Effect of cisterna magna plastic repairing on cerebrospinal fluid dynamics in Chiari malformation type I with syringomyelia

Objective To explore the effect of cisterna magna plastic repairing (posterior vertebral column resection and cerebella tonsillectomy and reconstruction of the cisterna magna by artificial dura) on cerebrospinal fluid dynamics in Chiari malformation type I with syringomyelia and evaluate the efficacy of this surgical method. Methods Forty patients with Chiari malformation type I with syringomyelia (CMI-SM), admitted to and diagnosed by MRI in our hospital from January 2011 to December 2013, were selected. All patients were treated with cisterna magna plastic repairing. Phasecontrast MR imaging (PC-MRI) was performed, changes of cerebrospinal fluid dynamics indicators of cerebral aqueduct, pons ventral side and C3 ventral side were detected and compared and Japanese Orthopaedic Association (JOA) scale scores were evaluated 24 h before operation and 12 months after operation. Results No neurological deterioration or death was noted; JOA scores in all patients were increased from 7.89±3.52 to 12.53±4.32, with significant difference (P<0.05); post-operated PC-MRI indicated that the cisterna magna formed well, spinal subarachnoid space was clear, syringomyelia in 30 patients was significantly reduced; as compared with those before operation, the stroke volume and mean flux were significantly increased, but maximum peak velocity was significantly reduced (P<0.05). Conclusion Cisterna magna plastic repairing can reduce syringomyelia, increase cerebrospinal fluid flow, and reduce peak flow of cerebrospinal fluid, which is an effective surgical procedure for Chiari malformation type I with syringomyelia. Key words: Cisterna magna plastic repairing; Chiari malformation; Syringomyelia; Cerebrospinal fluid dynamic