Non-invasive Intracranial Pressure Waveform Analysis in Chiari Malformation Type 1: A Pilot Trial

• Published in: World neurosurgery 2024-02, Vol.182, p.e178-e185
• Main Authors: Rusafa Neto, Eloy, Paiva, Wellingson Silva, Brock, Róger Schimidt, Hayashi, Cintya Yukie, Nagumo, Marcia Mitie, Segurado, Maurício Oriente, Zaninotto, Ana Luiza, Amorim, Róbson Luis
• Format: Article
• Language: English
• Subjects: Adult; Arnold-Chiari Malformation - diagnosis; Arnold-Chiari Malformation - surgery; Brain compliance; Chiari malformation 1; Cohort Studies; CSF flow dynamics; Decompression, Surgical - methods; Female; Humans; Intracranial Pressure; Male; Pilot Projects; Pilot study; Retrospective Studies; Treatment Outcome
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2023.11.067

This pilot study aimed to investigate the role of Posterior Fossa Decompression (PFD) on the intracranial pressure (ICP) waveform in patients with Chiari Malformation type 1 (CM1). It also sought to explore the relationship between symptom improvement and ICP waveform behavior. This exploratory cohort study evaluated adult patients diagnosed with CM1. The patients underwent PFD using a standard technique at our institution, which involved a 3 × 3 cm posterior craniectomy and excision of the posterior arch of C1. The ICP waveform was measured using an external strain-gauge device connected to a pin attached to the skull. Measurements were collected pre- and post-PFD, and the P2/P1 ratio was calculated pre- and postoperatively. The pilot study comprised 6 participants, 3 men and 3 women, with ages ranging from 39 to 68 years. The primary symptoms were cerebellar ataxia and typical headaches. The study found that most patients who showed clinical improvement, as judged by the Gestalt method, had a postoperative decrease in the P2/P1 ratio. However, 1 patient did not show an improvement in the P2/P1 ratio despite a good clinical outcome. This study suggests that the P2/P1 ratio may decrease after PFD. However, we highlight the need for further research with a larger sample size to confirm these preliminary results.