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Bach MBT, Stougaard CL, Thøfner MS, Reimann MJ, Westrup U, Koch J, Fredholm M, Martinussen T, Berendt M, Olsen LH. Relationship between syringomyelia and myxomatous mitral valve disease in Cavalier King Charles spaniels. J Vet Intern Med 2024; 38:904-912. [PMID: 38391152 PMCID: PMC10937514 DOI: 10.1111/jvim.17018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Syringomyelia (SM) and myxomatous mitral valve disease (MMVD) are highly prevalent in Cavalier King Charles spaniels (CKCS). Cardiac status in CKCS with and without SM is currently unknown. OBJECTIVES To investigate the association between SM and MMVD severity in CKCS and CKCS with SM with and without clinical signs of SM. ANIMALS Fifty-five CKCS: 40 with SM (22 symptomatic and 18 asymptomatic) and 15 without SM. METHODS A combined retrospective and prospective study. MRI and echocardiography were used to diagnose SM and MMVD, respectively. The association between SM and MMVD severity (left ventricle internal diameter in diastole normalized to bodyweight [LVIDDN] and left atrium to aortic ratio [LA/Ao]) were tested using multivariable linear regression analysis adjusting for sex and age. RESULTS Overall, no significant difference in LVIDDN and LA/Ao was found between CKCS with or without SM. However, CKCS with symptomatic SM had significantly smaller LVIDDN (1.45 [1.30-1.50]) (median [IQR]) and LA/Ao (1.20 [1.10-1.28]) compared to CKCS with asymptomatic SM (1.60 [1.50-1.90] and 1.40 [1.20-1.75]) as well as CKCS without SM (0.24 [0.03-0.45] and 0.30 [0.05-0.56]) (all P values <.03). CONCLUSIONS AND CLINICAL IMPORTANCE An association between MMVD and SM was not confirmed in this cohort of CKCS, indicating that MMVD and SM do not co-segregate. However, CKCS with symptomatic SM had smaller left ventricle and atrial size compared to CKCS with asymptomatic SM and CKCS without SM.
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Affiliation(s)
- Maiken B. T. Bach
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Camilla L. Stougaard
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Maria S. Thøfner
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Maria J. Reimann
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Ulrik Westrup
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Jørgen Koch
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Merete Fredholm
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Torben Martinussen
- Department of Public HealthUniversity of CopenhagenFrederiksberg CDenmark
| | - Mette Berendt
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Lisbeth H. Olsen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
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Bateman GA, Bateman AR. A perspective on the evidence for glymphatic obstruction in spaceflight associated neuro-ocular syndrome and fatigue. NPJ Microgravity 2024; 10:23. [PMID: 38418508 PMCID: PMC10901896 DOI: 10.1038/s41526-024-00365-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/12/2024] [Indexed: 03/01/2024] Open
Abstract
Spaceflight associated neuro-ocular syndrome (SANS) alters the vision of astronauts during long-duration spaceflights. Previously, the current authors have discussed the similarities and differences between SANS and idiopathic intracranial hypertension to try to elucidate a possible pathophysiology. Recently, a theory has been advanced that SANS may occur secondary to failure of the glymphatic system caused by venous dilatation within the brain and optic nerves. There is recent evidence to suggest glymphatic obstruction occurs in childhood hydrocephalus, multiple sclerosis and syringomyelia due to venous outflow dilatation similar to that proposed in SANS. The purpose of the current paper is to discuss the similarities and differences between the known CSF and venous pathophysiology in SANS with these other terrestrial diseases, to see if they can shed any further light on the underlying cause of this microgravity-induced disease.
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Affiliation(s)
- Grant Alexander Bateman
- Department of Medical Imaging, John Hunter Hospital, Newcastle, NSW, Australia.
- Newcastle University Faculty of Health, Callaghan Campus, Newcastle, NSW, Australia.
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Toader C, Ples H, Covache-Busuioc RA, Costin HP, Bratu BG, Dumitrascu DI, Glavan LA, Ciurea AV. Decoding Chiari Malformation and Syringomyelia: From Epidemiology and Genetics to Advanced Diagnosis and Management Strategies. Brain Sci 2023; 13:1658. [PMID: 38137106 PMCID: PMC10741770 DOI: 10.3390/brainsci13121658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
Chiari Malformation and Syringomyelia are neurosurgical entities that have been the subject of extensive research and clinical interest. Globally prevalent, these disorders vary demographically and have witnessed evolving temporal trends. Chiari Malformation impacts the normal cerebrospinal fluid flow, consequently affecting overall health. Key observations from canine studies offer pivotal insights into the pathogenesis of Syringomyelia and its extrapolation to human manifestations. Genetics plays a pivotal role; contemporary knowledge identifies specific genes, illuminating avenues for future exploration. Clinically, these disorders present distinct phenotypes. Diagnostically, while traditional methods have stood the test of time, innovative neurophysiological techniques are revolutionizing early detection and management. Neuroradiology, a cornerstone in diagnosis, follows defined criteria. Advanced imaging techniques are amplifying diagnostic precision. In therapeutic realms, surgery remains primary. For Chiari 1 Malformation, surgical outcomes vary based on the presence of Syringomyelia. Isolated Syringomyelia demands a unique surgical approach, the effectiveness of which is continually being optimized. Post-operative long-term prognosis and quality of life measures are crucial in assessing intervention success. In conclusion, this review amalgamates existing knowledge, paving the way for future research and enhanced clinical strategies in the management of Chiari Malformation and Syringomyelia.
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Affiliation(s)
- Corneliu Toader
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania
| | - Horia Ples
- Department of Neurosurgery, Centre for Cognitive Research in Neuropsychiatric Pathology 6 (NeuroPsy-Cog), 300736 Timișoara, Romania
- Department of Neurosurgery, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
| | - Horia Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
| | - Luca Andrei Glavan
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
- Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania
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4
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Bateman GA, Bateman AR. Syringomyelia Is Associated with a Reduction in Spinal Canal Compliance, Venous Outflow Dilatation and Glymphatic Fluid Obstruction. J Clin Med 2023; 12:6646. [PMID: 37892782 PMCID: PMC10607592 DOI: 10.3390/jcm12206646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
The cause of the cystic dilatation of the cord found in syringomyelia has been a source of conjecture for a considerable time. Recent studies have shown that there is a reduction in craniospinal compliance in both childhood hydrocephalus and multiple sclerosis which leads to venous outflow dilatation. Both diseases are associated with glymphatic outflow obstruction. Venous dilatation will narrow the perivenous glymphatic outflow pathway and lead to an increase in glymphatic outflow resistance. Syringomyelia has been shown to be associated with reduced spinal canal compliance. This paper discusses the possibility that venous dilatation and obstructed glymphatic outflow within the cord may be behind the cystic dilatation found within syringomyelia.
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Affiliation(s)
- Grant Alexander Bateman
- Department of Medical Imaging, John Hunter Hospital, Newcastle, NSW 2305, Australia
- Faculty of Health, Callaghan Campus, University of Newcastle, Newcastle, NSW 2308, Australia
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Baassiri W, Bani-Sadr A, Capo G, Brinzeu A, Barrey CY. Three-Dimensional Volumetric Magnetic Resonance Imaging Analysis of Syringomyelia Evolution After Posterior Fossa Decompression for Chiari Malformation Type1. World Neurosurg 2023; 178:e566-e577. [PMID: 37532020 DOI: 10.1016/j.wneu.2023.07.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE This study aims to introduce a method of three-dimensional (3D) volume magnetic resonance imaging (MRI) measurements to evaluate the evolution of syringomyelia (SM) in adults with Chiari malformation type 1 (CM-1) after posterior fossa decompression (PFD), to provide reproducible and accurate measurements. METHODS Radiologic and clinical data were obtained for 28 patients. MRI 3D syrinx volumes were evaluated by 2 observers using Philips Healthcare Tumor Tracking tool. RESULTS The mean SM preoperative volume was 9.1 ± 15.3 cm3 versus 4.6 ± 8.7 cm3 postoperatively, corresponding to a volume variation reduced by -50% ± 33.4%. A total of 21 patients (75%) showed >25% reduction in SM volume postoperatively and 25 patients (89.2%) showed good to excellent postoperative clinical outcomes. Very high interobserver and intraobserver agreement was noted for 3D volumetric analysis with Cohen weighted κ coefficients (0.899-0.991). A negative correlation was found between the number of involved metameres and the postoperative SM volume reduction (Pearson correlation coefficient = 0.378; P = 0.047). Patients with better clinical outcomes had fewer syrinx septae (F = 8.830; P = 0.001). Similarly, better syrinx volume reduction was associated with fewer septae (F = 1.554; P = 0.233). A positive relationship was observed between clinical outcomes and postoperative syrinx volume reduction (F = 1.554; P= 0.233), with data similar to the reported literature. CONCLUSIONS This study shows that 3D volume measurement of the syrinx cavity on MRI is a reproducible and accurate method to assess the postoperative evolution of SM in CM-1 after PFD. Most patients (75%) showed a reduction of SM volume, with a mean volume decrease of 50%. The reliability is yet to be validated in further larger studies.
