Radiographic studies of the ventricles in syringomyelia

Abstract

Radiographic investigations of 171 patients with "communicating' syringomyelia have been reviewed. Hydrocephalus was found in one-third of the cases and has occasionally progressed after operation on the posterior fossa, sometimes with accompanying clinical deterioration. The outlets of the fourth ventricle were usually abnormal; tonsillar descent, arachnoiditis and both together were seen. Arachnoiditis correlated strongly with a history of difficult birth. The foramen of Magendie was sometimes patent and sometimes blocked. There was no consistent level of occlusion corresponding to a persistent roof of the fourth ventricle. The cisterna magna was usually small or obliterated but some examples of large cisterns or subarachnoid pouches were found. Radiological demonstration of a communication from the fourth ventricle to the syrinx occurred in only seven patients by positive contrast material and not by air. It is suggested that a sizable communication is rare at the time when patients seek treatment.

Some observations on the pathogenesis of syringomyelia.

“…These differences were statistically significant (figs 7, 8, 9). A comparison of the Chiari patients with syringomyelia directly with the Chiari patients without syringomyelia (fig 10) illustrates the differences between these two groups which do not Newman, Terenty, Foster reach statistical significance because of the relatively few patients in the latter group. Discussion Williams" stated that difficult labour was more common in patients with communicating syringomyelia than in controls, or when these cases are compared with data available from the 1958 Perinatal Mortality Survey.…”

Syringomyelia as a sequel to traumatic paraplegia

“…It was supposed that there were mechanisms causing filling of the syrinx directly from the ventricular system. This communication is only present in about 10 per cent of patients with 'communicating' syringomyelia at the time that they present for investigation (West & Williams, 1980). The theories of Gardner have been somewhat marred by his attempt to include a wide variety of disorders into the same spectrum of disease which he calls 'dysraphism'.…”

“…This valve may become jammed in the foramen after coughing and straining, particularly during the post-Valsalva mana:uvre and be responsible for hindbrain symptoms and 'communicating' syringomyelia as well as further progression of the hindbrain hernia itself. With blockage at the foramen magnum the pressure thus measurable has been called cranio-spinal pressure dissociation (Williams, 1974(Williams, , 1976(Williams, , 1977(Williams, , 1980. It is immaterial whether the pressure above in spinal blockage is high or that below is low, the pressure differ ence exerts the same effects and thus the ponderous term 'cranio-caudal intraspinal pressure dissociation' as well as 'craniospinal pressure dissociation' may be replaced by 'suck'.…”

Symptomatic Chiari I Malformation in Childhood: A Report of 7 Cases

“…The midline cerebellar and brainstem structures are in normal anatomic posi tion. Hydrosyringomyelia is an associated finding in as many as 75% of reported adult cases [3][4][5], but hydrocephalus is only an occasional accompanying fea ture [6]. The more severe Chiari II malformation is that type commonly seen in association with myelodyspla sia.…”