Intramedullary Pressure in Syringomyelia: Clinical and Pathophysiological Correlates of Syrinx Distension

Milhorat, Thomas H.; Capocelli, Anthony L.; Kotzen, René M.; Bolognese, Paolo A.; Heger, Ian M.; Cottrell, James E.

doi:10.1097/00006123-199711000-00014

Cited by 78 publications

(32 citation statements)

References 37 publications

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“…Milhorat et al 26 (1997) measured the pressure in the interior of the syringomyelic cavity, and suggested that the distention would depended on different degrees of intramedullary pressure, causing lesion of long tracts, gray matter and microcirculation. The involvement of the anterior horns gives rise to fibrillation, fasciculation, muscular weakness and atrophy.…”

Section: Discussionmentioning

confidence: 99%

Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Silva¹,

Holanda

2003

Arq. Neuro-Psiquiatr.

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-The present study shows the results of 53 patients who have been treated surgically for basilar impression (BI), Chiari malformation (CM), and syringomyelia (SM). The patients were divided into two groups. Group I (24 patients) underwent osteodural decompression with large inferior occipital craniectomy, laminectomy from C 1 to C 3, dural opening in Y format, dissection of arachnoid adhesion between the cerebellar tonsils, medulla oblongata and spinal cord, large opening of the fourth ventricle and dural grafting with the use of bovine pericardium. Group II patients (29 patients) underwent osteodural-neural decompression with the same procedures described above plus dissection of the arachnoid adherences of the vessels of the region of the cerebellar tonsils, and tonsillectomy (amputation) in 10 cases, and as for the remainning 19 cases, intrapial aspiration of the cerebellar tonsils was performed. The residual pial sac was sutured to the dura in craniolateral position. After completion of the suture of the dural grafting, a thread was run through the graft at the level of the created cisterna magna and fixed to the cervical aponeurosis so as to move the dural graft on a posterior-caudal direction, avoiding, in this way, its adherence to the cerebellum. RESUMO -São analisados os resultados obtidos com o tratamento cirúrgico de 53 casos de impressão basilar (IB), malformação de Chiari (MC) e siringomielia (SM). Os pacientes foram divididos em dois grupos: no grupo I(24 casos) foi realizada a descompressão osteodural, caracterizada por craniectomia ampla occipital inferior, laminectomia variável de C 1 a C 3, abertura da dura-máter em forma de Y, dissecção das aderências aracnóideas das tonsilas cerebelares com o bulbo e medula cervical, abertura ampla do quarto ventrículo e enxerto dural; no grupo II (29 casos) foi utilizada a descompressão osteodural-neural, caracterizada pelos mesmos detalhes técnicos empregados no grupo I, acrescidos da tonsilectomia por amputação (10 casos) e por aspiração intrapial (19 casos). Nestes casos, o saco pial residual, resultante da aspiração intrapial das tonsilas cerebelares, foi suturado à dura-máter lateral e em posição cranial. Após o término do enxerto dural, foi passado um fio através do enxerto dural, à altura da cisterna criada, e fixado sobre a aponeurose cervical, com a finalidade de deslocar a plástica em direção caudal, evitando, desta forma, sua aderência ao cerebelo.PALAVRAS-CHAVE: impressão basilar, malformação de Chiari, siringomielia, tonsilectomia, enxerto da dura-máter.

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Section: Discussionmentioning

confidence: 99%

Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Silva¹,

Holanda

2003

Arq. Neuro-Psiquiatr.

