|
1
|
Kilgore MD, Mathkour M, Dunn RH, Scullen T, Gouveia EE, Shapiro SZ, Glynn R, Tubbs RS, Bui CJ. Spontaneous resolution of syringomyelia following pregnancy and parturition in a patient with type I chiari malformation: A case and systematic review. Clin Neurol Neurosurg 2022; 222:107413. [PMID: 36049402 DOI: 10.1016/j.clineuro.2022.107413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Spontaneous resolution of syringomyelia has rarely been reported in the literature. Rarer still are cases wherein this process is associated with pregnancy and parturition. We review theories on syringomyelia development and spontaneous resolution to better understand the role pregnancy and parturition may play in both processes. METHODS We present a 30-year-old female with MRI-confirmed spontaneous syrinx regression following caesarean delivery of a full-term pregnancy. We additionally review the literature to identify previously reported cases of spontaneous syrinx regression both independent of and associated with pregnancy. RESULTS Including the present case, 39 cases describing spontaneous regression of syringomyelia have been reported in the literature, of which only four are associated with pregnancy and parturition. 75% of all reported cases were associated with type I Chiari malformation, though several disorders of the craniocervical junction and spinal canal were implicated. Complete syrinx regression was achieved in 33.3% of cases and 5% of cases described recurrence of syringomyelia following the spontaneous resolution. CONCLUSION Syringomyelia likely develops due to disturbance of the physiologic flow of cerebrospinal fluid around the craniocervical junction and the obex. Several mechanisms including fissuring of the spinal cord parenchyma and reduction of subarachnoid scarring are likely involved in this process. In the setting of pregnancy, additional mechanisms surrounding the increased intraabdominal forces imparted by a growing fetus, Valsalva-like strain experienced during labor, and hemodynamic changes that occur to accommodate gestation are likely implicated. Nevertheless, patients should continue to be monitored periodically for syrinx recurrence.
Collapse
Affiliation(s)
- Mitchell D Kilgore
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Mansour Mathkour
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Neuroscience Institute, New Orleans, LA, USA.
| | - Rachel H Dunn
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Tyler Scullen
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Neuroscience Institute, New Orleans, LA, USA.
| | - Edna E Gouveia
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Stephen Z Shapiro
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Neuroscience Institute, New Orleans, LA, USA.
| | - Ryan Glynn
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Neuroscience Institute, New Orleans, LA, USA.
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Neuroscience Institute, New Orleans, LA, USA.
| | - Cuong J Bui
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Neuroscience Institute, New Orleans, LA, USA.
| |
Collapse
|