Effect of craniovertebral decompression on CSF dynamics in Chiari malformation Type I studied with computational fluid dynamics

Laboratory investigation

View More View Less
  • 1 Telemark University College, Porsgrunn;
  • 2 Center for Biomedical Computing, Simula Research Laboratory, Lysake;
  • 3 Norwegian Defense Research Establishment (FFI), Kjeller, Norway;
  • 4 Surgical Neurology Branch, National Institutes of Health, Bethesda, Maryland; and
  • 5 Department of Radiology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The effect of craniovertebral decompression surgery on CSF flow dynamics in patients with Chiari malformation Type I (CM-I) has been incompletely characterized. The authors used computational fluid dynamics to calculate the effect of decompression surgery on CSF flow dynamics in the posterior fossa and upper cervical spinal canal.

Methods

Oscillatory flow was simulated in idealized 3D models of the normal adult and the CM-I subarachnoid spaces (both previously described) and in 3 models of CM-I post–craniovertebral decompressions. The 3 postoperative models were created from the CM model by virtually modifying the CM model subarachnoid space to simulate surgical decompressions of different magnitudes. Velocities and pressures were computed with the Navier-Stokes equations in Star-CD for multiple cycles of CSF flow oscillating at 80 cycles/min. Pressure gradients and velocities were compared for 8 levels extending from the posterior fossa to the C3–4 level. Relative pressures and peak velocities were plotted by level from the posterior fossa to C3–4. The heterogeneity of flow velocity distribution around the spinal cord was compared between models.

Results

Peak systolic velocities were generally lower in the postoperative models than in the preoperative CM model. With the 2 larger surgical defects, peak systolic velocities were brought closer to normal model velocities (equal values at C-3 and C-4) than with the smallest surgical defect. For the smallest defect, peak velocities were decreased, but not to levels in the normal model. In the postoperative models, heterogeneity in flow velocity distribution around the spinal cord increased from normal model levels as the degree of decompression increased.

Pressures in the 5 models differed in magnitude and in pattern. Pressure gradients along the spinal canal in the normal and CM models were nonlinear, with steeper gradients below C3–4 than above. The CM model had a steeper pressure gradient than the normal model above C3–4 and the same gradient below. The postoperative models had lower pressure gradients than the CM model above C2–3. The most conservative decompression had lower pressure gradients than the normal model above C2–3. The two larger decompression defects had CSF pressure gradients below those in the normal model above C2–3. These 2 models had a less steep gradient above C-3 and a steeper gradient below.

Conclusions

In computer simulations, craniovertebral surgical defects generally diminished CSF velocities and CSF pressures.

Abbreviations used in this paper:CFD = computational fluid dynamics; CM = Chiari malformation; CM-I = CM Type I; PC = phase contrast.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Svein Linge, Ph.D., Telemark University College, P.O. Box 203, N-3901 Porsgrunn, Norway. email: sveinlin@simula.no.

Please include this information when citing this paper: published online August 1, 2014; DOI: 10.3171/2014.6.SPINE13950.

  • 1 Alperin N, , Sivaramakrishnan A, & Lichtor T: Magnetic resonance imaging-based measurements of cerebrospinal fluid and blood flow as indicators of intracranial compliance in patients with Chiari malformation. J Neurosurg 103:4652, 2005

    • Search Google Scholar
    • Export Citation
  • 2 Armonda RA, , Citrin CM, , Foley KT, & Ellenbogen RG: Quantitative cine-mode magnetic resonance imaging of Chiari I malformations: an analysis of cerebrospinal fluid dynamics. Neurosurgery 35:214224, 1994

    • Search Google Scholar
    • Export Citation
  • 3 Bertram CD: Evaluation by fluid/structure-interaction spinalcord simulation of the effects of subarachnoid-space stenosis on an adjacent syrinx. J Biomech Eng 132:061009, 2010

    • Search Google Scholar
    • Export Citation
  • 4 Bhadelia RA, , Bogdan AR, , Wolpert SM, , Lev S, , Appignani BA, & Heilman CB: Cerebrospinal fluid flow waveforms: analysis in patients with Chiari I malformation by means of gated phase-contrast MR imaging velocity measurements. Radiology 196:195202, 1995

    • Search Google Scholar
    • Export Citation
  • 5 Dolar MT, , Haughton VM, , Iskandar BJ, & Quigley M: Effect of craniocervical decompression on peak CSF velocities in symptomatic patients with Chiari I malformation. AJNR Am J Neuroradiol 25:142145, 2004

    • Search Google Scholar
    • Export Citation
  • 6 Hammersley J, , Haughton V, , Wang Y, & del Rio AM: Tapering of the cervical spinal canal in patients with scoliosis with and without the Chiari I malformation. AJNR Am J Neuroradiol 33:17521755, 2012

