊液流动(脑脊液向上流动的持续时间(向上))、脑脊液持续时间与脑脊液周期持续时间的比率(df%)、超滤持续时间与脑脊液周期持续时间的比率(uf%)。计算静止期(SP)持续时间与脑脊液周期持续时间的比值(SP%)。测量最大下流速度(VDmax)和最大上流速度(VUmax)。采用SPSS(Version 14.0)软件进行统计分析。脊柱侧弯组患者在不行枕下减压的情况下，行一期脊柱后路切除矫正畸形。术前冠状面Cobb角平均102.4°(76°~138°)。术后Cobb角12°~75°，平均41.7°，平均矫正率59.3%。随访期间，1例肌张力增高患者肌张力明显下降，1例肛门括约肌张力降低，恢复正常。共有5名患者的空洞明显缩小(30%)。在脑脊液血流动力学变化方面，空洞组较对照组下降更慢、更短，在枕骨大孔区和C-7节段差异更显著。在脊柱侧弯患者中，枕大孔水平的脑脊液下行明显受限，静止期延长表明脑脊液流动受阻增加。后路椎体切除后，枕大孔区脑脊液血流峰值速度增加，下流期持续时间明显延长。参数显示颅颈区域的脑脊液动力学恢复到几乎正常，这种改善在6-12个月的随访期内保持。脊髓空洞症患者在颅颈交界处有明显的脑脊液流量异常。合并严重脊柱畸形可加重下行血流动力学异常，后路脊柱切除矫正可改善下行血流动力学异常。(http://thejns.org/doi/abs/10.3171/2013.1.SPINE12366)
Object. Phase contrast-cine MRI (PC-cine MRI) studies in patients with syringomyelia and Chiari malformation Type I (CM-I) have demonstrated abnormal CSF flow across the foramen magnum, which can revert to normal after craniocervical decompression with syrinx shrinkage. In order to investigate the mechanisms leading to postoperative syringomyelia shrinkage, the authors studied the hydrodynamic changes of CSF flow in the craniocervical junction and spinal canal in patients with scoliosis associated with syringomyelia after one-stage deformity correction by posterior vertebral column resection.Methods. Preoperative and postoperative CSF flow dynamics at the levels of the foramen magnum, C-7, T-7 (or, apex), and L-1 were assessed by electrocardiogram-synchronized cardiac-gated PC-cine MRI in 8 adolescent patients suffering from severe scoliosis with syringomyelia and CM-I (scoliosis group) and undergoing posterior vertebral column resection. An additional 8 patients with syringomyelia and CM-I without spinal deformity (syrinx group) and 8 healthy volunteers (control group) were also enrolled. Mean values were obtained for the following parameters: the duration of a CSF cycle, the duration of caudad CSF flow (CSF downfiow [DF]) and cephalad CSF flow (CSF upflow [UP]), the ratio of DF duration to CSF cycle duration (DF%), and the ratio of UF duration to CSF cycle duration (UF%). The ratio of the stationary phase (SP) duration to CSF cycle duration was calculated (SP%). The maximum downflow velocities (VDmax) and maximum upflow velocities (VUmax) were measured. SPSS (version 14.0) was used for all statistical analysis.Results. Patients in the scoliosis group underwent one-stage posterior vertebral column resection for deformity correction without suboccipital decompression. The mean preoperative coronal Cobb angle was 102.4 degrees (range 76 degrees-138 degrees). The mean postoperative Cobb angle was 41.7 degrees (range 12 degrees-75 degrees), with an average correction rate of 59.3%. During the follow-up, 1 patient with hypermyotonia experienced a significant decrease of muscle tension and 1 patient with reduced anal sphincter tone manifested recovery. A total of 5 patients demonstrated a significant decrease (> 30%) in syrinx size. With respect to changes in CSF flow dynamics, the syrinx group was characterized by slower and shorter downfiow than the control group, and the difference was more significant at the foramen magnum and C-7 levels. In patients with scoliosis, CSF downflow at the foramen magnum level was significantly restricted, and a prolonged stationary phase indicated increased obstruction of CSF flow. After posterior vertebral column resection, the peak velocity of CSF flow at the foramen magnum increased, and the downflow phase duration was markedly prolonged. The parameters showed a return to almost normal CSF dynamics at the craniocervical region, and this improvement was maintained for 6-12 months of follow-up.Conclusions. There were distinct abnormalities of CSF flow at the craniocervical junction in patients with syringomyelia. Abnormal dynamics of downflow could be aggravated by associated severe spinal deformity and improved by correction via posterior vertebral column resection. (http://thejns.org/doi/abs/10.3171/2013.1.SPINE12366)