Cerebrospinal Fluid Flow in an Animal Model of Noncommunicating Syringomyelia

Stoodley, Marcus A.; Gutschmidt, Bernice; Jones, Nigel R.

doi:10.1097/00006123-199905000-00068

Cited by 97 publications

(66 citation statements)

References 10 publications

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“…2,5,8,10,20,28,30 Most contemporary reports have suggested that abnormal flow of CSF at the craniocervical junction leads to syrinx formation. 4,5,10,17,20,27,28,31 However, given the relatively common incidence of CM-I and syrinx found in patients undergoing MRI, it is also possible that in some cases, a patient with low tonsil position also will have an intramedullary spine cyst for reasons unrelated to the CM-I. This idea is reinforced by clinical experience, in that syringes are quite variable in terms of size and position within the spinal canal.…”

Section: Discussionmentioning

confidence: 99%

Syrinx location and size according to etiology: identification of Chiari-associated syrinx

Strahle¹,

Muraszko²,

Garton³

et al. 2015

PED

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OBJECT Syrinx size and location within the spinal cord may differ based on etiology or associated conditions of the brain and spine. These differences have not been clearly defined. METHODS All patients with a syrinx were identified from 14,118 patients undergoing brain or cervical spine imaging at a single institution over an 11-year interval. Syrinx width, length, and location in the spinal cord were recorded. Patients were grouped according to associated brain and spine conditions including Chiari malformation Type I (CM-I), secondary CM (2°CM), Chiari malformation Type 0 (CM-0), tethered cord, other closed dysraphism, and spinal tumors. Syringes not associated with any known brain or spinal cord condition were considered idiopathic. Syrinx characteristics were compared between groups. RESULTS A total of 271 patients with a syrinx were identified. The most common associated condition was CM-I (occurring in 117 patients [43.2%]), followed by spinal dysraphism (20 [7.4%]), tumor (15 [5.5%]), and tethered cord (13 [4.8%]). Eighty-three patients (30.6%) did not have any associated condition of the brain or spinal cord and their syringes were considered idiopathic. Syringes in patients with CM-I were wide (7.8 ± 3.9 mm) compared with idiopathic syringes (3.9 ± 1.0, p < 0.0001) and those associated with tethered cord (4.2 ± 0.9, p < 0.01). When considering CM-I–associated and idiopathic syringes, the authors found that CM-I–associated syringes were more likely to have their cranial extent in the cervical spine (88%), compared with idiopathic syringes (43%; p < 0.0001). The combination of syrinx width greater than 5 mm and cranial extent in the cervical spine had 99% specificity (95% CI 0.92–0.99) for CM-I–associated syrinx. CONCLUSIONS Syrinx morphology differs according to syrinx etiology. The combination of width greater than 5 mm and cranial extent in the cervical spine is highly specific for CM-I–associated syringes. This may have relevance when determining the clinical significance of syringes in patients with low cerebellar tonsil position.

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Section: Discussionmentioning

confidence: 99%

Syrinx location and size according to etiology: identification of Chiari-associated syrinx

Strahle¹,

Muraszko²,

Garton³

et al. 2015

PED

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“…29 Also, these spaces were found to be dilated in patients with syringomyelia 3,16 and to be the route of penetration of labeled tracers or other water-soluble media into the syrinx shortly after intrathecal injection. 6,8,13,18,20,22,23,30 In an animal model of noncommunicating syringomyelia, Stoodley et al, 33 have shown that horseradish peroxidase penetrates into the spinal cord and the dilated central canal (a condition mimicking a syrinx) via the perivascular spaces. This occurrence may possibly be induced by an increased pulse pressure rostral to the experimentally induced CSF block.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid flow dynamics study in Chiari I malformation: implications for syrinx formation

