The influence of the relative timing of arterial and subarachnoid space pulse waves on spinal perivascular cerebrospinal fluid flow as a possible factor in syrinx development.

OBJECT The mechanisms of syringomyelia have long puzzled neurosurgeons and researchers alike due to difficulties in identifying the driving forces behind fluid flow into a syrinx, apparently against a pressure gradient between the spinal cord and the subarachnoid space (SAS). Recently, the synchronization between CSF flow and the cardiac cycle has been postulated to affect fluid flow in the spinal cord. This study aims to determine the effect of changes in the timing of SAS pressure on perivascular flow into the spinal cord. METHODS This study uses a computational fluid dynamics model to investigate whether the relative timing of a spinal artery cardiovascular pulse wave and fluid pressure in the spinal SAS can influence CSF flow in the perivascular spaces. RESULTS The results show that the mass flow rate of CSF through a model periarterial space is strongly influenced by the relative timing of the arterial pulse wave and the SAS pressure. CONCLUSIONS These findings suggest that factors that might alter the timing of the pulse wave or the fluid flow in the SAS could potentially affect fluid flow into a syrinx.

[1]  W. Dillon,et al.  The "presyrinx" state: a reversible myelopathic condition that may precede syringomyelia. , 1999, AJNR. American journal of neuroradiology.

[2]  T H Shawker,et al.  Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. , 1994, Journal of neurosurgery.

[3]  Christopher J. Brown,et al.  Evidence for rapid fluid flow from the subarachnoid space into the spinal cord central canal in the rat , 1996, Brain Research.

[4]  L Solymosi,et al.  Phase-contrast MR imaging of the cervical CSF and spinal cord: volumetric motion analysis in patients with Chiari I malformation. , 2000, AJNR. American journal of neuroradiology.

[5]  David H. Frakes,et al.  Physics-Driven CFD Modeling of Complex Anatomical Cardiovascular Flows—A TCPC Case Study , 2005, Annals of Biomedical Engineering.

[6]  Jian Tu,et al.  Fluid flow in an animal model of post-traumatic syringomyelia , 2003, European Spine Journal.

[7]  D. Greitz.  Unraveling the riddle of syringomyelia , 2006, Neurosurgical Review.

[8]  L E Bilston,et al.  Focal spinal arachnoiditis increases subarachnoid space pressure: a computational study. , 2006, Clinical biomechanics.

[9]  D. Holdsworth,et al.  PIV-measured versus CFD-predicted flow dynamics in anatomically realistic cerebral aneurysm models. , 2008, Journal of biomechanical engineering.

[10]  B. Williams.  A blast against grafts--on the closing and grafting of the posterior fossa dura. , 1994, British journal of neurosurgery.

[11]  L. Bilston,et al.  Effects of Proteins, Blood Cells and Glucose on the Viscosity of Cerebrospinal Fluid , 1998, Pediatric Neurosurgery.

[12]  Lynne E Bilston,et al.  Arterial Pulsation-driven Cerebrospinal Fluid Flow in the Perivascular Space: A Computational Model , 2003, Computer methods in biomechanics and biomedical engineering.

[13]  A D Dayan,et al.  Pathogenesis of syringomyelia. , 1972, Lancet.

[14]  D. Levine.  The pathogenesis of syringomyelia associated with lesions at the foramen magnum: a critical review of existing theories and proposal of a new hypothesis , 2004, Journal of the Neurological Sciences.

[15]  O Jolivet,et al.  CSF flow measurement in syringomyelia. , 2000, AJNR. American journal of neuroradiology.

[16]  B. Williams.  Pathogenesis of post-traumatic syringomyelia. , 1992, British journal of neurosurgery.

[17]  S. Wolpert,et al.  Chiari I malformations: assessment with phase-contrast velocity MR. , 1994, AJNR. American journal of neuroradiology.

[18]  Guy Vanderstraeten,et al.  Noncommunicating cysts and cerebrospinal fluid flow dynamics in a patient with a Chiari I malformation and syringomyelia - Part II , 2005 .

[19]  P. Chowienczyk,et al.  Determination of age-related increases in large artery stiffness by digital pulse contour analysis. , 2002, Clinical science.

[20]  M Samii,et al.  Disturbances of Cerebrospinal Fluid Flow Attributable to Arachnoid Scarring Cause Interstitial Edema of the Cat Spinal Cord , 2001, Neurosurgery.

[21]  O. R. Blaumanis,et al.  Evidence for a ‘Paravascular’ fluid circulation in the mammalian central nervous system, provided by the rapid distribution of tracer protein throughout the brain from the subarachnoid space , 1985, Brain Research.

[22]  H. Nakagawa,et al.  Subarachnoid pressure-dependent change in syrinx size in a patient with syringomyelia associated with adhesive arachnoiditis. Case report. , 2005, Journal of Neurosurgery : Spine.

[23]  T. Shawker,et al.  Elucidating the pathophysiology of syringomyelia. , 1999, Journal of neurosurgery.

[24]  J. Heiss,et al.  Spinal cord swelling preceding syrinx development. Case report. , 2000, Journal of neurosurgery.