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Affiliation(s)
- Wassim Baassiri
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France.
| | - Alexandre Bani-Sadr
- Department of Neuroradiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France
| | - Gabriele Capo
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrei Brinzeu
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France; Department of Neurosciences, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Cédric Yves Barrey
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France; Laboratory of Biomechanics, École nationale supérieure d'Arts et Métiers, Arts et Metiers ParisTech, Paris, France
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Wu J, Ji S, Niu P, Zhang B, Shao D, Li Y, Xie S, Jiang Z. Knowledge mapping of syringomyelia from 2003 to 2022: A bibliometric analysis. J Clin Neurosci 2023; 110:63-70. [PMID: 36822071 DOI: 10.1016/j.jocn.2023.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/26/2022] [Accepted: 01/04/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Syringomyelia is a chronic, progressive disease of the spinal cord. Syringomyelia is an etiologically diverse affliction caused by disturbance of normal cerebrospinal fluid flow dynamics. Lesions are characterized by the formation of tubular cavities in the gray matter of the spinal cord and gliosis; however, the etiology is unknown and treatment methods differ. Many existing studies have focused on the relationship between other diseases and syringomyelia. There is a lack of comprehensive and objective reports on the research status of syringomyelia. Therefore, this study aimed to conduct a bibliometric analysis to quantify studies on Syringomyelia and trending issues in the last 20 years. METHODS Articles were acquired from the Web of Science Core Collection database. We used the Library Metrology online analysis platform, BICOMB, gCLUTO, CiteSpace bibliometrics tools for analysis, VOSviewer 1.6.16 (Nees Jan van Eck and Ludo Waltman, 2010), and Microsoft Excel 2019 to perform bibliometric analysis and visualization. Individual impact and collaborative information were quantified by analyzing annual publications, journals, co-cited journals, countries/regions, institutions, authors, and co-cited authors. We then identified the trending research areas of syringomyelia by analyzing the co-occurrence of keywords and co-cited references. RESULTS From January 2003 to August 2022, 9,556 authors from 66 countries published a total of 1,902 research articles on syringomyelia in 518 academic journals. Most publications come from the United States, China, the United Kingdom, and Japan, with the United States dominating. Nanjing University and the University of Washington are the most active institutions, Dr. Claire Rusbridge has published the most papers, and Miholat has the most co-citations. The Journal of Neurosurgery has the highest number of co-cited articles, which are mainly in the fields of neurology, surgery, and biology. High-frequency keywords included syringomyelia, Chiari-I malformation, children, surgical treatment, and spinal cord. CONCLUSIONS The number of articles on syringomyelia has increased steadily over the past two decades. At present, research on syringomyelia is mainly focused on the age of onset, potential therapeutic interventions, surgical treatment, avoidance of recurrence, and delay of pain. The use of surgical treatment of the disease and the mechanism of further treatment are the current hot research topics. The correlation between trauma and congenital factors, translational application, the effect of surgical treatment, postoperative recurrence, and complications are further hot research areas. These may provide ideas for further research into a radical cure for syringomyelia.
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Affiliation(s)
- Junyong Wu
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Shuxin Ji
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Pengyuan Niu
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Binbin Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Dongqi Shao
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yu Li
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Shan Xie
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Zhiquan Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.
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Avesani G, Perazzolo A, Elia L, Anghelone AG, Gaudino S, Russo L, Genco E, Di Paola V, Massimi L, De Santis M, Tamburrini G, Manfredi R. Fetal MRI prior to intrauterine surgery of open neural tube defects: What does the radiologist need to know. LA RADIOLOGIA MEDICA 2023; 128:113-124. [PMID: 36525177 DOI: 10.1007/s11547-022-01579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
The management of myelomeningocele study trial showed significant prognostic improvement in fetal repair before 26 weeks of gestation. Hence, surgery in utero represents the best treatment option for open-neural tube defects (NTDs). Fetal surgery of open-NTDs has specific inclusion and exclusion criteria, which can be adequately studied with fetal MRI. The main concern: the spine (spinal defects other than Myelomeningocele and Myeloschisis, the level of the lesion higher than T1 or lower than S1 and the degree of kyphosis ≥ 30°), the skull/brain (no cerebellum herniation and Chiari II malformation and the presence of any intracranial abnormality unrelated to open NTDs), the uterus (cervix length less than 2 cm, multiple gestations and placental and uterine abnormalities) and any other fetal abnormality not attributed to spinal defect. In this review, we describe the fundamental role of fetal MRI in supporting therapeutic decisions in pre-surgery intrauterine planning through the accurate and comprehensive description of findings, providing a proposal of a structured report. In addition, we describe how post-surgical MRI is important in investigating the effectiveness of surgery and detecting repairing complications.
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Affiliation(s)
- Giacomo Avesani
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | - Lorenzo Elia
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Simona Gaudino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Russo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Enza Genco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Valerio Di Paola
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Luca Massimi
- Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Marco De Santis
- Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Gianpiero Tamburrini
- Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Soleman J, Roth J, Constantini S. Chiari Type 1 Malformation and Syringomyelia in Children: Classification and Treatment Options. Adv Tech Stand Neurosurg 2023; 48:73-107. [PMID: 37770682 DOI: 10.1007/978-3-031-36785-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Chiari type 1 malformation (CIM) is defined as tonsillar ectopia of >5 mm, while syringomyelia (SM) is defined as a cerebrospinal fluid (CSF)-filled cavity larger than 3 mm dissecting the spinal cord. Over the last decades, our understanding of these pathologies has grown; however, many controversies still exist almost in every aspect of CIM and SM, including etiology, indication for treatment, timing of treatment, surgical technique, follow-up regime, and outcome. This chapter provides a comprehensive overview on different aspects of CIM and SM and on the still existing controversies, based on the evidence presently available. Future directions for clinical research concerning CIM and SM treatment and outcome are elaborated and discussed as well.
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Affiliation(s)
- Jehuda Soleman
- Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Children's University Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jonathan Roth
- Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.
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How Hong EA, Shalid A, Deepak S, Kounin G. Posterior Cranial Fossa Meningioma Causing Tonsillar Herniation and Giant Cervicothoracic Syringomyelia: Case Report and Review of Literature. Asian J Neurosurg 2022; 17:515-520. [PMCID: PMC9665991 DOI: 10.1055/s-0042-1756634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Syringomyelia is a fluid-filled cyst within the spinal cord and is usually associated with conditions that obstruct the cerebrospinal fluid (CSF) (flow at the foramen magnum or spinal levels such as Chiari malformations, arachnoiditis, and basilar invaginations). Very rarely, posterior cranial fossa tumors can lead to tonsillar herniation and secondary syringomyelia. There are only nine reported cases in the literature. We report a rare case of a 56-year-old female with posterior cranial meningioma and secondary syringomyelia, admitted with headache, nausea, vomiting, and ataxic gait. Magnetic resonance imaging (MRI) demonstrated a large posterior fossa lesion causing early ventriculomegaly and a giant cervicothoracic syrinx within the upper spinal cord extending from the hindbrain inferiorly to the level of T8. She underwent a posterior fossa craniectomy with left C1 hemilaminectomy and complete excision of the tumor. In 6 months following her procedure, an MRI scan showed a significant reduction in the caliber of the syringomyelia throughout its length, and there was a significant improvement in symptoms. Although the pathophysiology of syrinx formation is still poorly understood, the alteration of CSF dynamic flow has been implicated. A common unifying cause appears to be increased transcranial difference in intracranial pressure across the foramen magnum causing tonsillar herniation, irrespective of location in the posterior fossa. With high syrinx pressure, mechanical stress-induced structural change of the spinal cord occurs, allowing the persistence and progression of the syrinx in the spinal cord. Syringomyelia appears to be resolved partially or completely after craniotomy and excision of the posterior fossa lesion.
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Affiliation(s)
- Estelle Anne How Hong
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, United Kingdom,Address for correspondence Estelle Anne How Hong, MBCHB, MRCS ENT Department of Neurosurgery, Hull University Teaching HospitalsAnlaby Road, Hull, HU3 2JZUnited Kingdom
| | - Ahmed Shalid
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Srihari Deepak
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Gueorgui Kounin
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, United Kingdom
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Yilmaz TF, Toprak H, Sari L, Oz II, Kitis S, Kaya A, Alkan A. Chiari Type 1 malformation: CSF flow dynamics and morphology in the posterior fossa and craniocervical junction and correlation of these findings with syrinx formation. Neurochirurgie 2022; 68:595-600. [PMID: 35752467 DOI: 10.1016/j.neuchi.2022.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Chiari type 1 malformation (CMI) is a disorder in which cerebellar tonsils descend below the foramen magnum. Although syringomyelia associated with CMI thought to be caused by hypoplastic posterior fossa and stenosis at the craniocervical junction; it has characteristic neurological and radiological features and the exact mechanism of syringomyelia remains unknown. PURPOSE The purposes of this study were to gain insight into morphological changes in posterior fossa and to find whether there is a difference in aqueductal stroke volume (ASV) between CMI with syrinx and without syrinx which may be an underlying mechanism of syrinx development. MATERIALS AND METHODS We consecutively evaluated 85 patients with Chiari malformation between January 2017 and December 2019 who had undergone phase-contrast MRI examination for CSF flow and between 18-60-years-old. We divided patients into two groups as subjects with syrinx (n=19) and without syrinx (n=66). After evaluating morphological changes, peak and average velocity (cm/s), forward and reverse flow volume (μl), net forward flow volume (μl), ASV (aqueductal stroke volume) (μl), aqueductus Sylvi (AS) area (mm2), and prepontine cistern diameter to AS diameter ratio (PPC/AS) were calculated. Distribution of variables from two groups was evaluated by using Shapiro-Wilk normality test. Independent t test was used for groups comparison. RESULTS The forward and reverse volumes were statistically significantly higher in patients with syrinx (P=0.021, P=0.005 respectively). ASV was significantly increased in patients with syringomyelia (P=0.014). The PPC/AS was significantly lower in patients with syrinx compared to those without (P <0.001). AS area was significantly larger in those with syrinx. (P=0.022). The diameter of foramen magnum was significantly lower in patients with syrinx than those without (P <0.0001). The diameter of the herniated tonsilla at the foramen magnum level was found to be significantly lower in those with syrinx (P=0.011). CONCLUSION Foramen magnum diameter, ASV, diameter of herniated tonsil, and PPC/AS ratio are important factors in syrinx development.
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Affiliation(s)
- T F Yilmaz
- Departments of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - H Toprak
- Departments of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - L Sari
- Departments of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
| | - I I Oz
- Departments of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - S Kitis
- Department of Neurosurgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - A Kaya
- Departments of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - A Alkan
- Departments of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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11
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Nagaraj UD, Venkatesan C, Bierbrauer KS, Kline-Fath BM. Value of pre- and postnatal magnetic resonance imaging in the evaluation of congenital central nervous system anomalies. Pediatr Radiol 2022; 52:802-816. [PMID: 34232351 DOI: 10.1007/s00247-021-05137-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022]
Abstract
Fetal MRI and neonatal MRI of the central nervous system (CNS) are complementary tools that can help to accurately counsel and direct the management of children with anomalies of the central nervous system. Postnatal MRI can add to fetal MRI by allowing for monitoring of changes in the severity of disease, better delineation of a suspected prenatal anomaly, evaluation for secondary pathologies related to the primary diagnosis, and surgical management direction. In this review we discuss the roles of fetal and neonatal MRI in the diagnosis and treatment of congenital anomalies of the CNS through a series of case examples and how both are important in patient management.
