Summary
Foramen magnum decompression (FMD) is commonly performed for the treatment of Chiari type I-related syringomyelia. However, because no objective evaluation of cerebrospinal fluid (CSF) dynamics has been introduced to estimate the effect of FMD, many technical variations of FMD have been proposed. We reported previously that pressure/volume index (PVI) and CSF outflow resistance (Ro) calculated by the formula of Marmarou et al. were reliable indicators for the effects of FMD from the hydrodynamic point of view. This year, we measured PVI and Ro in another 8 patients (total, 21 patients) with Chiari type I malformation-related syringomyelia. To determine the extension of FMD, PVI and Ro were monitored during FMD in four stages: preoperation, after bone removal, after removal of the outer layer of the dura, and after dural plasty. CSF circulation improved in all 21 cases, and PVI and Ro were normalized. Postoperative MRI also showed a size reduction of the syrinx. Evaluation performed during surgery showed that bone removal alone was insufficient; 1 case showed improvement after removal of the outer layer of the dura but the remaining 5 cases required dural plasty. In conclusion, the measurement of PVI and Ro during operation is effective for determining the extent of decompression and is important for carrying out minimally invasive surgery.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Goto F, et al (1983) ICP & brain edema. Yodosha, Tokyo, pp 63–76
Wachi A, Tsuji O, Sato K, et al (1993) Lumbar CSF pressure monitoring for external spinal cord decompression. Jpn J Neurosurg (Tokyo) 2:226–231
Okuda Y, Tani S, Abe T, et al (1998) Efficacy of foramen magnum decompression upon the CSF dynamics of Chiari type 1 associated syringomyelia. Spinal Surg 12(2):169–176
Marmarou A, Shapiro K, LaMorgese J (1975) Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 43:523–534
Shapiro K, Marmarou A, Shulaman K (1980) Characterization of clinical CSF dynamics and neural axis compliance using the pressure-volume index. Ann Neurol 7:508–514
Abe T (1992) Operative procedure for syringomyelia associated with Chiari malformation. Spine Spinal 5(9):659–663
Abe T (1995) Pathogenesis and surgical treatment of syringomyelia. No Shinkei Geka 23:759–766
Abe T, Okuda Y, Tani S, et al (1995) Surgical treatment of syringomyelia. Clin Neurol 35:1406–1408
Yamaura A (1992) Surgical technique for Chiari malformation 1 associated with syringomyelia: foramen magnum decompression with lateral extention. Spine Spinal 5(9):665–670
Yamaura A, Ozawa Y, Arai S, et al (1996) Analysis of syringomyelia in children, associated with Chiari type 1 malformation. Nerv Syst Child 21:307–313
Hakuba A, Tokunou N, Nishimura S, et al (1988) Surgical treatment of syringomyelia. Spine Spinal Cord 1:227–234
Hakuba A, Tokunou N, Nishimura S, et al (1990) Surgical treatment of syringomyelia associated with Chiari malformation. Spinal Surg 4:69–76
Sakamoto H, Nishikawa M, Hakuba A, et al (1994) Surgical treatment of syringomyelia associated with Chiari malformation. Spinal Surg 8:1–6
Isu T (1992) Surgical treatment of Chiari malformation: foramen magnum decompression combined with dissection and removal of outer layer of the dura mater. Spine Spinal 5(9):671–676
Isu T, Sasaki H, Takamura H, et al (1993) Foramen magnum decompression with removal of the outer layer of the dura as treatment for syringomyelia occurring with Chiari I malformation. Neurosurgery 33(5):844–849
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2001 Springer-Verlag Tokyo
About this paper
Cite this paper
Okuda, Y., Hida, T., Isoshima, A., Nagashima, H., Tani, S., Abe, T. (2001). Variation of Foramen Magnum Decompression for the Treatment of Syringomyelia Determined by Intraoperative CSF Flow Dynamics Study. In: Tamaki, N., Batzdorf, U., Nagashima, T. (eds) Syringomyelia. Springer, Tokyo. https://doi.org/10.1007/978-4-431-67893-9_23
Download citation
DOI: https://doi.org/10.1007/978-4-431-67893-9_23
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-67995-0
Online ISBN: 978-4-431-67893-9
eBook Packages: Springer Book Archive