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Tomita Y, Yagi M, Seki F, Komaki Y, Suzuki S, Watanabe K, Matsumoto M, Nakamura M. The significance of cerebrospinal fluid dynamics in adolescent idiopathic scoliosis using time-SLIP MRI. Sci Rep 2024; 14:12214. [PMID: 38806612 PMCID: PMC11133356 DOI: 10.1038/s41598-024-63135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/24/2024] [Indexed: 05/30/2024] Open
Abstract
Adolescent idiopathic scoliosis (AIS) affects approximately 3% of the global population. Recent studies have drawn attention to abnormalities in the dynamics of the CSF as potential contributors. This research aims to employ the Time-Spatial Labeling Inversion Pulse (Time-SLIP) MRI to assess and analyze cerebrospinal fluid (CSF) dynamics in AIS patients. 101 AIS patients underwent Time-SLIP MRI. Images were taken at the mid-cervical and craniocervical junction regions. The sum of the maximum movement distances of CSF on the ventral and dorsal sides of the spinal canal within a single timeframe was defined and measured as Travel Distance (TD). Correlations between TD, age, Cobb angle, and Risser grade were analyzed. TD comparisons were made across Lenke classifications. TD for all patients was a weak correlation with the Cobb angle (r = - 0.16). Comparing TD between Lenke type 1 and 5, type 5 patients display significantly shorter TD (p < 0.05). In Risser5 patients with Lenke type 5 showed a significant negative correlation between Cobb angle and TD (r = - 0.44). Lenke type 5 patients had significantly shorter CSF TD compared to type1, correlating with worsening Cobb angles. Further analysis and exploration are required to understand the mechanism of onset and progression.
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Affiliation(s)
- Yusuke Tomita
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda Narita, Chiba, 286-0124, Japan.
| | - Fumiko Seki
- Department of Physiology, Keio University School of Medicine, Tokyo, Japan
- Live Animal Imaging Center, Central Institute for Experimental Animals, Kanagawa, Japan
| | - Yuji Komaki
- Department of Physiology, Keio University School of Medicine, Tokyo, Japan
- Live Animal Imaging Center, Central Institute for Experimental Animals, Kanagawa, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Yamahata H, Ijiri K, Tanabe F, Murasumi K, Nagano Y, Makino R, Higa N, Hanaya R. Radiological Analysis of Cerebrospinal Fluid Dynamics at the Craniovertebral Junction Using Time-Spatial Labeling Inversion Pulse Magnetic Resonance Imaging in Patients with Cervical Spinal Canal Stenosis. World Neurosurg 2024; 184:e731-e736. [PMID: 38340799 DOI: 10.1016/j.wneu.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Spondylotic changes in the cervical spine cause degeneration, leading to cervical spinal canal stenosis. This stenotic change can affect cerebrospinal fluid (CSF) dynamics by compressing the dural sac and reducing space in the subarachnoid space. We examined CSF dynamics at the craniovertebral junction (CVJ) using time-spatial labeling inversion pulse magnetic resonance imaging (Time-SLIP MRI) in patients with cervical spinal canal stenosis. METHODS The maximum longitudinal movement of the CSF at the CVJ was measured as length of motion (LOM) in the Time-SLIP MRI of 56 patients. The sum of ventral and dorsal LOM was defined as the total LOM. Patients were classified into 3 groups depending on their spinal sagittal magnetic resonance imaging findings: control (n = 27, Kang classification grades 0 and 1), stenosis (n = 14, Kang classification grade 2), and severe stenosis (n = 15, Kang classification grade 3). RESULTS Time-SLIP MRI revealed pulsatile movement of the CSF at the CVJ. The mean total, ventral, and dorsal LOM was 14.2 ± 9, 8.1 ± 5.7, and 3.8 ± 2.9 mm, respectively. The ventral LOM was significantly larger than the dorsal LOM. The total LOM was significantly smaller in the severe stenosis group (6.1 ± 3.4 mm) than in the control (16.0 ± 8.4 mm) or stenosis (11 ± 5.4 mm) groups (P < 0.001, Kruskal-Wallis H-test). In 5 patients, postoperative total LOM was improved after adequate decompression surgery. CONCLUSIONS This study demonstrates that CSF dynamics at the CVJ are influenced by cervical spinal canal stenosis. Time-SLIP MRI is useful for evaluating CSF dynamics at the CVJ in patients with spinal canal stenosis.