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Affiliation(s)
- Usha D Nagaraj
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. .,University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Charu Venkatesan
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karin S Bierbrauer
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beth M Kline-Fath
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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12
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Sinha A, Vankipuram S, Ellenbogen J. Management of Chiari 1 malformation and hydrocephalus in syndromic craniosynostosis: A review. J Pediatr Neurosci 2022; 17:S67-S76. [PMID: 36388008 PMCID: PMC9648655 DOI: 10.4103/jpn.jpn_49_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/16/2022] [Accepted: 04/07/2022] [Indexed: 11/26/2022] Open
Abstract
Chiari 1 malformation and hydrocephalus are frequent findings in multi-suture and syndromic craniosynostosis patients. In this article, we review the pathogenesis, clinical significance, and management options for these conditions with comments from our own experience. The role of premature fusion of skull base sutures leading to a crowded posterior fossa and venous outflow obstruction resulting in impaired cerebrospinal fluid (CSF) absorption is highlighted. Management options are unique in this group and we advocate early (prior to 6 months of age) posterior vault expansion by distraction osteogenesis (DO) in the management of Chiari 1 malformation. Foramen magnum decompression is recommended for a select few either as part of posterior vault expansion or at a later date. Treatment of hydrocephalus, utilizing a ventriculoperitoneal (VP) shunt with preferably a programmable high-pressure valve and anti-siphon device, is required in a small percentage of cases despite successful posterior vault expansion. Patients need to be carefully selected and managed as hydrocephalus often serves as an important cranial vault growth stimulus. Further, they require careful monitoring and thought to ensure the management of these conditions and the timing of any intervention provides the optimal long-term outcome for the patient.
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13
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Egu CB, Kumaria A, Paterson A, Robertson I. Delayed presentation of syringomyelia after retrosigmoid craniectomy and resection of vestibular schwannoma: discussion of mechanisms. BMJ Case Rep 2021; 14:e246714. [PMID: 34969805 PMCID: PMC8719159 DOI: 10.1136/bcr-2021-246714] [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] [Accepted: 11/25/2021] [Indexed: 11/04/2022] Open
Abstract
We present a case of syringomyelia following retrosigmoid craniectomy and resection of vestibular schwannoma complicated by Cerebrospinal fluid (CSF) leak, multiple infections and CSF diversion procedures. We believe this is the first reported case of syrinx formation after this type of surgery. Potential mechanisms by which the syrinx may have developed are discussed.
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Affiliation(s)
| | - Ashwin Kumaria
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
| | | | - Iain Robertson
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
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14
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Pukale DD, Farrag M, Leipzig ND. Detection of locomotion deficit in a post-traumatic syringomyelia rat model using automated gait analysis technique. PLoS One 2021; 16:e0252559. [PMID: 34762669 PMCID: PMC8584658 DOI: 10.1371/journal.pone.0252559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/24/2021] [Indexed: 11/24/2022] Open
Abstract
Syringomyelia (SM) is a spinal cord disorder in which a cyst (syrinx) filled with fluid forms in the spinal cord post-injury/disease, in patients syrinx symptoms include loss of pain and temperature sensation or locomotion deficit. Currently, there are no small animal models and connected tools to help study the functional impacts of SM. The objective of this study was to determine the detectability of subtle locomotion deficits due to syrinx formation/expansion in post-traumatic syringomyelia (PTSM) rat model using the recently reported method of Gait Analysis Instrumentation, and Technology Optimized for Rodents (GAITOR) with Automated Gait Analysis Through Hues and Areas (AGATHA) technique. First videos of the rats were collected while walking in an arena (using GAITOR) followed by extracting meaningful locomotion information from collected videos using AGATHA protocol. PTSM injured rats demonstrated detectable locomotion deficits in terms of duty factor imbalance, paw placement accuracy, step contact width, stride length, and phase dispersion parameters compared to uninjured rats due to SM. We concluded that this technique could detect mild and subtle locomotion deficits associated with PTSM injury, which also in future work could be used further to monitor locomotion responses after different treatment strategies for SM.
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Affiliation(s)
- Dipak D. Pukale
- Department of Chemical, Biomolecular, and Corrosion Engineering, University of Akron, Akron, Ohio, United States of America
| | - Mahmoud Farrag
- Integrated Bioscience Program, University of Akron, Akron, Ohio, United States of America
| | - Nic D. Leipzig
- Department of Chemical, Biomolecular, and Corrosion Engineering, University of Akron, Akron, Ohio, United States of America
- Integrated Bioscience Program, University of Akron, Akron, Ohio, United States of America
- * E-mail:
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15
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Slosh Simulation in a Computer Model of Canine Syringomyelia. Life (Basel) 2021; 11:life11101083. [PMID: 34685454 PMCID: PMC8541149 DOI: 10.3390/life11101083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 11/16/2022] Open
Abstract
The exact pathogenesis of syringomyelia is unknown. Epidural venous distention during raised intrathoracic pressure (Valsalva) may cause impulsive movement of fluid ("slosh") within the syrinx. Such a slosh mechanism is a proposed cause of syrinx dissection into spinal cord parenchyma resulting in craniocaudal propagation of the cavity. We sought to test the "slosh" hypothesis by epidural excitation of CSF pulse in a computer model of canine syringomyelia. Our previously developed canine syringomyelia computer model was modified to include an epidural pressure pulse. Simulations were run for: cord free of cavities; cord with small syringes at different locations; and cord with a syrinx that was progressively expanding caudally. If small syringes are present, there are peaks of stress at those locations. This effect is most pronounced at the locations at which syringes initially form. When a syrinx is expanding caudally, the peak stress is typically at the caudal end of the syrinx. However, when the syrinx reaches the lumbar region; the stress becomes moderate. The findings support the "slosh" hypothesis, suggesting that small cervical syringes may propagate caudally. However, when the syrinx is large, there is less focal stress, which may explain why a syrinx can rapidly expand but then remain unchanged in shape over years.
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16
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Gallo E, Rahmathulla G, Rao D, Tavanaiepour K, Tavanaiepour D. Spontaneous syrinx resolution in patient with Chiari I malformation: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE21236. [PMID: 35854904 PMCID: PMC9245757 DOI: 10.3171/case21236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUIND Chiari malformations include a spectrum of congenital hindbrain herniation syndromes. In patients with the most common subtype, Chiari malformation Type I, 50% to 75% develop a syrinx. The pathogenesis of syringomyelia is not well understood, with multiple theories outlined in the literature. Although the presence of a syrinx in a patient with Chiari malformation is generally accepted as an indication for surgical intervention, there are documented cases of spontaneous resolution that support a more conservative approach to management. OBSERVATIONS The authors reported a case of spontaneous resolution of a cervical syrinx in an adult with an unchanged Chiari malformation. LESSONS Given the possibility of spontaneous resolution over time, the authors believe a more conservative approach of observation with periodic surveillance, magnetic resonance imaging, and neurological examination should be considered in the management of a patient with a Chiari malformation and associated syringomyelia.
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Affiliation(s)
| | | | - Dinesh Rao
- Division of Neuroradiology, University of Florida, College of Medicine, Jacksonville, Florida
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17
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Yang MJ, Arkun K, Kryzanski JT. C1-2 cyst presenting with syringobulbia: a case report. J Surg Case Rep 2021; 2021:rjab097. [PMID: 33854761 PMCID: PMC8024048 DOI: 10.1093/jscr/rjab097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
Extradural atlantoaxial cysts are typically related to C1-2 degeneration. Intradural cysts may cause secondary syringobulbia depending on the size and cerebrospinal fluid flow obstruction. However, medullary syrinxes have not been previously described with extradural cysts. Treatment of symptomatic lesions involves surgical resection, often via a far-lateral approach, with consideration of fusion if C1-2 instability is present. We present a case of an extradural C1-2 cyst with intradural extension causing syringobulbia. Effective surgical resection was accomplished via a far-lateral, partial transcondylar approach without fusion. It is important to recognize that cysts of extradural origin may exhibit intradural extension and compress critical neurovascular structures.
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Affiliation(s)
- Michael J Yang
- Department of Neurosurgery, Tufts Medical Center, Boston, MA 02111, USA
| | - Knarik Arkun
- Department of Neurosurgery, Tufts Medical Center, Boston, MA 02111, USA
| | - James T Kryzanski
- Department of Neurosurgery, Tufts Medical Center, Boston, MA 02111, USA
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18
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Kwiecien JM, Dąbrowski W, Yaron JR, Zhang L, Delaney KH, Lucas AR. The Role of Astrogliosis in Formation of the Syrinx in Spinal Cord Injury. Curr Neuropharmacol 2021; 19:294-303. [PMID: 32691715 PMCID: PMC8033977 DOI: 10.2174/1570159x18666200720225222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/09/2020] [Accepted: 07/16/2020] [Indexed: 12/28/2022] Open
Abstract
A massive localized trauma to the spinal cord results in complex pathologic events driven by necrosis and vascular damage which in turn leads to hemorrhage and edema. Severe, destructive and very protracted inflammatory response is characterized by infiltration by phagocytic macrophages of a site of injury which is converted into a cavity of injury (COI) surrounded by astroglial reaction mounted by the spinal cord. The tissue response to the spinal cord injury (SCI) has been poorly understood but the final outcome appears to be a mature syrinx filled with the cerebrospinal fluid with related neural tissue loss and permanent neurologic deficits. This paper reviews known pathologic mechanisms involved in the formation of the COI after SCI and discusses the integrative role of reactive astrogliosis in mechanisms involved in the removal of edema after the injury. A large proportion of edema fluid originating from the trauma and then from vasogenic edema related to persistent severe inflammation, may be moved into the COI in an active process involving astrogliosis and specifically over-expressed aquaporins.
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Affiliation(s)
- Jacek M. Kwiecien
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Wojciech Dąbrowski
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, ul. Jaczewskiego 8, Lublin 20-090 Poland
| | - Jordan R Yaron
- Center for Personalized Diagnostics and Center for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, U.S.A
| | - Liqiang Zhang
- Center for Personalized Diagnostics and Center for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, U.S.A
| | - Kathleen H. Delaney
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Alexandra R. Lucas
- Center for Personalized Diagnostics and Center for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, U.S.A
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19
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Ishisaka E, Usami K, Ogiwara H. Surgical outcomes by sectioning a filum terminale in patients with terminal syringomyelia. Childs Nerv Syst 2020; 36:3035-3039. [PMID: 32318892 DOI: 10.1007/s00381-020-04615-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although terminal syringomyelia suggests a tethered spinal cord, a consensus has still not been established for surgical indications, when there are no associated abnormalities or only minor associated abnormalities. We analyzed surgical outcomes of sectioning a filum terminale in patients with terminal syringomyelia to elucidate the significance of untethering surgery. METHODS Fifty-seven pediatric patients with terminal syringomyelia who underwent untethering via sectioning the filum terminale between 2007 and 2018 were retrospectively analyzed. Postoperative outcomes of symptoms and MRI findings were evaluated. RESULTS Of 57 patients, 40 had other associated abnormalities (25 with filar lipoma and 29 with low conus medullaris) that could be responsible for tethered cord. Nineteen patients had symptoms. The mean age at the time of surgery was 18 months (3-96 months). The mean follow-up period was 3.3 years (1-9 years). Preoperative symptoms improved in 9 patients (47%) after surgery. At 1 year after the surgery, the size of syringomyelia decreased in 19 (33%), increased in 4 (8%), and did not change in 34 (69%) patients. Of 28 patients who were followed up for more than 3 years, the size decreased in 17 (61%), increased in 1 (4%), and did not change in 10 (35%). CONCLUSION When untethering was performed by sectioning a filum terminale, the size of terminal syringomyelia decreased in more than half of patients in the long term. Sectioning the filum terminale demonstrated the possibility of radiological and clinical improvement in patients with terminal syringomyelia.
