Treatment of Syringomyelia in Patients with Arachnoiditis at the Craniocervical Junction

Davidoff, Christopher L.; Liu, Shinuo; Wong, Johnny; Koustais, Stavros; Rogers, Jeffrey M.; Stoodley, Marcus A.

doi:10.1016/j.wneu.2017.08.064

Cited by 20 publications

(20 citation statements)

References 28 publications

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“…Furthermore, sporadic cases with no remarkable history explaining CSAA have been reported (3.6%) [ 4 , 19 , 20 ]. Historically, infections [ 5 , 18 , [21] , [22] , [23] , [24] ], mostly tuberculous meningitis [ 5 , [25] , [26] , [27] , [28] , [29] ], or myelographies due to the application of an oil-based contrast agent [ 2 , [30] , [31] , [32] , [33] , [34] , [35] ] played a major role as the cause of CSAA. Spinal surgery [ 6 , 11 , 22 , [36] , [37] , [38] , [39] , [40] ] and subarachnoid hemorrhages [ 3 ] continue to play a key role in the development of CSAA.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Immunotherapies in chronic adhesive arachnoiditis - A case series and literature review

Hackert¹,

Maßmann²,

Sure

et al. 2021

eNeurologicalSci

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Chronic spinal adhesive arachnoiditis (CSAA) is a rare condition with limited therapeutic options. Surgical treatment proves effective in approximately 60% of cases. Conservative treatment options have not been extensively investigated. Here, we report the course of the disease, analyze the effect of immune treatments in patients with CSAA who were treated in the University Hospital Essen between 2015 and 2020, and conduct a literature review. Three out of four patients showed no improvement after treatment with corticosteroids, methotrexate, or plasmapheresis. All non-responders suffered from CSAA for several years, while one patient who had a disease duration of less than one month fully recovered. It is necessary to verify whether treatment at an early stage of the disease is better than treatment after chronic adhesion manifestation, as it interrupts the development of adhesions and all subsequent complications.

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Section: Discussionmentioning

confidence: 99%

“…This does not reflect the majority of reported cases. Most of the authors report cases with arachnoiditis and syringomyelia [ 23 , 25 , 28 , 47 ], therefore cases of arachnoiditis without these findings were underrepresented. This is important to consider when treating patients with arachnoiditis.…”

Section: Discussionmentioning

confidence: 99%

Immunotherapies in chronic adhesive arachnoiditis - A case series and literature review

Hackert¹,

Maßmann²,

Sure

et al. 2021

eNeurologicalSci

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show abstract

“…1 9 Usage of advanced imaging, microsurgical techniques, limiting unnecessary arachnoid dissection, and lesser blood in surgical field should aid in achieving better patient outcomes. 2 10 In view of insufficient evidence, surgery at present is only indicated if the patients’ neurological status is progressively worsening.…”

Section: Discussionmentioning

confidence: 99%

Craniovertebral Junction Arachnoiditis: An Unusual Sequelae to Tuberculous Meningitis

Pruthi

Vora

Shukla

2019

JNRP

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Adhesive arachnoiditis at the craniovertebral junction should be suspected in patients with a history of meningitis having delayed onset gradually progressive tetra paresis. Patients can present after an asymptomatic interval of 2 to 20 years. Cardiac gated cine magnetic resonance imaging is useful for its diagnosis. Posterior fossa decompression with upper cervical laminectomy and adhesiolysis appears to be a reasonable treatment for the same. We illustrate two patients who presented to us with gradually progressive spastic tetra paresis; both had prior history of cured tuberculous meningitis.

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“…Existing studies have identified the significance of the physiological and biomechanical properties of PAC in central nervous system (CNS) pathologies, such as TBI, spinal cord stenosis, and Space Flight Associated Neuro-Ocular syndrome (also called SANS), as well as in applications such as CSF-based drug delivery [4][5][6][7]. Neurosurgical dissection of spinal "arachnoiditis", or inflammation of the PAC surrounding the spinal cord, is a procedure believed to reduce CSF flow obstruction by removing SAT fibers [7][8][9][10][11][12]. Gottschalk et al found in-vivo flow alterations due spinal arachnoiditis [13].…”

Section: Introductionmentioning

confidence: 99%

Ex-vivo Quantification of Ovine Pia Arachnoid Complex Biomechanical Properties Under Uniaxial Tension

Natividad

Theodossiou

Schiele

et al. 2020

Preprint

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The pia arachnoid complex (PAC) is a cerebrospinal fluid-filled tissue conglomerate that surrounds the brain and spinal cord. Pia mater adheres directly to the surface of the brain while the arachnoid mater adheres to the inferior side of the dura mater. Collagen fibers, known as subarachnoid trabeculae (SAT) fibers, and microvascular structure lie intermediately to the pia and arachnoid meninges. Due to its structural role, alterations to the biomechanical properties of the PAC may change surface stress loading in traumatic brain injury (TBI) caused by sub-concussive hits. The aim of this study was to quantify the mechanical and morphological properties of ovine PAC. Ovine brain samples (n = 10) were removed from the skull and tissue was harvested within 30 minutes post-mortem. To access the PAC, ovine skulls were split medially from the occipital region down the nasal bone on the superior and inferior aspects of the skull. A template was used to remove arachnoid samples from the left and right sides of the frontal occipital regions of the brain. 10 ex-vivo samples were tested with uniaxial tension at 2 mm/s, average strain rate of 0.59 s− 1, until failure at < 5 hours post extraction. The force and displacement data were acquired at 100 Hz using LabVIEW. PAC tissue collagen fiber microstructure was characterized using second-harmonic generation (SHG) imaging on a subset of n = 4 stained tissue samples. Samples were stained with DAPI and anti-von Willebrand Factor to visualize cell nuclei and epithelial cells, respectively. The Mooney-Rivlin model for average stress-strain curve fit was used to model PAC material properties. The elastic modulus, ultimate stress, and ultimate strain were found to be 7.7 ± 3.0 MPa, 2.7 ± 0.76 MPa, and 0.60 ± 0.13, respectively. No statistical significance was found across brain dissection locations in terms of biomechanical properties. SHG images were post-processed to obtain average SAT fiber intersection density, concentration, porosity, tortuosity, segment length, orientation, radial counts, and diameter as 0.23%, 26.14%, 73.86%, 1.07 ± 0.28, 17.33 ± 15.25 µm, 84.66 ± 49.18º, 8.15%, 3.46 ± 1.62 µm, respectively. For the sizes, strain, and strain rates tested, our results suggest that ovine PAC mechanical behavior is isotropic, and that the Mooney-Rivlin model is an appropriate curve-fitting constitutive equation for obtaining material parameters of PAC tissues.

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Treatment of Syringomyelia in Patients with Arachnoiditis at the Craniocervical Junction

Cited by 20 publications

References 28 publications

Immunotherapies in chronic adhesive arachnoiditis - A case series and literature review

Immunotherapies in chronic adhesive arachnoiditis - A case series and literature review

Craniovertebral Junction Arachnoiditis: An Unusual Sequelae to Tuberculous Meningitis

Ex-vivo Quantification of Ovine Pia Arachnoid Complex Biomechanical Properties Under Uniaxial Tension

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