Post-surgery Ultrasound Liquor Flow Measurement under Cranio-cervical Junction Decompression in Chiari Type I Malformation

Česká verzia

Authors: M. Filip ¹; P. Linzer ¹; F. Šámal ¹; R. Lipina ²; D. Školoudík ^3,4
Authors place of work: Neurochirurgické oddělení, Krajská nemocnice T. Bati, a. s., Zlín ¹; Neurochirurgická klinika Fakultní nemocnice Ostrava ²; Neurologická klinika LF OU a Fakultní nemocnice Ostrava ³; Neurologická klinika LF UP a FN Olomouc ⁴
Published in the journal: Cesk Slov Neurol N 2011; 74/107(3): 320-324
Category: Short Communication

Summary

First experiences with the use of intra-operative ultrasound examination in the course of foramen magnum decompression to treat type 1 Chiari malformation are presented. The authors focus on the intra-operative diagnostics of the obstruction together with control of the patency of cerebrospinal fluid (CSF) pathways at the malformed cerebrospinal junction. A small group of 7 patients operated upon in the years 2004 – 2009 at two neurosurgical departments underwent intra-operative ultrasound diagnostics by examination in B-mode and dopplerometric measurement. Postoperative results demonstrated that ultrasound examination properly detected an obstruction and subsequently monitored restoration of CSF flow in the course of operation. The use of ultrasound examination contributed to satisfactory surgical treatment in the sense of simple bone decompression or bone decompression with duraplasty in 6 patients. Duplex ultrasound imaging in combination with B mode imaging and dopplerometric measurement of CSF flow may be considered a suitable approach to diagnostic examination in this disease.

Key words:
Chiari malformation type I – intraoperative ultrasound examination – Duplex ultrasound imaging – decompression

Zdroje

1. Cooke RS. Chiari malformations. In: Palmer JD (ed). Neurosurgery 96. Manual of Neurosurgery. New York: Churchill Livingston 1996: 680–684.

2. Chiari H. Ueber Veränderungen des Kleinhirns infolge von Hydrocephalie des Grosshirns. Dtsch Med Wochenschr 1891; 17: 1172–1175.

3. Häckel M, Beneš V. Malformace zadního mozku 1. Přehled systematiky a etiologických teorií. Cesk Slov Neurol N 1996; 59/96(1): 21–32.

4. Alzate JC, Kothbauer KF, Jallo GI, Epstein FJ. Treatment of Chiari I malformation in patiens with and without syringomyelia: a consecutive series of 66 cases. Neurosurg Focus 2001; 11(1): E3.

5. Häckel M, Beneš V. Chiariho malformace bez myelodysplázie. Zkušenosti s léčbou 50 nemocných. Cesk Slov Neurol N 2004; 67/100(5): 370–376.

6. Greenberg MS. Handbook of Neurosurgery. New York: Thieme 2001.

7. Šteňo J, Biksadský P, Matejčík V, Krist J. Chirurgické liečenie syringomyelie pri Chiariho malformácii u dospelých. Cesk Slov Neurol N 2000; 63/96(3): 162–166.

8. Sova M, Smrčka M, Smrčka V, Hanoun G. Chiariho malformace: Vlastní zkušenosti. Cesk Slov Neurol N 2007; 70/103(3): 304–307.

9. Attenello FJ, McGirt MJ, Gathinji M, Datoo G, Atiba A, Weingart J et al. Outcome of Chiari-associated syringomyelia after hindbrain decompression in children: analysis of 49 consecutive cases. Neurosurgery 2008; 62(6): 1307–1313.

10. Gardner WJ. Hydrodynamic mechanism of syringomyelia: its relationship to myelocele. J Neurol Neurosurg Psychiat 1965; 28: 247–259.

11. Williams B. On the pathogenesis of syringomyelia: a review. J Roy Soc Med 1980; 73(11): 798–806.

12. McGirt MJ, Nimjee SM, Fuchs HE, George TM. Relationship of cine phase-contrast magnetic resonance imaging with outcome after decompression for Chiari I malformations. Neurosurgery 2006; 59(1): 140–146.

13. Häckel M, Beneš V, Mohapl M. Metodiky měření a monitorování tlaku likvoru při indikaci chirurgického řešení malformací zadního mozku. Soubor 25 nemocných. Cesk Slov Neurol N 2002; 65/98(3): 150–159.

14. Školoudík D, Majvald Č, Chudoba V. Možnosti diagnostiky tkáňových lézí mozku pomocí ultrazvuku. Cesk Slov Neurol N 1999; 62/95(3): 135–140.

15. Milhorat TH, Bolognese PA. Tailored operative technique for Chiari type I malformation using intraoperative color Doppler ultrasonography. Neurosurgery 2003; 53(4): 899–906.

16. Scott RM. Tailored operative technique for Chiari type I malformation using intraoperative color Doppler ultrasonography. Neurosurgery 2004; 55(4): 1008.