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Affiliation(s)
- Eitaro Ishisaka
- Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kenichi Usami
- Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Hideki Ogiwara
- Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan.
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20
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Imaging of open spinal dysraphisms in the era of prenatal surgery. Pediatr Radiol 2020; 50:1988-1998. [PMID: 33252764 DOI: 10.1007/s00247-020-04734-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/15/2020] [Accepted: 05/20/2020] [Indexed: 01/24/2023]
Abstract
Over the last decade fetal surgery to repair open spinal dysraphisms has become an acceptable and in some cases desirable alternative to the traditional method of postnatal closure. Fetal MRI is an essential part of the workup in these patients, not only to select the appropriate candidates for fetal surgery but also to guide prenatal counseling and perinatal management. In this article we review current surgical techniques for prenatal repair, relevant imaging findings in the era of fetal surgery, and expected imaging findings of the brain and spine in the fetal and postnatal periods.
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21
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Leclerc A, Matveeff L, Emery E. Syringomyelia and hydromyelia: Current understanding and neurosurgical management. Rev Neurol (Paris) 2020; 177:498-507. [PMID: 32826067 DOI: 10.1016/j.neurol.2020.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
Syringomyelia is a rare disorder in which a fluid-filled cyst forms within the spinal cord, resulting in myelopathy. Meanwhile, the abnormal dilatation of the central canal is referred to as hydromyelia or slit-like syrinx. The most prevailing classification is based on anatomical features and pathogeny rather than pathophysiological mechanisms. It is usual to distinguish foraminal syringomyelia related mainly to abnormalities at the craniocervical junction, non-foraminal syringomyelia dealing with any cause of arachnoiditis (infection, inflammation, trauma…) and more rarely syringomyelia associated with intramedullary tumors. Although many pathophysiological theories have been argued over time, the prevailing one is that disturbances in cerebrospinal fluid (CSF) flow in the sub-arachnoid spaces disrupt flow velocity leading to the syrinx. Symptoms of paralysis, sensory loss and chronic pain commonly develop during the third/fourth decades of life. The natural history of syringomyelia is typically one of gradual, stepwise neurological deterioration extending over many years. Diagnosis is based on magnetic resonance imaging (MRI) including excellent morphological sequences (T1-, T2-, FLAIR-, T2*-, enhanced T1-) and dynamic MRI with careful study of CSF velocity (CISS, cine-MR sequences). Surgical management is at first dedicated to treat the cause of the syringomyelia, mainly to re-establish a physiological CSF pathway in the subarachnoid spaces. Mostly, the surgical goal is to enlarge the craniocervical junction with duraplasty. Other surgical strategies such as arachnoidolysis or shunt procedures are performed based on the pathogenic mechanisms or as second-line treatment. Medical treatments are also necessary as chronic pain is the main long-lasting symptom. As evolutive syringomyelia is a severe disease with a high impact on quality of life, it is recommended to treat without delay. There is no evidence for surgery for incidental asymptomatic syringomyelia or hydromyelia. Finally, syringomyelia associated with intramedullary tumors resolves spontaneously after tumor resection. Syringomyelia is a rare disease, which requires a dedicated multidisciplinary approach, emphasizing the need for a nationwide scientific organization so as to offer optimal care to the patient.
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Affiliation(s)
- A Leclerc
- CHU Caen, Department of Neurosurgery, Avenue de la Côte-de-Nacre, 14000 Caen, France; Université Caen Normandie, Medical School, 14000 Caen, France
| | - L Matveeff
- CHU Caen, Department of Neurosurgery, Avenue de la Côte-de-Nacre, 14000 Caen, France; Université Caen Normandie, Medical School, 14000 Caen, France
| | - E Emery
- CHU Caen, Department of Neurosurgery, Avenue de la Côte-de-Nacre, 14000 Caen, France; Université Caen Normandie, Medical School, 14000 Caen, France; INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, 14000 Caen, France.
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22
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Middlebrooks EH, Okromelidze L, Vilanilam GK, Gopal N, Luetmer PH, Gupta V. Syrinx Secondary to Chiari-like Tonsillar Herniation in Spontaneous Intracranial Hypotension. World Neurosurg 2020; 143:e268-e274. [PMID: 32711143 DOI: 10.1016/j.wneu.2020.07.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Syrinx development in patients with spontaneous intracranial hypotension (SIH) has rarely been described. To better understand this entity, we compared the clinical and radiographic findings in a series of patients with SIH and acquired Chiari-like tonsillar herniation with and without syrinx formation. METHODS Six patients with syrinx in the setting of SIH and Chiari-like tonsillar herniation were retrospectively identified. The clinical and radiographic findings and outcomes were compared with those from a control group of patients with SIH and Chiari-like tonsillar herniation without syrinx. RESULTS The patients with SIH and syrinx had had a higher opening pressure than had the control group (mean, 14.0 cm H2O vs. 7.4 cm H2O; P = 0.02) and a higher body mass index (mean, 33 kg/m2 vs. 26 kg/m2; P = 0.01). The patients with syrinx had had an average obex displacement of 3.7 ± 2.2 mm below the plane of the foramen magnum compared with a position of 1.9 ± 3.1 mm above the plane of the foramen magnum in the control group (P = 0.004). The mean tonsillar descent was 12.7 ± 4.7 mm below the foramen magnum in those with syrinx compared with 5.9 ± 2.5 in the control group (P = 0.009). The clinical symptoms had improved in 83.3% of the patients with syrinx and 75% of the control patients after spinal cerebrospinal fluid leak closure. Three patients (50%) also had radiographic syrinx reduction. CONCLUSION Our results have shown that SIH can be an underrecognized cause of syrinx with key differences in body habitus and obex displacement compared with SIH without syrinx. In patients with tonsillar herniation into the foramen magnum associated with syrinx, the presence of SIH should be considered to avoid unnecessary foramen magnum decompression, even in those with a normal opening pressure.
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Affiliation(s)
| | - Lela Okromelidze
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Neethu Gopal
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Vivek Gupta
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA.
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23
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Kwiecien JM, Dabrowski W, Dąbrowska-Bouta B, Sulkowski G, Oakden W, Kwiecien-Delaney CJ, Yaron JR, Zhang L, Schutz L, Marzec-Kotarska B, Stanisz GJ, Karis JP, Struzynska L, Lucas AR. Prolonged inflammation leads to ongoing damage after spinal cord injury. PLoS One 2020; 15:e0226584. [PMID: 32191733 PMCID: PMC7081990 DOI: 10.1371/journal.pone.0226584] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/28/2020] [Indexed: 12/27/2022] Open
Abstract
The pathogenesis of spinal cord injury (SCI) remains poorly understood and treatment remains limited. Emerging evidence indicates that post-SCI inflammation is severe but the role of reactive astrogliosis not well understood given its implication in ongoing inflammation as damaging or neuroprotective. We have completed an extensive systematic study with MRI, histopathology, proteomics and ELISA analyses designed to further define the severe protracted and damaging inflammation after SCI in a rat model. We have identified 3 distinct phases of SCI: acute (first 2 days), inflammatory (starting day 3) and resolution (>3 months) in 16 weeks follow up. Actively phagocytizing, CD68+/CD163- macrophages infiltrate myelin-rich necrotic areas converting them into cavities of injury (COI) when deep in the spinal cord. Alternatively, superficial SCI areas are infiltrated by granulomatous tissue, or arachnoiditis where glial cells are obliterated. In the COI, CD68+/CD163- macrophage numbers reach a maximum in the first 4 weeks and then decline. Myelin phagocytosis is present at 16 weeks indicating ongoing inflammatory damage. The COI and arachnoiditis are defined by a wall of progressively hypertrophied astrocytes. MR imaging indicates persistent spinal cord edema that is linked to the severity of inflammation. Microhemorrhages in the spinal cord around the lesion are eliminated, presumably by reactive astrocytes within the first week post-injury. Acutely increased levels of TNF-alpha, IL-1beta, IFN-gamma and other pro-inflammatory cytokines, chemokines and proteases decrease and anti-inflammatory cytokines increase in later phases. In this study we elucidated a number of fundamental mechanisms in pathogenesis of SCI and have demonstrated a close association between progressive astrogliosis and reduction in the severity of inflammation.
