caa a22 4500 606216111 CHVBK 20210128101102.0 cr unu---uuuuu 210128e20150801xx s 000 0 eng 10.1007/s00701-015-2465-x doi (NATIONALLICENCE)springer-10.1007/s00701-015-2465-x Comparison of pulsatile and static pressures within the intracranial and lumbar compartments in patients with Chiari malformation type 1: a prospective observational study [Elektronische Daten] [Radek Frič, Per Eide] Background: In Chiari malformation type 1 (CMI), the obstruction of cerebrospinal fluid (CSF) flow through the foramen magnum is believed to cause alterations of intracranial pressure (ICP) pulsations. Foramen magnum decompression (FMD) is therefore considered a treatment of choice. However, the pathophysiology of CMI is poorly understood and it remains unknown how ICP alterations relate to symptoms and radiological findings. This study was undertaken to measure pulsatile pressure and its gradient between intracranial and lumbar compartments, and to determine its relationship to clinical and radiological findings. Method: In patients with symptomatic CMI, we simultaneously measured ICP and lumbar CSF pressure, with particular focus on analysis of pulsatile pressure. Ventricular CSF volume (VV), intracranial volume (ICV) and posterior cranial fossa volume (PCFV) were calculated using volumetry software. Results: In 26 patients (median 35years), we found clearly abnormal or borderline values of pulsatile ICP in 18/26 patients (69%; median 4.5mmHg) and abnormal pulsatile pressure gradient in 17/24 patients (71%; median 2.6mmHg). The correlation between pulsatile ICP and the pulsatile pressure gradient was significantly positive (p < 0.001). We found no significant correlation between pulsatile or static pressure and extent of tonsillar ectopy, VV, ICV or PCFV. The pulsatile pressure gradient was significantly higher in patients with syringomyelia (p = 0.02). Conclusions: In this cohort, the pulsatile ICP was elevated in 69%. The intracranial-lumbar pulsatile pressure gradient was abnormal in 71% and significantly higher in patients with syringomyelia. The elevated pulsatile ICP significantly correlated with pulsatile pressure gradient; no similar correlation was found for static ICP. We interpret the results as providing evidence of impaired intracranial compliance as an important pathophysiological mechanism in CMI. Springer-Verlag Wien, 2015 Chiari malformation type I nationallicence Cerebrospinal fluid dynamics nationallicence Foramen magnum nationallicence Syringomyelia nationallicence Intracranial pressure nationallicence Frič Radek Department of Neurosurgery, Oslo University Hospital—Rikshospitalet, P.O.Box 4950, 0424, Oslo, Nydalen, Norway aut Eide Per Department of Neurosurgery, Oslo University Hospital—Rikshospitalet, P.O.Box 4950, 0424, Oslo, Nydalen, Norway aut Acta Neurochirurgica Springer Vienna 157/8(2015-08-01), 1411-1423 0001-6268 157:8<1411 2015 157 701 https://doi.org/10.1007/s00701-015-2465-x text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2465-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Frič Radek Department of Neurosurgery, Oslo University Hospital—Rikshospitalet, P.O.Box 4950, 0424, Oslo, Nydalen, Norway aut NATIONALLICENCE 700 1- Eide Per Department of Neurosurgery, Oslo University Hospital—Rikshospitalet, P.O.Box 4950, 0424, Oslo, Nydalen, Norway aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/8(2015-08-01), 1411-1423 0001-6268 157:8<1411 2015 157 701