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Cerebrospinal Fluid Hydrodynamics in Chiari I Malformation and Syringomyelia: Modeling Pathophysiology

John D Heiss1

  • 1Clinical Unit, Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, National Institutes of Health, 10 Center Drive, Room 3D20, MSC-1414, Bethesda, MD 20892, USA.

Neurosurgery Clinics of North America
|November 24, 2022
PubMed

Insights

Chiari I malformation obstructs cerebrospinal fluid (CSF) pathways at the foramen magnum. This blockage increases pressure waves within the spinal cord, potentially leading to syrinx formation, though adult central canal septations may prevent this.

Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Chiari I malformation involves cerebellar tonsil herniation through the foramen magnum.
  • Obstructed cerebrospinal fluid (CSF) pathways at the foramen magnum are characteristic of this condition.
  • Understanding the impact of this obstruction on CSF dynamics is crucial for patient management.

Purpose of the Study:

  • To elucidate the mechanism by which Chiari I malformation obstructs CSF flow.
  • To investigate the resultant effects on hindbrain motion and spinal CSF pressure.
  • To explore the role of central canal septations in preventing syrinx formation.

Main Methods:

  • Anatomic magnetic resonance imaging (MRI).
  • Cerebrospinal fluid (CSF) flow studies using MRI.
  • Intraoperative ultrasonography.

Main Results:

  • Demonstrated obstruction of CSF pathways at the foramen magnum due to Chiari I malformation.
  • Revealed impaired CSF displacement across the foramen magnum during the cardiac cycle.
  • Showed increased pulsatile hindbrain motion and pressure transmission to the spinal subarachnoid space.
  • Identified CSF subarachnoid pressure waves driving CSF into the spinal cord.
  • Observed that central canal septations in adults prevent syrinx formation by directly transmitting pressure waves.

Conclusions:

  • Chiari I malformation significantly impedes normal CSF dynamics at the foramen magnum.
  • Altered CSF flow dynamics contribute to increased pressure and motion within the hindbrain and spinal cord.
  • Adult central canal septations appear to be a protective factor against syrinx formation in the context of Chiari I malformation.

Keywords:
Aquaporin 4Cerebrospinal fluid dynamicsChiari I malformationForamen magnum decompressionGlymphatic systemHydrocephalusPathophysiologySyringomyelia

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