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Affiliation(s)
- Jacek M. Kwiecien
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Wojciech Dabrowski
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Beata Dąbrowska-Bouta
- Laboratory of Pathoneurochemistry, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
| | - Grzegorz Sulkowski
- Laboratory of Pathoneurochemistry, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
| | - Wendy Oakden
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Jordan R. Yaron
- Centers for Personalized Diagnostics and Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
| | - Liqiang Zhang
- Centers for Personalized Diagnostics and Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
| | - Lauren Schutz
- Centers for Personalized Diagnostics and Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
| | | | - Greg J. Stanisz
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - John P. Karis
- Department of Neuroradiology, Barrow Neurological Institute, Dignity Health St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, United States of America
| | - Lidia Struzynska
- Laboratory of Pathoneurochemistry, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
| | - Alexandra R. Lucas
- Centers for Personalized Diagnostics and Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
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24
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Massimi L, Pennisi G, Frassanito P, Tamburrini G, Di Rocco C, Caldarelli M. Chiari type I and hydrocephalus. Childs Nerv Syst 2019; 35:1701-1709. [PMID: 31227858 DOI: 10.1007/s00381-019-04245-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/30/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The association between Chiari type I malformation (CIM) and hydrocephalus raises a great interest because of the still unclear pathogenesis and the management implications. The goal of this paper is to review the theories on the cause-effect mechanisms of such a relationship and to analyze the results of the management of this condition. METHODS A review of the literature has been performed, focusing on the articles specifically addressing the problem of CIM and hydrocephalus and on the series reporting about its treatment. Also, the personal authors' experience is briefly discussed. RESULTS As far as the pathogenesis is concerned, it seems clear that raised intracranial pressure due to hydrocephalus can cause a transient and reversible tonsillar caudal ectopia ("pressure from above" hypothesis), which is something different from CIM. A "complex" hypothesis, on the other hand, can explain the occurrence of hydrocephalus and CIM because of the venous engorgement resulting from the hypoplasia of the posterior cranial fossa (PCF) and the occlusion of the jugular foramina, leading to cerebellar edema (CIM) and CSF hypo-resorption (hydrocephalus). Nevertheless, such a mechanism can be advocated only in a minority of cases (syndromic craniosynostosis). In non-syndromic CIM subjects, the presence of hydrocephalus could be explained by an occlusion of the basal CSF pathways, which would occur completely in a minority of cases (only 7-10% of CIM patients show hydrocephalus) while it would be partial in the remaining cases (no hydrocephalus). This hypothesis still needs to be demonstrated. As far as the management is concerned, the strategy to treat the hydrocephalus first is commonly accepted. Because of the "obstructive" origin of CIM-related hydrocephalus, the use of endoscopic third ventriculostomy (ETV) is straightforward. Actually, the analysis of the literature, concerning 63 cases reported so far, reveals very high success rates of ETV in treating hydrocephalus (90.5%), CIM (78.5%), and syringomyelia symptoms (76%) as well as in giving a radiological improvement of both CIM (74%) and syringomyelia (89%). The failures of ETV were not attributable to CIM or syringomyelia. Only 11% of cases required PCF decompression after ETV. CONCLUSIONS The association between CIM and hydrocephalus probably results from different, multifactorial, and not yet completely understood mechanisms, which place the affected patients in a peculiar subgroup among those constituting the heterogeneous CIM population. ETV is confirmed as the best first approach for this subset of patients.
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Affiliation(s)
- Luca Massimi
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Roma, Italy.
- Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Roma, Italy.
- International Neuroscience Institute, Hannover, Germany.
| | - Giovanni Pennisi
- Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Paolo Frassanito
- Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gianpiero Tamburrini
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Roma, Italy
- Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Massimo Caldarelli
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Roma, Italy
- Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
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Coll G, El Ouadih Y, Abed Rabbo F, Jecko V, Sakka L, Di Rocco F. Hydrocephalus and Chiari malformation pathophysiology in FGFR2-related faciocraniosynostosis: A review. Neurochirurgie 2019; 65:264-268. [PMID: 31525395 DOI: 10.1016/j.neuchi.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/25/2019] [Accepted: 09/03/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with syndromic faciocraniosynostosis due to the mutation of the fibroblast growth factor receptor (FGFR) 2 gene present premature fusion of the coronal sutures and of the cranial base synchondrosis. Cerebrospinal fluid (CSF) circulation disorders and cerebellar tonsil prolapse are frequent findings in faciocraniosynostosis. OBJECTIVE We reviewed the medical literature on the pathophysiological mechanisms of CSF disorders such as hydrocephalus and of cerebellar tonsil prolapse in FGFR2-related faciocraniosynostosis. DISCUSSION Different pathophysiological theories have been proposed, but none elucidated all the symptoms present in Apert, Crouzon and Pfeiffer syndromes. The first theory that addressed CSF circulation disruption was the constrictive theory (cephalocranial disproportion): cerebellum and brain stem are constricted by the small volume of the posterior fossa. The second theory proposed venous hyperpressure due to jugular foramens stenosis. The most recent theory proposed a pressure differential between CSF in the posterior fossa and in the vertebral canal, due to foramen magnum stenosis.
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Affiliation(s)
- G Coll
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, CNRS, SIGMA, Institut Pascal, Clermont-Ferrand, France.
| | - Y El Ouadih
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - F Abed Rabbo
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - V Jecko
- Service de Neurochirurgie, CHU Bordeaux, Bordeaux, France
| | - L Sakka
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, Faculté de Médecine, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - F Di Rocco
- Service de Neurochirurgie Pédiatrique, Hôpital Femme Mère Enfant, Lyon, France; Université Claude Bernard, INSERM 1033, Lyon, France
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Pacca P, Marengo N, Di Perna G, Penner F, Ajello M, Garbossa D, Zenga F. Endoscopic Endonasal Approach for Urgent Decompression of Craniovertebral Junction in Syringobulbia. World Neurosurg 2019; 130:499-505. [PMID: 31295597 DOI: 10.1016/j.wneu.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Syringobulbia is an uncommon lesion that occurs in the central nervous system; it is often defined as a pathologic cavitation in the brainstem. The cases with partial blockage of the cerebrospinal fluid pathways at the level of the foramen magnum are more common and the most important group. The most common treatment of syringobulbia is craniovertebral decompression. CASE DESCRIPTION This paper reports a case of a symptomatic syringobulbia in which an urgent endoscopic endonasal approach to the craniovertebral junction (CVJ) was done to limit bulbo-medullary compression and rapid neurologic deterioration. A 69-year-old man was admitted to the hospital because of acute onset of dysphonia, dysphagia, imbalance, and vomiting. Magnetic resonance imaging revealed a cystic lesion in the brainstem, suggestive of a syringobulbia in Klippel Feil syndrome with CVJ stenosis. CONCLUSIONS This case report details the successful use of endoscopic endonasal anterior decompression to treat syringobulbia, and adds to the growing literature in support of the endonasal endoscopic approach as a safe and feasible means for decompressing the craniocervical junction, even in the setting of urgency. However, prudent patient selection, combined with sound clinical judgment, access to instrumentation, and intraoperative imaging cannot be overemphasized.
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Affiliation(s)
- Paolo Pacca
- Division of Neurosurgery, Department of Neurosciences, University of Torino, Turin, Italy
| | - Nicola Marengo
- Division of Neurosurgery, Department of Neurosciences, University of Torino, Turin, Italy
| | - Giuseppe Di Perna
- Division of Neurosurgery, Department of Neurosciences, University of Torino, Turin, Italy.
| | - Federica Penner
- Division of Neurosurgery, Department of Neurosciences, University of Torino, Turin, Italy
| | - Marco Ajello
- Division of Neurosurgery, Department of Neurosciences, University of Torino, Turin, Italy
| | - Diego Garbossa
- Division of Neurosurgery, Department of Neurosciences, University of Torino, Turin, Italy
| | - Francesco Zenga
- Division of Neurosurgery, Department of Neurosciences, University of Torino, Turin, Italy
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Giner J, Pérez López C, Hernández B, Gómez de la Riva Á, Isla A, Roda J. Update on the pathophysiology and management of syringomyelia unrelated to Chiari malformation. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Takahashi F, Kouno S, Yamaguchi S, Hara Y. Evaluation of atlantooccipital overlapping and cerebral ventricle size in dogs with atlantoaxial instability. J Vet Med Sci 2019; 81:229-236. [PMID: 30584199 PMCID: PMC6395205 DOI: 10.1292/jvms.17-0553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study investigated cerebral ventricle size and concurrent craniocervical junction
abnormality in relation to atlantooccipital overlapping (AOO) in dogs with atlantoaxial
instability (AAI). A total of 61 dogs were treated with atlantoaxial ventral fixation.
Medical records of each dog, including magnetic resonance (MR) and computed tomography
(CT) images, were retrospectively reviewed. CT images were assessed for the presence of
AOO and the dogs were then assigned to either an AOO group or a non-AOO group accordingly.
CT images were also evaluated to determine the foramen magnum (FM) index. Syringomyelia,
cerebellar compression, dorsal compression, and the degree of enlargement of each cerebral
ventricle were evaluated using MR images. Of the 61 dogs, 23 had AOO and 38 did not.
Furthermore, the ventricle/brain height ratio, the fourth ventricle height/cerebellum
length ratio, and the fourth ventricle width/cerebellum length ratio were significantly
higher in the AOO group than in the non-AOO group. However, the FM index, third
ventricle/brain height ratio, and incidence of syringomyelia did not differ significantly
between the two groups. Dogs with concurrent AOO exhibited significantly more dilatation
of the lateral and fourth ventricles.
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Affiliation(s)
- Fumitaka Takahashi
- The Laboratory of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1 Kyonan, Musashino-shi, Tokyo 180-0023, Japan.,YPC Tokyo Animal Orthopedic Surgery Hospital, 7-1-13 Oojima, Koutou-ku, Tokyo 136-0072, Japan
| | - Shigenori Kouno
- The Laboratory of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1 Kyonan, Musashino-shi, Tokyo 180-0023, Japan
| | - Shinya Yamaguchi
- The Laboratory of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1 Kyonan, Musashino-shi, Tokyo 180-0023, Japan.,YPC Tokyo Animal Orthopedic Surgery Hospital, 7-1-13 Oojima, Koutou-ku, Tokyo 136-0072, Japan
| | - Yasushi Hara
- The Laboratory of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1 Kyonan, Musashino-shi, Tokyo 180-0023, Japan
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Rajasekhar R, Karthigeyan M, Salunke P, Gupta K. A novel fixation technique using anterior C1 screw in a pediatric solitary cervical spinal juvenile xanthogranuloma. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:56-60. [PMID: 30771048 DOI: 10.1007/s00586-019-05915-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/22/2018] [Accepted: 02/09/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Juvenile xanthogranuloma (JXG) presenting as solitary vertebral body lesion is infrequently seen and usually limited to one or two levels. We report a case of an isolated JXG with extensive cervical spinal (bony and extradural) involvement in a 6-year-old child. There was a diagnostic dilemma as the radiologic and intraoperative picture resembled tuberculosis. The spinal reconstruction was also challenging due to involvement of multiple vertebral levels and necessitated an anterior C1 screw. METHODS The lytic lesion was multicompartmental, involving the craniovertebral junction and the subaxial spine (till C6 vertebral body) and extending into the retropharyngeal space. Noticeably, an associated thoracic syringomyelia was also present. Near-total excision of the lesion and 360° spinal fixation was performed using fibular strut graft. The graft was cranially anchored to the C1 anterior arch, thereby sharing the load with the posterior occipito-cervical instrumentation in order to avoid a construct failure due to cantilever effect. RESULTS At 12-month follow-up, the patient had good clinico-radiologic outcome with evidence of bony fusion and resolution of syrinx. CONCLUSION The report highlights the diagnostic dilemma of JXG lesion on both the radiology and surgery and discusses the challenges in the management and the relevant literature. The described technique can be a viable option in pediatric tumors with extensive C2 vertebral body involvement. Occasionally, extradural compression can have associated syrinx formation and the primary treatment per se could tackle the underlying syringomyelia.
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Affiliation(s)
- Rekhapalli Rajasekhar
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India.