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“…Several pathophysiological factors are proposed to promote syringomyelia development: 1) reduction of subarachnoid compliance and accentuated pulse pressure in the cervical portion of the spinal subarachnoid space [16,43], 2) increased intrasyrinx pressure [36], 3) pressure gradients within the intramedullary extracellular fluid [23], 4) intrasyrinx fluid pulsation [9], 5) pulsation of the intramedullary arteries [51], and 6) patency of the central canal of the spinal cord [33]. However, because communication between the syrinx and fourth ventricle is usually not found in radiographic or post-mortem studies, it cannot play a role in pathogenesis of most cases of syringomyelia [34,43,45].…”

Section: Discussionmentioning

confidence: 99%

“…However, once myelopathy develops it is largely irreversible and it improves modestly, if at all, even if the syrinx is eliminated [25,43,54]. Factors other than syrinx diameter, such as intra-and extrasyrinx fluid pressures [16,36] and gliosis around the cavity, may play a role in the development of myelopathy.…”

Section: Discussionmentioning

confidence: 99%

“…In patients in other series who undergo surgical treatment, the prognosis for improvement decreases as the duration of syringomyelia before surgery increases [41]. Irreversible injury to the spinal cord from chronically increased intra-and extramedullary pressure [16,36] and from gliosis around the syrinx cavities [34] prevents clinical restoration when the syrinx collapses spontaneously or from surgery. It is unknown if gliosis can progress after resolution of the syrinx filling mechanism and collapse of the syrinx cavity.…”

Section: Discussionmentioning

confidence: 99%

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The post–syrinx syndrome: stable central myelopathy and collapsed or absent syrinx

2006

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Among 168 cases with neurologic findings of cervicothoracic syringomyelia and MRI findings of Chiari 1 malformation and/or underdevelopment of the posterior cranial fossa, 15 patients (9.1%) had collapsed, flat syrinxes and 14 patients (8.3%) did not have syrinxes. Both groups of patients had clinical findings of central myelopathy that had been stable for at least 3 years. Magnetic resonance imaging detected atrophy of the cervical spinal cord in both groups and spontaneous communications between the syrinx and the subarachnoid space in 3 patients of the group with collapsed syrinxes. Analysis of these results and review of the literature suggest that patients with clinical signs of syringomyelia and Chiari 1 malformation or underdeveloped posterior fossa, but with small or absent syringomyelitic cavities, have the "postsyrinx" state as a result of spontaneous collapse of distended syrinxes.

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“…2) This dynamic compression is a source of repetitive trauma, which results in vascular insufficiency of the affected spinal cord. 1,2) Marked improvements in rSCBF were observed immediately after drainage of the syrinx in patients with syringomelia, 22,38) based on laser Doppler flowmetry (LDF) during syrinx shunting. 22) LDF allows real-time monitoring of regional blood flow and can be used intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

Perfusion-Weighted Magnetic Resonance Imaging of the Spinal Cord in Cervical Spondylotic Myelopathy

Uemura

Matsumura

Isobe

et al. 2006

Neurol. Med. Chir.(Tokyo)

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Principles of echo shifting with a train of observations was used to perform magnetic susceptibilityweighted magnetic resonance imaging with bolus-tracking in 14 patients with spondylotic myelopathy to assess changes in perfusion parameters of the spinal cord before and after decompression surgery for cervical spondylotic myelopathy. The mean transit time (MTT), bolus arrival time (T0), and time to peak (TTP) were obtained from regions of interest (ROIs) and assessed as the ratio between the spinal cord and the pons (MTT index ＝ MTT ROI /MTT pons , T0 index ＝ T0 ROI /T0 pons , TTP index ＝ TTP ROI / TTP pons ). The patients were divided into two groups according to percentage improvement on the Neurosurgical Cervical Spine Scale. The MTT index in patients with good recovery (AE50%) was significantly reduced. The T0 index and TTP index showed no significant change in both groups. Reduction of MTT index may indicate improved perfusion of the spinal cord following surgery for cervical spondylotic myelopathy.

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Intramedullary Pressure in Syringomyelia: Clinical and Pathophysiological Correlates of Syrinx Distension

Cited by 78 publications

References 37 publications

Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

The post–syrinx syndrome: stable central myelopathy and collapsed or absent syrinx

Perfusion-Weighted Magnetic Resonance Imaging of the Spinal Cord in Cervical Spondylotic Myelopathy

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