Hydrosyringomyelia and Its Management in Childhood

Hoffman, Harold J.; Neill, John C.; Crone, Kerry R.; Hendrick, E B; Humphreys, Robin P.

doi:10.1227/00006123-198709000-00012

Cited by 84 publications

(41 citation statements)

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“…There is increasing evidence that hydrosyringomyelia and scoliosis are commonly associated. In the series reported by Hoffman et al [20], 10 of 47 children with hydrosyringomyelia presented with scoliosis, as did 57% of the patients described by Dyste and Menezes [6]. There also is increasing evidence that posterior fossa decompression addresses the scoliosis.…”

Section: Discussionmentioning

confidence: 99%

“…Plugging of the obex of the fourth ventricle has been commonly used since its first description by Gardner [4, 6, 11, 14, 15, 20, 22, 31, 34, 35, 36, 37, 38, 39]. While the data from some series support obex plugging, others do not affirm its efficiency [14, 36, 40, 41].…”

Section: Discussionmentioning

confidence: 99%

“…However, this pressure theory has not been proven in cases of syringes associated with a Chiari I malformation and, when taken with the observation of cerebellar tonsillar descent after lumboperitoneal shunting [20, 69, 70, 71, 72, 73, 74], cannot be recommended as a primary procedure of choice.…”

Section: Discussionmentioning

confidence: 99%

“…This approach is supported by the work of Vernet et al [75]who attributed a beneficial effect to syringopleural shunting in cases refractory to posterior fossa decompression. However, the 2 Chiari I patients described by Hoffman et al [20]who failed to improve after decompression also failed to improve after subsequent shunting.…”

Section: Discussionmentioning

confidence: 99%

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Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Krieger

McComb

Levy³

1999

Pediatr Neurosurg

131

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A wide variety of surgical adjuvants to the standard bony decompression have been advocated in the treatment of the Chiari I malformation, especially when the tonsillar herniation is associated with hydrosyringomyelia. These include various shunting procedures, duroplasty, obex plugging, and resection of the cerebellar tonsils. Our practice has been to avoid these adjuvants and to perform a simple limited occipital craniectomy, C₁ laminectomy, and dural opening. The dura mater is left open and overlain with oxidized cellulose. To evaluate the efficacy of this more limited procedure, a retrospective review was performed of the medical records of 31 consecutive patients treated over a 6-year period. Twenty-six (84%) of these patients had an associated spinal cord syrinx; all underwent the same procedure. The follow-up period ranged from 15 to 93 months, with all patients having at least one postoperative magnetic resonance imaging at 6 months. Twenty-three of the 26 patients (88%) who presented with a syrinx had significant resolution of the syrinx on follow-up scans with concomitant improvement of presenting signs and symptoms. Of the remaining 3 patients, 1 had progressive hydrocephalus and received a ventriculoperitoneal shunt, with symptom resolution. In the other 2 patients the syrinx did not diminish; both received syringopleural shunts. Postoperative morbidity includes a 26% incidence of headaches, of which half resolved within 5 days, and only 1 persisted beyond 2 weeks. Nausea and vomiting occurred in 16%. Neither of these figures significantly exceeds those of other large surgical series in which the dura mater was closed with a patch graft. Three patients (10%) did have a postoperative cerebrospinal fluid leak; all responded to bedside suturing without further sequelae. This study indicates that a simple bone removal and open dural decompression of the cervicomedullary junction is a safe, effective operative treatment for Chiari I malformation in children. Shunts, duroplasty, obex plugging, and tonsillar resection offer no benefit regarding the outcome when our series is compared to others in which such adjuvants were used.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Krieger

McComb

Levy³

1999

Pediatr Neurosurg

131

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“…In the literature, various types of surgical procedures have been proposed for the treatment of hydromyelia in children, and a wide variety of results have been reported for each type of operation [1,3,[7][8][9][10][11], On the other hand, a specific series of indications regarding a precise thera peutic approach for treating children with hydromyelia associated with myelomeningocele and Chiari type-11 malformation has never been clearly stated.…”

Section: Introductionmentioning

confidence: 99%

Presentation and Management of Hydromyelia in Children with Chiari Type-II Malformation

et al. 1997

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Hydromyelia in patients with myelomeningocele and Chiari-II malformation is a relatively frequent finding on MRI studies. However, not all children develop symptoms from the hydromyelia that requires treatment. Furthermore, treatment of hydromyelia in spina bifida patients is rather complex due to the associated malformations. The authors retrospectively analyzed 231 MRI studies carried out on spina bifida patients who presented neurological deterioration. Hydromyelia was found in 48.5% of the patients. Forty-five children with severe hydromyelia required treatment. These patients were first divided into 2 groups: those with holocord hydromyelia, and those with a segmental lesion. Fifteen patients presented symptoms characteristic of symptomatic Chiari-II malformation: neck rigidity; swallowing difficulty; pain in the upper extremeties; weakness or spasticity in the upper extremeties. Eighteen patients presented symptoms typical of the tethered cord syndrome: scoliosis; worsening bladder and/or bowel function; pain in the lower extremeties; weakness or spasticity in the lower extremeties. Twelve patients presented a mixed-type symptomatology. These patients subsequently underwent posterior cervical decompression, tethered cord release or insertion of a hydromyelia-pleural shunt according to the type of presenting symptoms and to the extent of the hydromyelic lesion. A pattern of successful treatment was identified for each type of presenting clinical and radiological picture. This has allowed the authors to determine an algorithm for optimal treatment of hydromyelia associated with Chiari-II malformation and myelomeningocele, which is proposed here.

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Improvement in Hindbrain Herniation Demonstrated by Serial Fetal Magnetic Resonance Imaging Following Fetal Surgery for Myelomeningocele

Sutton¹

1999

JAMA

403

230

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Hydrosyringomyelia and Its Management in Childhood

Cited by 84 publications

References 0 publications

Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Presentation and Management of Hydromyelia in Children with Chiari Type-II Malformation

Improvement in Hindbrain Herniation Demonstrated by Serial Fetal Magnetic Resonance Imaging Following Fetal Surgery for Myelomeningocele

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