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Kirti Gupta
- Department of Histopathology, PGIMER, Chandigarh, India
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Chiari 1 Malformation Surgery: Comparing Non-violation of the Arachnoid versus Arachnoid Opening and Thermocoagulation of the Tonsils. World Neurosurg 2018; 121:e605-e613. [PMID: 30292659 DOI: 10.1016/j.wneu.2018.09.175] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Evidence is lacking concerning the myriad surgical techniques for type 1 Chiari malformation. This study evaluated the impact of arachnoid violation with tonsil thermocoagulation during surgical craniovertebral junction decompression. METHODS The evaluation included aspects of the neurologic examination and parameters of cerebrospinal fluid flow on magnetic resonance imaging during preoperative and postoperative periods. All patients underwent craniovertebral junction decompression and opening of the dura mater. Patients were divided into 2 study groups. Patients in group 1 did not undergo arachnoid violation. Patients in group 2 underwent tonsil manipulation and systematic opening of the fourth ventricle outlet. RESULTS There were 16 patients enrolled in each group (total of 32 patients). Regarding clinical improvement, there were no significant differences between groups in the postoperative period. Group 2 had more adverse events (relative risk 2.45, 95% confidence interval 1.55-3.86). In terms of cerebrospinal fluid flow parameter analyses, patients in group 1 achieved better results (P < 0.05). CONCLUSIONS For treatment of symptomatic type 1 Chiari malformation, craniovertebral junction decompression with arachnoid preservation (i.e., without tonsillar manipulation) seems more suitable than the addition of arachnoid opening and thermocoagulation of the tonsils.
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Nagaraj UD, Bierbrauer KS, Stevenson CB, Peiro JL, Lim FY, Zhang B, Kline-Fath BM. Spinal Imaging Findings of Open Spinal Dysraphisms on Fetal and Postnatal MRI. AJNR Am J Neuroradiol 2018; 39:1947-1952. [PMID: 30237301 PMCID: PMC7410740 DOI: 10.3174/ajnr.a5760] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/25/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Fetal MRI has become a valuable tool in the evaluation of open spinal dysraphisms making studies comparing prenatal and postnatal MRI findings increasingly important. Our aim was to determine the accuracy of predicting the level of the spinal dysraphic defect of open spinal dysraphisms on fetal MR imaging and to report additional findings observed when comparing fetal and postnatal MR imaging of the spine in this population. MATERIALS AND METHODS A single-center retrospective analysis was performed of fetal MRIs with open spinal dysraphisms from 2004 through 2016 with available diagnostic postnatal spine MR imaging. Images were reviewed by 2 board-certified fellowship-trained pediatric neuroradiologists. Corresponding clinical/operative reports were reviewed. RESULTS One hundred nineteen fetal MRIs of open spinal dysraphisms were included. The level of the osseous defect between fetal and postnatal MR imaging was concordant in 42.9% (51/119) of cases and was 1 level different in 39% (47/119) of cases. On postnatal MR imaging, type II split cord malformation was seen in 8.4% (10/119) of cases, with only 50% (5/10) of these cases identified prospectively on fetal MR imaging. Syrinx was noted in 3% (4/119) of prenatal studies, all cervical, all confirmed on postnatal MR imaging. CONCLUSIONS Fetal MR imaging is accurate in detecting the level of the spinal dysraphic defect, which has an impact on prenatal counseling, neurologic outcomes, and eligibility for fetal surgery. In addition, fetal MR imaging is limited in its ability to detect split cord malformations in patients with open spinal dysraphisms. Although rare, fetal MR imaging has a high specificity for detection of cervical spinal cord syrinx.
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Affiliation(s)
- U D Nagaraj
- From the Department of Radiology and Medical Imaging (U.D.N., B.Z., B.M.K.-F.)
| | | | - C B Stevenson
- Department of Pediatric Neurosurgery (K.S.B., C.B.S.)
| | - J L Peiro
- Department of Pediatric Surgery (J.L.P., F.Y.L.)
| | - F Y Lim
- Department of Pediatric Surgery (J.L.P., F.Y.L.)
| | - B Zhang
- From the Department of Radiology and Medical Imaging (U.D.N., B.Z., B.M.K.-F.)
- Department of Biostatistics and Epidemiology (B.Z.),University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center; Cincinnati, Ohio
| | - B M Kline-Fath
- From the Department of Radiology and Medical Imaging (U.D.N., B.Z., B.M.K.-F.)
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Vadivelu S, Vadivelu S, Mealy M, Patel S, Kosnik-Infinger L, Becker D. Chiari I malformation in children with transverse myelitis. Dev Neurorehabil 2018; 21:402-407. [PMID: 28537458 DOI: 10.1080/17518423.2017.1323972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Transverse myelitis (TM) is an acute inflammatory spinal cord injury. Asymptomatic Chiari I malformation (CMI) management is highly controversial, particularly when associated with a spinal syrinx. Here, we assess the occurrence of CMI in the pediatric TM population and management outcomes. METHODS We performed a retrospective cohort study based on 61 consecutively identified pediatric TM cases over an -8-year period. We reviewed demographic characteristics, radiographic findings, presenting symptoms, and long-term outcomes. RESULTS Eight CMI cases were identified within the TM cohort; all presented with TM by 16 months of age and affecting the cervical spinal cord. In three cases, CMI developed 15 months to 6 years after the onset of TM. One in 10 children with TM had CMI. CONCLUSION These findings demonstrate a high prevalence of CMI in patients with TM. Large prospective clinical studies are needed to further investigate the natural history and recovery strategies of CMI involved with neuroinflammatory disorders.
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Affiliation(s)
- Sathya Vadivelu
- a Department of Pediatric Rehabilitation Medicine , Johns Hopkins University and the Kennedy Krieger Institute , Baltimore , MD , USA
| | - Sudhakar Vadivelu
- b Division of Pediatric Neurosurgery , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,c Department of Neurosurgery , University of Cincinnati School of Medicine , Cincinnati , OH , USA
| | - Maureen Mealy
- d Department of Neurology , Johns Hopkins University and the Kennedy Krieger Institute , Baltimore , MD , USA
| | - Smurti Patel
- c Department of Neurosurgery , University of Cincinnati School of Medicine , Cincinnati , OH , USA
| | - Libby Kosnik-Infinger
- b Division of Pediatric Neurosurgery , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Daniel Becker
- d Department of Neurology , Johns Hopkins University and the Kennedy Krieger Institute , Baltimore , MD , USA
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Abstract
Background Syringomyelia is a pathological condition in which fluid-filled cavities (syringes) form and expand in the spinal cord. Syringomyelia is often linked with obstruction of the craniocervical junction and a Chiari malformation, which is similar in both humans and animals. Some brachycephalic toy breed dogs such as Cavalier King Charles Spaniels (CKCS) are particularly predisposed. The exact mechanism of the formation of syringomyelia is undetermined and consequently with the lack of clinical explanation, engineers and mathematicians have resorted to computer models to identify possible physical mechanisms that can lead to syringes. We developed a computer model of the spinal cavity of a CKCS suffering from a large syrinx. The model was excited at the cranial end to simulate the movement of the cerebrospinal fluid (CSF) and the spinal cord due to the shift of blood volume in the cranium related to the cardiac cycle. To simulate the normal condition, the movement was prescribed to the CSF. To simulate the pathological condition, the movement of CSF was blocked. Results For normal conditions the pressure in the SAS was approximately 400 Pa and the same applied to all stress components in the spinal cord. The stress was uniformly distributed along the length of the spinal cord. When the blockage between the cranial and spinal CSF spaces forced the cord to move with the cardiac cycle, shear and axial normal stresses in the cord increased significantly. The sites where the elevated stress was most pronounced coincided with the axial locations where the syringes typically form, but they were at the perimeter rather than in the central portion of the cord. This elevated stress originated from the bending of the cord at the locations where its curvature was high. Conclusions The results suggest that it is possible that repetitive stressing of the spinal cord caused by its exaggerated movement could be a cause for the formation of initial syringes. Further consideration of factors such as cord tethering and the difference in mechanical properties of white and grey matter is needed to fully explore this possibility. Electronic supplementary material The online version of this article (10.1186/s12917-018-1410-7) contains supplementary material, which is available to authorized users.
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Hechler AC, Moore SA. Understanding and Treating Chiari-like Malformation and Syringomyelia in Dogs. Top Companion Anim Med 2018; 33:1-11. [DOI: 10.1053/j.tcam.2018.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 11/11/2022]
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Oh AJ, Lanzman BA, Liao YJ. Vertical diplopia and oscillopsia due to midbrain keyhole aqueduct syndrome associated with severe cough. Am J Ophthalmol Case Rep 2018; 10:128-131. [PMID: 29687086 PMCID: PMC5910451 DOI: 10.1016/j.ajoc.2018.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/09/2018] [Accepted: 02/09/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose Midline structural defects in the neural axis can give rise to neuro-ophthalmic symptoms. We report a rare case of keyhole aqueduct syndrome presenting after two years of severe cough due to gastroesophageal reflux disease. Observations A 58-year-old woman with a 2-year history of daily, severe cough presented to the neuro-ophthalmology clinic with progressive diplopia and oscillopsia. Examination revealed a 1-2 Hz down-beating nystagmus in primary gaze that worsened with left, right, and down gazes. Gaze evoked nystagmus and mild paresis were also seen with up gaze. There was an incomitant left hypertropia due to skew deviation that worsened with right and up gazes and improved with down gaze. She also had a right-sided ptosis and a 3 mm anisocoria not due to cranial nerve 3 paresis or Horner's syndrome. Brain magnetic resonance imaging showed a 1.5 mm × 11.7 mm × 6 mm midline cleft in the ventral midbrain communicating with the cerebral aqueduct, consistent with keyhole aqueduct syndrome. Her nystagmus and diplopia improved with oral acetazolamide treatment, at high doses of 2500-3000 mg per day. Conclusions and importance We report the first case of midbrain keyhole aqueduct syndrome with ocular motor and other neuro-ophthalmic manifestations associated with severe cough. Although her cough was effectively treated and intracranial pressure measurement was normal, her ophthalmic symptoms continued to progress, which is common in previous cases reported. Treatment with acetazolamide led to significant improvement, supporting the use of acetazolamide in this rare condition.
