{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T06:03:30Z","timestamp":1741068210106,"version":"3.38.0"},"reference-count":51,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T00:00:00Z","timestamp":1729555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Asian J Neurosurg"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003Chiari I malformation refers to cerebellar tonsillar descent below the foramen magnum and is frequently associated with syringomyelia. Prior cerebrospinal fluid (CSF) flow studies correlated the clinical severity of these lesions with general flow velocity or bulk flow at the foramen magnum; however, these techniques have not assessed the effect on surgical outcomes. The study aims to present clinical and radiological factors and CSF flow parameters (pre- and postoperative) that affect the surgical outcome.<\/jats:p><jats:p>\n          Materials and Methods\u2003The institutional ethics committee approved the study. We collected the prospective clinical data, including pre- and postoperative symptoms. Functional grades were determined along with the change in clinical improvement based on clinical examination notes, the change in functional grade was calculated, and the radiologic data were analyzed according to the degree of clinical improvement. The surgical procedure included suboccipital bony decompression with duroplasty. Patients were followed up at 1 month, 3 months, and 1 year.<\/jats:p><jats:p>\n          Results\u2003There were a total of 25 patients. The mean age of the patients was 45.52\u2009\u00b1\u200913.37 years, with 40% being males and 60% being females. After the surgery, there was a significant increase in the anterior and posterior CSF flows at the foramen magnum. Most had a resolution in the headache and sensory symptoms, while the lower cranial nerve and motor symptoms had a minor resolution at follow-up. Age, sex, and headache do not correlate with the outcome or syrinx improvement. Motor power in the lower limb (preintervention) and syrinx shape (preintervention) were significantly associated with the variable \u201canterior flow at the foramen magnum\u201d (preintervention; p\u2009&lt;\u20090.05). Average flow, cervicomedullary angle (postintervention), sensory symptom progression, and CSF flow change anterior to the foramen magnum were significantly associated with the variable \u201canterior flow at the foramen magnum\u201d (postintervention; p\u2009&lt;\u20090.05).<\/jats:p><jats:p>\n          Conclusion\u2003Even after surgery, persistent foramen magnum CSF outflow obstruction has a robust negative correlation with the outcome. The Chiari outcome predictability index has shown a significant correlation with patient outcomes and can be used to inform patients about the expected outcome. The results of the present study will be helpful in stratifying patients according to their desired outcomes.<\/jats:p>","DOI":"10.1055\/s-0044-1791710","type":"journal-article","created":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T23:30:56Z","timestamp":1729639856000},"page":"043-051","source":"Crossref","is-referenced-by-count":0,"title":["A Prospective Study of CSF Flow Dynamics Across Foramen Magnum in Adult Chiari Malformation\/Syringomyelia Complex and its Clinical Correlation with Outcomes after Surgery"],"prefix":"10.1055","volume":"20","author":[{"given":"Manas","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Saket Nagar, Madhya Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adesh","family":"Shrivastava","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Saket Nagar, Madhya Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9426-9320","authenticated-orcid":false,"given":"Pradeep","family":"Chouksey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Saket Nagar, Madhya Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumit","family":"Raj","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Saket Nagar, Madhya Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakesh","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3287-5448","authenticated-orcid":false,"given":"Amit","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Saket Nagar, Madhya Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suresh","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,10,22]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.3171\/2014.10.PEDS14295","article-title":"Pediatric and adult Chiari malformation type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes","volume":"15","author":"A Arnautovic","year":"2015","journal-title":"J Neurosurg Pediatr"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1136\/jnnp.28.3.247","article-title":"Hydrodynamic mechanism of syringomyelia: its relationship to myelocele","volume":"28","author":"W J Gardner","year":"1965","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3171\/jns.1994.80.1.0003","article-title":"Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. 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