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Affiliation(s)
- Hitoshi Yamahata
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | | | | | | | - Yushi Nagano
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ryutaro Makino
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Nayuta Higa
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Pindrik J, McAllister AS, Jones JY. Imaging in Chiari I Malformation. Neurosurg Clin N Am 2023; 34:67-79. [DOI: 10.1016/j.nec.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mugge L, Caras A, Henkel N, Dassi C, Schroeder J, Prevedello DM. Headache and Other Symptoms in Chiari Malformation Type I Are Associated with Cerebrospinal Fluid Flow Improvement After Decompression: A Two-Institutional Study. World Neurosurg 2022; 163:e253-e262. [PMID: 35364297 DOI: 10.1016/j.wneu.2022.03.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Chiari malformation type I (CMI) is a common neurologic condition and surgery is the standard treatment. We aim to establish the cerebrospinal fluid (CSF) flow change as a potential objective indicator of surgical efficacy to improve symptoms. METHODS We performed a retrospective 2-center analysis of surgically treated patients with CMI. Qualitative CSF flow studies obtained preoperatively and postoperatively were analyzed by the neuroradiologist, seeking improvement in CSF flow. Symptom status, including headache and neck pain, were recorded. RESULTS Forty-nine patients were identified between 2010 and 2017. The average age was 36 years, with 47 females. After decompression, CSF flow was improved in 41 patients (group A) and unchanged in 8 (group B). Group A and B had a mean age of 34 and 42 years (P < 0.05) and an average tonsillar herniation of 8.3 and 8.5 mm (P = 0.40), respectively. Group A had improved clinical outcomes, compared with group B (P = 0.024), more specifically, in headache (50% vs. 37%), neck pain (66% vs. 33%), dizziness (78% vs. 50%), vision symptoms (84% vs. 80%), and weakness (100% vs. 66%), respectively. Group B had the only patient who did worse on clinical follow-up. CONCLUSIONS Patients with CMI often present with a constellation of symptoms. We showed a significant association between improved CSF flow after decompression and symptom alleviation. Further, our study suggests that the presence of improved CSF flow postoperatively could represent an objective indicator for improved patient outcomes.
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Affiliation(s)
- Luke Mugge
- Department of Neurosciences, Inova Neuroscience and Spine Institute, Falls Church, Virginia, USA
| | - Andrew Caras
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nicholas Henkel
- Department of Neurosurgery, The University of Toledo Medical Center, Toledo, Ohio, USA
| | - Camila Dassi
- Department of Neurosurgery, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Jason Schroeder
- Department of Neurosurgery, The University of Toledo Medical Center, Toledo, Ohio, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University Medical Center, Columbus, Ohio, USA.
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Kotaki Y, Hattori G, Uchikado H, Komaki S, Takeshige N, Miyahara T, Hasegawa Y, Morioka M. "Motion-specific Headache": A Predictor for Diagnosis and Favorable Prognosis after Surgery in Young Patients with Chiari Malformation Type 1. Neurol Med Chir (Tokyo) 2021; 61:577-582. [PMID: 34321386 PMCID: PMC8531875 DOI: 10.2176/nmc.oa.2020-0427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
As headache is known as one of the most common symptoms in the patients with Chiari malformation type 1 (CM1), it is difficult to find out CM1-related headache among the symptoms because headache itself is commonly seen. Herein, we retrospectively review the cases of six CM1 patients complaining only of headache by which they complained of deterioration in daily life activities. The symptom of headache worsened during anteflexion (n = 2; 33%), retroflexion (n = 1; 17%), jumping (n = 3; 50%), going up the stairs (n = 1; 17%), and running (n = 1; 17%). Mean age at the onset was 15.7 years old (ranging 11–18) and four out of six were female. These inductive factors were clearly different from “Valsalva-like maneuvers,” although the mechanism might originate from dynamic tonsil changes. We named these headaches as “motion-specific.” These headaches radiated to the posterior side. MRI revealed that the extent of tonsillar ectopia was 11.3 mm, while syringomyelia was observed in three out of six patients (50%). All patients underwent surgical treatment, with the “motion-specific headache” completely disappearing 12.5 days thereafter. Although headaches are common, “motion-specific headache” may be a good candidate symptom to distinguish CM1 patients, especially among teenagers with headaches, and a good predictor for favorable outcomes after surgical treatment.