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Affiliation(s)
- Angela Jinsook Oh
- Department of Ophthalmology, Stanford School of Medicine, 2452 Watson Court, Palo Alto, CA 94303-5353, USA
| | - Bryan Alexander Lanzman
- Department of Radiology, Neuroradiology Division, Stanford University Medical Center, 300 Pasteur Dr. S031, Stanford, CA 94305, USA
| | - Yaping Joyce Liao
- Department of Ophthalmology, Stanford School of Medicine, 2452 Watson Court, Palo Alto, CA 94303-5353, USA.,Department of Neurology, Stanford School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
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Badri M, Gader G, Bahri K, Zammel I. Cervicothoracic syringomyelia caused by cervical spinal stenosis: Case report and literature review. Surg Neurol Int 2017; 8:288. [PMID: 29285404 PMCID: PMC5735432 DOI: 10.4103/sni.sni_350_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/08/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Syringomyelia is commonly associated with Chiari malformations, spinal trauma, arachnoiditis, or tumors. However, rarely, cervical canal stenosis is implicated in intramedullary cavitations. Case Discription: Here, we report the case of a 60-year-old male patient who presented with loss of pain and temperature sensation in upper extremities associated with a spastic tetraparesis. On magnetic resonance imaging, the patient was found to have syringomyelia extending from C1 to Th3. Following posterior decompressive surgery, the syrinx resolved along with the patient's neurological complaints. Conclusion: Here, the authors presented a case and reviewed the literature regarding how cervical spinal stenosis may contribute to cervical or thoracic syringomyelia.
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Affiliation(s)
- Mohamed Badri
- Department of Neurosurgery, Faculty of medicine of Tunis, El Manar-Tunis University, Burns and Trauma Center, Ben Arous, Tunisia
| | - Ghassen Gader
- Department of Neurosurgery, Faculty of medicine of Tunis, El Manar-Tunis University, Burns and Trauma Center, Ben Arous, Tunisia
| | - Kamel Bahri
- Department of Neurosurgery, Faculty of medicine of Tunis, El Manar-Tunis University, Burns and Trauma Center, Ben Arous, Tunisia
| | - Ihsen Zammel
- Department of Neurosurgery, Faculty of medicine of Tunis, El Manar-Tunis University, Burns and Trauma Center, Ben Arous, Tunisia
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Bertram CD, Heil M. A Poroelastic Fluid/Structure-Interaction Model of Cerebrospinal Fluid Dynamics in the Cord With Syringomyelia and Adjacent Subarachnoid-Space Stenosis. J Biomech Eng 2017; 139:2552971. [PMID: 27617710 DOI: 10.1115/1.4034657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Indexed: 11/08/2022]
Abstract
An existing axisymmetric fluid/structure-interaction (FSI) model of the spinal cord, pia mater, subarachnoid space, and dura mater in the presence of syringomyelia and subarachnoid-space stenosis was modified to include porous solids. This allowed investigation of a hypothesis for syrinx fluid ingress from cerebrospinal fluid (CSF). Gross model deformation was unchanged by the addition of porosity, but pressure oscillated more in the syrinx and the subarachnoid space below the stenosis. The poroelastic model still exhibited elevated mean pressure in the subarachnoid space below the stenosis and in the syrinx. With realistic cord permeability, there was slight oscillatory shunt flow bypassing the stenosis via the porous tissue over the syrinx. Weak steady streaming flow occurred in a circuit involving craniocaudal flow through the stenosis and back via the syrinx. Mean syrinx volume was scarcely altered when the adjacent stenosis bisected the syrinx, but increased slightly when the syrinx was predominantly located caudal to the stenosis. The fluid content of the tissues over the syrinx oscillated, absorbing most of the radial flow seeping from the subarachnoid space so that it did not reach the syrinx. To a lesser extent, this cyclic swelling in a boundary layer of cord tissue just below the pia occurred all along the cord, representing a mechanism for exchange of interstitial fluid (ISF) and cerebrospinal fluid which could explain recent tracer findings without invoking perivascular conduits. The model demonstrates that syrinx volume increase is possible when there is subarachnoid-space stenosis and the cord and pia are permeable.
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Affiliation(s)
- C D Bertram
- School of Mathematics and Statistics, University of Sydney, New South Wales 2006, Australia
| | - M Heil
- School of Mathematics, University of Manchester, Manchester M13 9PL, UK
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Syringomyelia associated with cervical spondylotic myelopathy causing canal stenosis. A rare association. Neurol Neurochir Pol 2017; 51:471-475. [PMID: 28844366 DOI: 10.1016/j.pjnns.2017.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 01/01/2017] [Accepted: 08/03/2017] [Indexed: 11/22/2022]
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Tonkins M, Farooqi N, Ahmed R, Sinha S, Bhattacharyya D. Closing the dura: dural hitching versus surgicel and tisseel overlay graft in craniocervicaldecompression for Chiari 1 malformation. Br J Neurosurg 2017. [PMID: 28637109 DOI: 10.1080/02688697.2017.1297363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study compares dural hitching to surgicel and tisseel overlay graft following craniocervical decompression and C1 laminectomy with simple durotomy for Chiari I malformation. Outcome measures were syrinx decompression, headache resolution and complication rates. METHODS A retrospective analysis of case notes was conducted. Patients who had undergone craniocervical decompression (CCD) were grouped by method of dural closure. Outcomes compared were rates of syrinx decompression, headache resolution, and post-operative complications. Statistical analysis was conducted using SPSS v20. RESULTS We identified 32 adult patients for inclusion in this study. 53.1% (n = 17) had asyrinx, and 78.1% (n = 25) had a pre-operative headache. All were treated with suboccipital craniectomy, C1 laminectomy (with or without C2 laminectomy), and durotomy. The dura was either left open by dural hitching (n = 23) or closed with surgicel and tisseel overlay graft (n = 9). We found a statistically significant association between the method of dural closure and the rate of syrinx resolution. Resolution occurred in 91.7% (n = 11) of the hitching group, compared to 20.0% (n = 1) of the overlay graft group: Χ2(1) = 5.6, p = .018. There were no statistically significant differences between the two groups in the rates of headache resolution or other complications. CONCLUSIONS In patients with symptomatic Chiari I malformation and associated syringomyelia, syrinx resolution is more likely if the dura is hitched open rather than closed bysurgicel and tisseel overlay graft after durotomy.
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Affiliation(s)
- Michael Tonkins
- a The Medical School , University of Sheffield , Sheffield , South Yorkshire , UK
| | - Naeem Farooqi
- b Department of Neurosurgery , Queen Elizabeth Hospital , Birmingham , West Midlands , UK
| | - Rohan Ahmed
- a The Medical School , University of Sheffield , Sheffield , South Yorkshire , UK
| | - Saurabh Sinha
- c Department of Neurosurgery , Royal Hallamshire Hospital , Sheffield , South Yorkshire , UK
| | - Debapriya Bhattacharyya
- c Department of Neurosurgery , Royal Hallamshire Hospital , Sheffield , South Yorkshire , UK
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Update on the pathophysiology and management of syringomyelia unrelated to Chiari malformation. Neurologia 2016; 34:318-325. [PMID: 27939111 DOI: 10.1016/j.nrl.2016.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/20/2016] [Accepted: 09/30/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Much has been published on syringomyelia related to Chiari malformation. In contrast, little is known about the condition when it is not associated with this malformation, but this presentation of syringomyelia constitutes a different entity and therefore requires specific management. We conducted a literature review to summarise the most accepted and widespread ideas about the pathophysiology, management and other aspects of syringomyelia unrelated to Chiari malformation. DEVELOPMENT We reviewed the most relevant literature on this condition, focusing on the pathophysiology, clinical presentation, diagnosis, and treatment. CONCLUSIONS Syringomyelia unrelated to Chiari malformation is a distinct entity that must be well understood to guarantee correct diagnosis, monitoring, and management. When the disease is suspected, a thorough study should be conducted to identify its aetiology. Treatment must aim to eliminate the cause of the disease; symptomatic treatment should remain a second-line option.
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Magnetic resonance imaging-based measures of atlas position: Relationship to canine atlantooccipital overlapping, syringomyelia and clinical signs. Vet J 2016; 209:133-8. [DOI: 10.1016/j.tvjl.2016.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 12/22/2015] [Accepted: 01/11/2016] [Indexed: 11/18/2022]
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Yan H, Han X, Jin M, Liu Z, Xie D, Sha S, Qiu Y, Zhu Z. Morphometric features of posterior cranial fossa are different between Chiari I malformation with and without syringomyelia. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2202-9. [PMID: 26821142 DOI: 10.1007/s00586-016-4410-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate whether the posterior cranial fossa (PCF) morphology in Chiari I malformation without syringomyelia (also called syrinx) (CMI-only) is different from that in Chiari I malformation with syrinx (CMI-S). METHODS Nineteen CMI patients without syrinx constituted the CMI-only group, whereas 48 CMI patients with syrinx were assigned to the CMI-S group. Another cohort of 40 age-matched asymptomatic adolescents was enrolled to serve as the control group. Six measurements were evaluated and compared between these three groups from T1-weighted magnetic resonance (MR) imaging, including the length of the clivus (AB), the anteroposterior diameter of the foramen magnum (BC), the length of the supraocciput (CD), the anteroposterior diameter of the posterior fossa (DA), the posterior fossa height (BE) and the clivus gradient ([Formula: see text]). The posterior cranial fossa morphology in relation to syrinx severity was also investigated. RESULTS Compared to the normal controls, the AB, CD, DA, BE and [Formula: see text] were significantly larger in the CMI-S group. Similar changes in AB, CD, DA and BE were also demonstrated in the CMI-only group, while the clivus gradient ([Formula: see text]) was found to be normal when compared with the control group. A significantly decreased clivus gradient was observed in the CMI-S group as compared to CMI-only group. In addition, the clivus was significantly flattened in patients with a distended-syrinx in comparison to those with a non-distended syrinx. CONCLUSIONS Small size of the posterior fossa was detected both in CMI cases with and without syrinx. The clivus gradient served as the only morphologic difference in the PCF between CMI-S and CMI-only patients and was correlated with the severity of the syrinx, may support the theory that the restricted circulation of cerebrospinal fluid at the anterior paramedial subarachnoid space contributes to the formation of a syrinx.
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Affiliation(s)
- Huang Yan
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Xiao Han
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Mengran Jin
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Zhen Liu
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Dingding Xie
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Shifu Sha
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Yong Qiu
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China
| | - Zezhang Zhu
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing, 210008, China.