    • Search Google Scholar
    • Export Citation
  • 7 Heiss JD, , Suffredini G, , Bakhtian KD, , Sarntinoranont M, & Oldfield EH: Normalization of hindbrain morphology after decompression of Chiari malformation Type I. Clinical article. J Neurosurg 117:942946, 2012

    • Search Google Scholar
    • Export Citation
  • 8 Hentschel S, , Mardal KA, , Løvgren AE, , Linge S, & Haughton V: Characterization of cyclic CSF flow in the foramen magnum and upper cervical spinal canal with MR flow imaging and computational fluid dynamics. AJNR Am J Neuroradiol 31:9971002, 2010

    • Search Google Scholar
    • Export Citation
  • 9 Hirano M, , Haughton V, & Munoz del Rio A: Tapering of the cervical spinal canal in patients with Chiari I malformations. AJNR Am J Neuroradiol 33:13261330, 2012

    • Search Google Scholar
    • Export Citation
  • 10 Iskandar BJ, , Quigley M, & Haughton V: Foramen magnum cerebrospinal fluid flow characteristics in children with Chiari I malformation before and after craniocervical decompression. J Neurosurg (2 Suppl) 101:169178, 2004

    • Search Google Scholar
    • Export Citation
  • 11 Linge SO, , Haughton V, , Løvgren AE, , Mardal KA, , Helgeland A, & Langtangen HP: Effect of tonsillar herniation on cyclic CSF flow studied with computational flow analysis. AJNR Am J Neuroradiol 32:14741481, 2011

    • Search Google Scholar
    • Export Citation
  • 12 Linge SO, , Haughton V, , Løvgren AE, , Mardal KA, & Langtangen HP: CSF flow dynamics at the craniovertebral junction studied with an idealized model of the subarachnoid space and computational flow analysis. AJNR Am J Neuroradiol 31:185192, 2010

    • Search Google Scholar
    • Export Citation
  • 13 Loth F, , Yardimci MA, & Alperin N: Hydrodynamic modeling of cerebrospinal fluid motion within the spinal cavity. J Biomech Eng 123:7179, 2001

    • Search Google Scholar
    • Export Citation
  • 14 Mardal KA, , Rutkowska G, , Linge S, & Haughton V: Estimation of CSF flow resistance in the upper cervical spine. Neuroradiol J 26:106110, 2013

    • Search Google Scholar
    • Export Citation
  • 15 Panigrahi M, , Reddy BP, , Reddy AK, & Reddy JJM: CSF flow study in Chiari I malformation. Childs Nerv Syst 20:336340, 2004

  • 16 Pinna G, , Alessandrini F, , Alfieri A, , Rossi M, & Bricolo A: Cerebrospinal fluid flow dynamics study in Chiari I malformation: implications for syrinx formation. Neurosurg Focus 8:3 E3, 2000

    • Search Google Scholar
    • Export Citation
  • 17 Rutkowska G, , Haughton V, , Linge S, & Mardal KA: Patient specific 3D simulation of cyclic CSF flow at the craniovertebral region. AJNR Am J Neuroradiol 33:17561762, 2012

    • Search Google Scholar
    • Export Citation
  • 18 Shah S, , Haughton V, & del Río AM: CSF flow through the upper cervical spinal canal in Chiari I malformation. AJNR Am J Neuroradiol 32:11491153, 2011

    • Search Google Scholar
    • Export Citation
  • 19 Sivaramakrishnan A, , Alperin N, , Surapaneni S, & Lichtor T: Evaluating the effect of decompression surgery on cerebrospinal fluid flow and intracranial compliance in patients with Chiari malformation with magnetic resonance imaging flow studies. Neurosurgery 55:13441351, 2004

    • Search Google Scholar
    • Export Citation
  • 20 Støverud KH, , Langtangen HP, , Haughton V, & Mardal KA: CSF pressure and velocity in obstructions of the subarachnoid spaces. Neuroradiol J 26:218226, 2013

    • Search Google Scholar
    • Export Citation
  • 21 Wentland AL, , Wieben O, , Korosec FR, & Haughton VM: Accuracy and reproducibility of phase-contrast MR imaging measurements for CSF flow. AJNR Am J Neuroradiol 31:13311336, 2010

    • Search Google Scholar
    • Export Citation
  • 22 Yiallourou TI, , Kröger JR, , Stergiopulos N, , Maintz D, , Martin BA, & Bunck AC: Comparison of 4D phase-contrast MRI flow measurements to computational fluid dynamics simulations of cerebrospinal fluid motion in the cervical spine. PLoS ONE 7:e52284, 2012

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 119 119 12
Full Text Views 289 16 0
PDF Downloads 154 11 0
EPUB Downloads 0 0 0