Magnetic Resonance Imaging of Progressive Hydrosyringomyelia in Two Patients with Meningomyelocele

Hall, Michelle L.; Beuls, E. A. M.; Wilmink, J. T.; Boiten, Jelis; Vles, J. S. H.

doi:10.1055/s-2008-1071358

Cited by 8 publications

(3 citation statements)

References 7 publications

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“…• It was noticed among the symptornatic hydrornyelia cases that central canal enlargemen18 over a long segment appeared to be septated as reported by van Hall (16).…”

Section: Discussionmentioning

confidence: 79%

Anatomy of the Spinal Cord in Patients with Meningomyelocele with and without Hypoplasia or Hydromyelia

Moskowitz¹,

Shurtleff²,

Weinberger³

et al. 1998

Eur J Pediatr Surg

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We compared the cross-sectional areas of spinal cords of patients with normal cords to the area of patients with meningomyelocele. The control group consisted of examinations of 27 patients with normal spinal cords providing 1547 axial images at 20 levels, C2-L2. The meningomyelocele group consisted of 67 MRI examinations of 41 patients, providing 4,095 axial images at 23 levels C2 to S1. Thirty-four examinations were of 21 patients with minimal hydromyelia, 7 examinations were of 3 patients with operable hydromyelia, and 26 examinations were of 17 patients without hydromyelia. In an additional analysis, we selected those meningomyelocele patients with cord tethering but without hydromyelia or hypoplasia (53 examinations of 30 patients) and compared them to symptomatic hypoplasia cases (9 examinations of 6 patients). The symptomatic hypoplasia cases were chosen because of progressive loss of muscle strength and worsening spasticity not relieved by surgical adhesiolysis. The test, retest error was 5.6% with differences between the means of repeated readings not being significant. All tests for significance were paired T test. The areas of spine levels C7-L2 for the controls were significantly larger than for the meningomyelocele patients (p = 0.000007). Including all levels C2-S1, the minimal hydromyelia cases were not significantly different from those without hydromyelia (p = 0.5). The areas C2-S1 of operable hydromyelia cases were larger than both non-shunted minimal hydromyelia (p = 0.00009) and of meningomyelocele patients without hydromyelia (p = 0.00003). The areas C7-L2, of hypoplasia cases were significantly smaller compared to the "normal" meningomyelocele cases (p = 0.0004). These data suggest that hydromyelia stimulates overgrowth of the cord, as does hydrocephalus of the brain, and that adhesiolysis procedures are of no value with hypoplasia of the spinal cord.

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“…• It was noticed among the symptornatic hydrornyelia cases that central canal enlargemen18 over a long segment appeared to be septated as reported by van Hall (16).…”

Section: Discussionmentioning

confidence: 79%

Anatomy of the Spinal Cord in Patients with Meningomyelocele with and without Hypoplasia or Hydromyelia

Moskowitz¹,

Shurtleff²,

Weinberger³

et al. 1998

Eur J Pediatr Surg

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“…Only one patient experienced any functional improvement, and that patient died 10 weeks after surgery of bronchopneumonia related to general debilitation. Van Hall, et al, 43 mentioned treatment of two children in whom a syringoperitoneal shunt was placed. They noted the obliteration of the subarachnoid space at the level of the syrinx by adhesions.…”

Section: Treatment Of Syringomyeliamentioning

confidence: 99%

Syringomyelia complicating myelomeningocele: review of the evidence

Piatt¹

2004

Journal of Neurosurgery: Pediatrics

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Syringomyelia is frequently found in association with myelomeningocele. Although often asymptomatic, it can, in exceptional cases, cause severe morbidity. The author performed a structured literature review to address the following aspects of this clinical problem. What is the natural history? There are data concerning the imaging prevalence, the autopsy prevalence, and the prevalence of clinically active syringomyelia among patients with myelomeningocele, but literature provides no description of the course of this condition over time. What is the clinical significance? That correlations among symptoms, signs, treatments, and imaging findings are poorly described is no surprise in view of the large fraction of patients with syringomyelia who are asymptomatic. There is, however, an impressive mass of anecdotal evidence associating progressive syringomyelia with untreated (or inadequately treated) hydrocephalus. How to make the diagnosis? There is no disagreement that magnetic resonance imaging is the diagnostic modality of choice, but the literature provides very little guidance about who should undergo this investigation. There is no analysis of the costs and benefits of screening or periodic surveillance. What is the best treatment? Many surgical procedures have been reported to be useful as components of complex algorithms relating clinical factors and imaging data to treatment recommendations. There have been no controlled studies. There have been no prospective studies. There have been no multiinstitutional studies. No studies in which outcomes have been evaluated using objective, validated instruments. No studies in which the robustness of treatment effects over time have been documented. The complexity of treatment selection in contemporary practice makes syringomyelia unsuitable for randomized controlled trials of different therapies. Prospective cohort studies are feasible, however, and hold the potential to address many important questions about natural history and patient outcomes.

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“…[2] Multiseptated syringomyelia has been reported in the literature in association with trauma and after spinal surgical procedures for extramedullary lesions and meningomyelocele but not with TBM. [34]…”

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confidence: 99%