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Affiliation(s)
- Yoshikuni Kotaki
- Department of Neurosurgery, Kurume University School of Medicine
| | - Gohsuke Hattori
- Department of Neurosurgery, Kurume University School of Medicine
| | - Hisaaki Uchikado
- Department of Neurosurgery, Kurume University School of Medicine
| | - Satoru Komaki
- Department of Neurosurgery, Kurume University School of Medicine
| | | | | | - Yu Hasegawa
- Department of Neurosurgery, Kurume University School of Medicine.,Department of Pharmaceutical Sciences, School of Pharmacy at Fukuoka, International University of Health and Welfare
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine
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Petryaykin AV, Smorchkova AK, Sergunova KA, Akhmad ES, Semenov DS, Kudryavtsev ND, Blokhin IA, Morozov SP, Vladzimirskiy AV, Maer RY. [Application of a modified Time-SLIP MRI sequence for visualization of cerebrospinal fluid movement in the cerebral aqueduct and cervical spinal canal]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2019; 83:64-71. [PMID: 32031169 DOI: 10.17116/neiro20198306164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
UNLABELLED Direct visualization of rapid cerebrospinal fluid movements is a topical task of neurosurgery, which has applications such as evaluating hydrocephalus and the effectiveness of 3rd ventriculostomy. PURPOSE The study purpose was to evaluate the capabilities of a modified Time-SLIP pulse MRI sequence for visualization of fluid (CSF) movements in the phantom, healthy subject, and patient. MATERIAL AND METHODS The study was performed in a phantom simulating pulsed CSF movements, healthy volunteers (9 people), and patients without impaired CSF dynamics (12 people), whose data were used to determine mean CSF flow parameters, as well as in 1 patient after 3rd ventriculostomy. A 1.5 T MRI instrument was used. The Time-SLIP parameters were as follows: TR = 8,500 ms; TEeff = 80 ms; Thk = 5.0 mm; tag spacing = 30 mm; NEX 7; inversion time (BBTI) = 2,000/3,000 ms; no cardiosynchronization. Scanning time was 2:16 min. The estimated parameter was the length of motion (LOM) of CSF. RESULTS According to a study on a phantom simulating various conditions of oscillatory fluid motion, the mean LOM determination error in the modified Time-SLIP mode was 20%. This technique provided the following LOM data for the cerebral aqueduct (median, 25-75% quartiles): 13.0 (9.5-16.0) mm for BBTI of 2,000ms and 30.2 (23.7-35.3) mm for BBTI of 3,000 ms, i.e. 2.3-fold higher. This difference may be explained by an intense turbulent current leading to rapid CSF exchange between the 3rd and 4th ventricles and prolonged CSF movement during several heart contractions. Quantitative parameters of CSF movement at the C1-C2 level were determined. Additionally, Time-SLIP was used to evaluate performance of a third ventricle fistula. CONCLUSION We have proposed a modified Time-SLIP pulse sequence that does not require cardiosynchronization. The mean relative error in determining the CSF movement distance was 20%. The mean quantitative parameters of CSF movement in the cerebral aqueduct and at the C1-C2 level were obtained. Turbulent CSF flow is found in the cerebral aqueduct, which leads to rapid exchange between the 3rd and 4th ventricles.
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Affiliation(s)
- A V Petryaykin
- Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russia
| | - A K Smorchkova
- Sechenov First Moscow State Medical University Department of Health Care of Moscow, Moscow, Russia
| | - K A Sergunova
- Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russia
| | - E S Akhmad
- Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russia
| | - D S Semenov
- Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russia
| | - N D Kudryavtsev
- Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russia
| | - I A Blokhin
- Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russia
| | - S P Morozov
- Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russia
| | - A V Vladzimirskiy
- Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russia
| | - R Yu Maer
- Research Institute of Healthcare Organization and Medical Management, Department of Health Care of Moscow, Moscow, Russia
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