{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:09:30Z","timestamp":1772168970329,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.72823.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T00:00:00Z","timestamp":1691020800000}}],"reference-count":40,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T00:00:00Z","timestamp":1691020800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background:<\/ns4:bold>\n                    Despite several hypotheses, our understanding of syringomyelia\u2019s pathophysiology remains limited. The hypothesis proposed by Oldfield et al. suggests that piston-like movement of the cerebellar tonsils propels the cerebrospinal fluid (CSF) into the syrinx via the spinal perivascular space. However, a significant question remains unanswered: how does the CSF enter and stay in the syrinx, which has a higher pressure than the subarachnoid space. In the current study, we attempted to verify Oldfield\u2019s hypothesis using phase-contrast magnetic resonance imaging (MRI) data from patients with syringomyelia.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Methods:<\/ns4:bold>\n                    We analyzed phase-contrast MRI scans of 18 patients with Chiari-I malformation associated with syringomyelia, all of whom underwent foramen magnum decompression, and 21 healthy volunteers. We obtained velocity waveforms for CSF and brain tissue from regions of interest (ROI) set at the various locations. These waveforms were synchronized at the peak timing of downward CSF flow. We compared the preoperative patient data with the control data and also compared the preoperative patient data with the postoperative patient data.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Results:<\/ns4:bold>\n                    The syrinx shrank in 17 (94%) of the patients, and they experienced significant clinical improvement. When comparing pre- and postoperative MRI results, the only significant difference noted was the preoperative elevated velocity of the cerebellar tonsil, which disappeared post-surgery. The CSF velocities in the subarachnoid space were higher in the preoperative patients than in the controls, but they did not significantly differ in the postoperative MRI. The tonsillar velocity in the preoperative MRI was significantly lower than that of the CSF, suggesting that the elevated tonsillar velocity was more of an effect, rather than the cause, of the elevated CSF velocity.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusions:<\/ns4:bold>\n                    Given these findings, a completely new paradigm seems necessary. We, therefore, propose a novel hypothesis: the generative force of syringomyelia may be the direction-selective resistance to CSF flow in the subarachnoid space.\n                  <\/ns4:p>","DOI":"10.12688\/f1000research.72823.2","type":"journal-article","created":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T06:25:06Z","timestamp":1691043906000},"page":"996","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Hypothesis on the pathophysiology of syringomyelia based on analysis of phase-contrast magnetic resonance imaging of Chiari-I malformation patients"],"prefix":"10.12688","volume":"10","author":[{"given":"Han Soo","family":"Chang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2023,8,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"131-40","DOI":"10.1093\/neurosurgery\/6.cn_suppl_1.131","article-title":"The mechanism of syringomyelia and its surgical correction.","volume":"6","author":"W Gardner","year":"1958","journal-title":"Clin Neurosurg."},{"key":"ref2","first-page":"798-806","article-title":"On the pathogenesis of syringomyelia: a review.","volume":"73","author":"B Williams","year":"November 1980","journal-title":"J R Soc Med."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1005-1017","DOI":"10.1097\/00006123-199905000-00042","article-title":"Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients.","volume":"44","author":"T Milhorat","year":"May 1999","journal-title":"Neurosurgery."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"799-801","DOI":"10.1016\/s0140-6736(72)92152-6","article-title":"Pathogenesis of syringomyelia.","volume":"2","author":"M Ball","year":"October 1972","journal-title":"Lancet (London, England)."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"649-664","DOI":"10.1007\/s00701-002-0944-3","article-title":"The pathophysiology of syringomyelia - historical overview and current concept.","volume":"144","author":"J Klekamp","year":"July 2002","journal-title":"Acta Neurochir."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"579-587","DOI":"10.1259\/0007-1285-47-561-579","article-title":"The mechanism of hydromyelia in Chiari type 1 malformations.","volume":"47","author":"G du Boulay","year":"September 1974","journal-title":"Br J Radiol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"553-562","DOI":"10.3171\/jns.1999.91.4.0553","article-title":"Elucidating the pathophysiology of syringomyelia.","volume":"91","author":"J Heiss","year":"October 1999","journal-title":"J Neurosurg."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"748-754","DOI":"10.1227\/00006123-199305000-00008","article-title":"Anatomical basis of syringomyelia occurring with hindbrain lesions.","volume":"32","author":"T Milhorat","year":"May 1993","journal-title":"Neurosurgery."},{"key":"ref9","first-page":"1069-1070","article-title":"Pathophysiology of syringomyelia.","volume":"92","author":"M Stoodley","year":"June 2000","journal-title":"J Neurosurg."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"125-129","DOI":"10.1007\/BF00588077","article-title":"Increased pulsatile movement of the hindbrain in syringomyelia associated with the Chiari malformation: cine-MRI with presaturation bolus tracking.","volume":"36","author":"S Terae","year":"1994","journal-title":"Neuroradiology."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"344-347","DOI":"10.1136\/jnnp.74.3.344","article-title":"Hypothesis on the pathophysiology of syringomyelia based on simulation of cerebrospinal fluid dynamics.","volume":"74","author":"H Chang","year":"March 2003","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"754-757","DOI":"10.1136\/jnnp.2003.018671","article-title":"Theoretical analysis of the pathophysiology of syringomyelia associated with adhesive arachnoiditis.","volume":"75","author":"H Chang","year":"May 2004","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"251-263","DOI":"10.1007\/s10143-006-0029-5","article-title":"Unraveling the riddle of syringomyelia.","volume":"29","author":"D Greitz","year":"October 2006","journal-title":"Neurosurg Rev."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"3-15","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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Klinge, Brown University, Providence, 09 Aug 2023, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/10-996\/v2#referee-response-193499","order":0,"name":"referee-response-193499","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.154031.r193500, Yuichiro Ohnishi, National Cerebral and Cardiovascular Center, Osaka, 24 Aug 2023, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/10-996\/v2#referee-response-193500","order":1,"name":"referee-response-193500","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}