Time-STAMP MRI of CSF motion for evaluation of Chiari malformation and endoscopic third ventriculostomy

OBJECTIVE Assessing abnormal CSF motion at the craniocervical junction (CCJ) and aqueduct of Sylvius (AS) can be clinically useful in the pediatric neurosurgical evaluation. Noninvasive monitoring of CSF flow at these locations can assist in determining the need for surgery or conservative management and in monitoring the outcomes of such interventions. In this retrospective study, the authors investigated the use of noninvasive time static tagging and monocontrast preservation (Time-STAMP) MRI as a diagnostic adjunct for neurosurgical evaluation at a high-volume pediatric institution. METHODS Radiology records were queried to identify Time-STAMP studies conducted from April 2014 to March 2023. Search parameters included patients who had undergone or were undergoing clinical assessment for Chiari decompression or endoscopic third ventriculostomy (ETV). An independent panel performed a quality review of the Time-STAMP studies to determine their interpretability. Patient records were then reviewed to determine the extent to which Time-STAMP scans contributed to clinical decision-making. RESULTS Screening of the radiology records yielded 175 patients with Time-STAMP studies, of whom 102 had been assessed for Chiari decompression and 73 for ETV. Among this group, 147 patients (84%) had interpretable Time-STAMP studies, which aided in the decision to clinically observe versus perform surgery in 130 of these patients (88%). The Time-STAMP interpretation was not contradicted by later follow-up studies in any of these patients. CONCLUSIONS The authors found that the noninvasive Time-STAMP technique to visualize CSF motion at the CCJ or AS is helpful to the clinician in managing these conditions.