Pinna¹,

Alessandrini²,

Alfieri³

et al. 2000

FOC

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Cerebrospinal fluid (CSF) flow abnormalities are known to be present in Chiari I malformation and to underlie the origin and progression of associated syringomyelia. The incidence of syrinx formation, however, is variable for unknown reasons. The aim of this study was to investigate whether differences in CSF flow dynamics in patients with Chiari I malformation may account for the different clinical and radiological presentation. Presurgical and postsurgical phase-contrast magnetic resonance imaging investigations were prospectively conducted in 47 adult patients with symptomatic Chiari I malformation. Patients were divided into two groups according to the presence (32 cases) or absence (15 cases) of syrinx. Cerebrospinal fluid flow patterns were evaluated at four regions of interest: prebulbar cistern, foramen magnum, and the ventral and dorsal spinal subarachnoid spaces at the C-5 level. A temporal analysis of CSF flow waveforms was performed with measurement of cranial- and caudal-directed flow durations. All patients underwent a craniocervical decompressive procedure. Preoperatively, a prolonged caudal-directed (systolic) flow pattern was observed in patients with syringomyelia, as compared with normal control values obtained in 15 healthy volunteers. Conversely, a decreased systolic duration was observed in Chiari I patients who had malformation without syrinx. These trends were not statistically significant because of the considerable degree of overlap with the control values recorded in both groups. Additional comparison of the observed preoperative values obtained in patients with and those without syringomyelia indicated that the difference in systolic flow duration was significant at the ventral spinal subarachnoid space level (p = 0.003) and remarkable at the other levels, although not reaching statistical significance. Cerebrospinal fluid flow was minimal or absent at the foramen magnum (dorsal aspect) due to tonsillar herniation, precluding reliable quantitative measurement at this level. There was no evidence of communication between the fourth ventricle and syrinx in any case. Postoperatively, unobstructed CSF flow was recorded across the enlarged foramen magnum and into the artificial cisterna magna in all patients. A gradual restoration of near-normal flow patterns was observed in both groups. Inside the syrinx, fluid motion gradually tapered, no longer being detectable in 12 patients (37.5%) 1 year postsurgery. In patients with Chiari I malformation and associated syringomyelia different CSF flow patterns were demonstrated as compared with patients in whom syrinx was absent. Analysis of this study's findings supports the hypothesis that in Chiari I malformation an elongated systolic flow may prolong the condition of increased spinal subarachnoid pressure caused by the junctional obstruction, thus favoring CSF penetration into the spinal cord. It may be also proposed that a shortened systolic flow may be insufficient to maintain a hypertensive condition for enough time to induce syrinx formation.

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“…5,49 A subsequent imbalance between CSF inflow and outflow causes syrinx enlargement. 6,[37][38][39][40] It is unclear when cyst formation finishes and at what time its enlargement begins, although the 2 stages probably overlap. The present study provides evidence that progenitor proliferation persists during the 2 stages.…”

Section: Figmentioning

confidence: 99%

Reaction of endogenous progenitor cells in a rat model of posttraumatic syringomyelia

Liao

Stoodley

et al. 2011

SPI

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Object Endogenous stem cells theoretically could replace lost tissue and repair deficits caused by syringes. In this study the authors quantitatively examined 1) whether neural progenitor cells exist in an adult rat model of posttraumatic syringomyelia (PTS); 2) and if so, how long an active population of progenitor cells can persist; 3) whether the cell population's location is associated with the syrinx; 4) the degree of differentiation of the progenitor cells; and 5) the phenotypic fate of the progenitor cells. Methods Wistar rats were divided into intact, sham-operated, and experimental syrinx groups. Animals in each group were equally subdivided according to 4 time points: 7, 14, 28, and 56 days post–syrinx induction. Rats in the experimental syrinx group underwent a C-7 and T-1 laminectomy and then received 0.5 μl of a 24-mg/ml quisqualic acid spinal cord injection at the C-8 level to mimic an excitotoxic injury with an initial cyst, and 10 μl of a 250-mg/ml kaolin injection into the subarachnoid space at the C-8 level to create arachnoiditis. The proliferation, distribution, and differentiation of endogenous progenitor cells were identified immunocytochemically. Results The authors observed a 20-fold increase in progenitor cells excluding inflammatory cells in the 1st 2 weeks post–syrinx induction. The cells persisted for at least 56 days, and 80% of them were located in the gray matter along the border of cysts. They included neural multipotential progenitor cells, oligodendroglial progenitor cells, and astrocytes. Conclusions Data in this study provide evidence for proliferation, distribution, and differentiation of endogenous progenitor cells in a model of PTS in adult rats. These progenitor cells proliferate rapidly, extend for long periods, and are mainly located in the gray matter along the border of syringes. Neural multipotential progenitor cells are expected to be associated with reparative and regenerative mechanisms of PTS. Glial cells are involved in the formation of a glial scar barrier that surrounds the syrinx and may prevent cyst enlargement. The authors' findings suggest that neural progenitor cells play a protective role in PTS.

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Cerebrospinal Fluid Flow in an Animal Model of Noncommunicating Syringomyelia

Cited by 97 publications

References 10 publications

Syrinx location and size according to etiology: identification of Chiari-associated syrinx

Syrinx location and size according to etiology: identification of Chiari-associated syrinx

Cerebrospinal fluid flow dynamics study in Chiari I malformation: implications for syrinx formation

Reaction of endogenous progenitor cells in a rat model of posttraumatic syringomyelia

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