Development , validation , and incorporation of a small number of disease-specific patient-based instruments will improve the quality of research and care of CM-I patients
OBJECT Chiari malformation Type I ( CM-I ) is a common and often debilitating neurological disease .
Efforts to improve treatment of CM-I are impeded by inconsistent and limited methods of evaluating clinical outcomes .
CSF flow study in Chiari I malformation
Objective The aim of this prospect i ve study was to define the role of cardiac gated phase-contrast ciné magnetic resonance imaging in deciding the therapeutic strategy in patients with Chiari I malformation . Material s and methods Twenty-one patients operated on between February 2000 and July 2002 were enrolled in the study . All patients underwent a detailed preoperative neurological examination . MRI of the craniovertebral junction and the whole spine was done , followed by cardiac gated phase contrast ciné magnetic resonance imaging . Results Signs and symptoms of syringomyelia were noted in 15 patients and cerebellar signs in 11 patients . Three of them had trigeminal nerve involvement , and 4 had ninth and tenth cranial nerve involvement . The sixth and accessory nerves were involved in 1 patient each . Preoperative CSF flow studies revealed obstructive flow both anteriorly and posteriorly in 6 patients and only posterior block in 15 patients . One patient investigated for failed foramen magnum decompression revealed obstruction to CSF flow ventrally .  Foramen magnum decompression with duroplasty was done in all these cases . The patient who had a persistent ventral flow block underwent odontoidectomy . Patients were followed up for a maximum of 36 months , with a mean of 18 months . MRI  CSF flow studies revealed established flow dorsally in all cases . Seventeen patients showed clinical improvement and 2 of them did not show any neurological changes . Two patients deteriorated following an initial period with a shunt . Conclusion MRI CSF flow study is an effective tool for deciding the type of surgery to be performed and also for monitoring patients postoperatively
Development , validation , and incorporation of a small number of disease-specific patient-based instruments will improve the quality of research and care of CM-I patients
OBJECT Chiari malformation Type I ( CM-I ) is a common and often debilitating neurological disease .
Efforts to improve treatment of CM-I are impeded by inconsistent and limited methods of evaluating clinical outcomes .