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Wang K, Dai J. Conus medullaris ganglioneuroma with syringomyelia radiologically mimicking ependymoma: A case report. Oncol Lett 2016; 10:3803-3806. [PMID: 26788212 DOI: 10.3892/ol.2015.3815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 10/01/2015] [Indexed: 12/18/2022] Open
Abstract
Ganglioneuromas are rare, benign, well-differentiated tumors of the conus medullaris. Approximately 20 cases of spinal cord ganglioneuroma, and only 1 case of mixed chemodectoma-ganglioneuroma of the conus medullaris have been previously reported. The present study presents the case of a 38-year-old man with a histopathological diagnosis of conus medullaris ganglioneuroma. The patient presented with hypoesthesia in the lower limbs, muscle atrophy of the right lower limb and dysuria. Magnetic resonance imaging analysis led to a diagnosis of ependymoma. Histopathological analysis of the excised mass revealed typical, well-differentiated ganglion cells, consistent with a ganglioneuroma. The mass was associated with a neighboring syringomyelia. At an 18 month follow-up the patient had recovered, although some remaining difficulty in walking and urinating remained. The aim of the present report was to raise awareness that when ganglioneuromas present in unusual locations, analogous radiological findings may mislead investigators to consider more common pathologies and thus result in misdiagnosis. The present case demonstrates the importance of considering the potential differential diagnoses for neural tissue neoplasms.
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Affiliation(s)
- Kai Wang
- Department of Neuroradiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jianping Dai
- Department of Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P.R. China
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Surgical management of syringomyelia unrelated to Chiari malformation or spinal cord injury. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:1836-46. [DOI: 10.1007/s00586-015-4262-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 09/27/2015] [Accepted: 09/27/2015] [Indexed: 10/23/2022]
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Abstract
Background: The etiopathogenesis of syringomyelia is still an enigma. The authors present a novel theory based on fluid dynamics at the craniovertebral (CV) junction to explain the genesis of syringomyelia (SM). The changes in volume of spinal canal, spinal cord, central canal and spinal subarachnoid space (SSS) in relation to the posterior fossa have been analysed, specifically during postural movements of flexion and extension. The effect of fluctuations in volume of spinal canal and its contents associated with cerebrospinal fluid (CSF) flow dynamics at the CV junction have been postulated to cause the origin and propagation of the syringomyelia. The relevant literature on the subject has been reviewed and the author's theory has been discussed. Conclusion: Volume of spinal canal in flexion is always greater than that in extension. Flexion of spine causes narrowing of the ventral subarachnoid space (SAS) and widening of dorsal SAS while extension causes reverse changes leading to fluid movement in dorsal spinal SAS in flexion and ventral spinal SAS in extension. Cervical and lumbar spinal region with maximum bulk hence maximum area and volume undergo maximum deformation during postural changes. SSS CSF is the difference between the volume of spinal canal and spinal cord, varies in flexion and extension which is compensated by changes in posterior fossa (CSF) volume in normal circumstances. Blocked SAS at foramen magnum donot permit spinal SAS CSF exchange which during postural changes is compensated by cavitatory/cystic (syrinx) change at locations in cervical and lumbar spine with propensity for maximum deformation. Augmentation of posterior fossa volume by decompression helps by normalization of this CSF exchange dynamics but immobilizing the spinal movement theoretically will cease any dynamic volume changes thereby minimizing the destructive influence of the fluid exchange on the cord. Thus, this theory strengthens the rational of treating patients by either methodology.
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Affiliation(s)
- Survendra Kumar Rajdeo Rai
- Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Sion, Mumbai, Maharashtra, India
| | - Pooja Survendra Kumar Rai
- Department of Biochemistry, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India
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Coll G, Arnaud E, Collet C, Brunelle F, Sainte-Rose C, Di Rocco F. Skull base morphology in fibroblast growth factor receptor type 2-related faciocraniosynostosis: a descriptive analysis. Neurosurgery 2015; 76:571-83; discussion 583. [PMID: 25886248 DOI: 10.1227/neu.0000000000000676] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Children with faciocraniosynostosis present skull base abnormalities and may develop hydrocephalus or cerebellar tonsils ectopia (CTE). Several pathophysiological hypotheses were formulated in the past decades to explain these associations. However, no study has described in a genetically homogeneous population with confirmed fibroblast growth factor receptor type 2 (FGFR2) mutation eventual correlations between skull base abnormalities and hydrocephalus or CTE. OBJECTIVE To illustrate these features in children <2 years of age with a genetically confirmed FGFR2-related faciocraniosynostosis. METHODS We measured the foramen magnum area (FMA) and its sagittal and transversal components: the right, left, and mean area of the jugular foramen; the posterior fossa volume; and the cerebellar volume on preoperative millimetric computed tomography scan slices in 31 children with an FGFR2 mutation (14 with Crouzon syndrome, 11 with Apert syndrome, and 6 with Pfeiffer syndrome). They were compared with 17 children without synostosis. All children were <24 months of age. We correlated all these measures with the presence of hydrocephalus or CTE. RESULTS We observed a significantly small FMA in children with Crouzon (P = .03) and in children with Pfeiffer (P = .05) resulting from a reduced sagittal diameter (P = .02 for Crouzon and P = .002 for Pfeiffer). Hydrocephalus was associated with small FMA (P = .02). The jugular foramen area, posterior fossa volume, and cerebellar volume were not associated with hydrocephalus or CTE. Hydrocephalus and CTE were statistically associated (P = .002). CONCLUSION Hydrocephalus in FGFR2-related Crouzon and Pfeiffer syndromes is statistically associated with a small FMA. Hydrocephalus is statistically associated with CTE.
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Affiliation(s)
- Guillaume Coll
- *Unité de Chirurgie Craniofaciale, Service de Neurochirurgie Pédiatrique, Centre de Référence National des Dysostoses Crâniofaciales, Hôpital Necker-Enfants Malades, APHP, Paris, France; ‡Service de Neurochirurgie, Hôpital Gabriel Montpied, Clermont-Ferrand, France; §Laboratoire d'anatomie, UFR Médecine, Universite[Combining Acute Accent] d'Auvergne, Clermont-Ferrand, France; ¶Image-Guided Clinical Neuroscience and Connectomics, EA 7282, UFR Médecine, Université Clermont 1, Universite d'Auvergne, Clermont-Ferrand, France; ‖Service de Biochimie et Biologie Moléculaire, Hôpital Lariboisière, APHP, Paris, France; #Département de Radiologie, Hôpital Necker-Enfants Malades, APHP, Paris, France
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Pulse wave myelopathy: An update of an hypothesis highlighting the similarities between syringomyelia and normal pressure hydrocephalus. Med Hypotheses 2015; 85:958-61. [PMID: 26362731 DOI: 10.1016/j.mehy.2015.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
Abstract
Most hypotheses trying to explain the pathophysiology of idiopathic syringomyelia involve mechanisms whereby CSF is pumped against a pressure gradient, from the subarachnoid space into the cord parenchyma. On review, these theories have universally failed to explain the disease process. A few papers have suggested that the syrinx fluid may originate from the cord capillary bed itself. However, in these papers, the fluid is said to accumulate due to impaired fluid drainage out of the cord. Again, there is little evidence to substantiate this. This proffered hypothesis looks at the problem from the perspective that syringomyelia and normal pressure hydrocephalus are almost identical in their manifestations but only differ in their site of effect within the neuraxis. It is suggested that the primary trigger for syringomyelia is a reduction in the compliance of the veins draining the spinal cord. This reduces the efficiency of the pulse wave dampening, occurring within the cord parenchyma, increasing arteriolar and capillary pulse pressure. The increased capillary pulse pressure opens the blood-spinal cord barrier due to a direct effect upon the wall integrity and interstitial fluid accumulates due to an increased secretion rate. An increase in arteriolar pulse pressure increases the kinetic energy within the cord parenchyma and this disrupts the cytoarchitecture allowing the fluid to accumulate into small cystic regions in the cord. With time the cystic regions coalesce to form one large cavity which continues to increase in size due to the ongoing interstitial fluid secretion and the hyperdynamic cord vasculature.
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Kromhout K, van Bree H, Broeckx B, Bhatti S, De Decker S, Polis I, Gielen I. Low-Field Magnetic Resonance Imaging and Multislice Computed Tomography for the Detection of Cervical Syringomyelia in Dogs. J Vet Intern Med 2015; 29:1354-9. [PMID: 26249824 PMCID: PMC4858036 DOI: 10.1111/jvim.13579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/13/2015] [Accepted: 06/11/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Syringomyelia (SM) is defined as the presence of fluid-containing cavities within the parenchyma of the spinal cord. Sagittal magnetic resonance (MR) images have been described as the preferred technique for visualizing SM in dogs and humans. OBJECTIVE To investigate whether computed tomography (CT) can be used to diagnose SM. ANIMALS Thirty-two client-owned dogs referred for investigation of the cervical spine on magnetic resonance imaging (MRI) and CT. METHODS Two reviewers retrospectively analyzed sagittal and transverse T1-weighted spin echo (T1WSE) MR images and CT images from each dog for the presence of SM and, if SM was present, the width (mm, syrinx width [SW]) was measured. The results were analyzed statistically. RESULTS For the presence of SM there was a moderate interobserver agreement for MR (81%, κ = 0.54) and almost perfect agreement for CT (94%, κ = 0.87). There was a moderate intramodality agreement for both observers (observer 1 81%, κ = 0.59; observer 2 81%, κ = 0.57). For measurement of SW the repeatability was the best on the midsagittal T1WSE images (95% repeatability coefficient <0.52 mm) and the reproducibility was the best on midsagittal images in both modalities (95% limits of agreement -0.55-0.45; P = 0.002). CONCLUSION AND CLINICAL IMPORTANCE Both techniques can be used to detect SM. Midsagittal MR and CT images are best used for measuring SW. Computed tomography can be used as a diagnostic tool for SM when MRI is not available, but CT cannot replace MRI as the standard screening technique for the detection of SM in Cavalier King Charles Spaniel for breeding purposes.
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Affiliation(s)
- K. Kromhout
- Department of Veterinary Medical Imaging and Small Animal OrthopedicsFaculty of Veterinary MedicineGhent UniversityGhentBelgium
| | - H. van Bree
- Department of Veterinary Medical Imaging and Small Animal OrthopedicsFaculty of Veterinary MedicineGhent UniversityGhentBelgium
| | - B.J.G. Broeckx
- Laboratory of Pharmaceutical BiotechnologyFaculty of Pharmaceutical SciencesGhent UniversityGhentBelgium
| | - S. Bhatti
- Department of Small Animal Medicine and Clinical BiologyFaculty of Veterinary MedicineGhent UniversityGhentBelgium
| | - S. De Decker
- Department of Clinical Science and ServicesRoyal Veterinary CollegeUniversity of LondonLondonUK
| | - I. Polis
- Department of Small Animal Medicine and Clinical BiologyFaculty of Veterinary MedicineGhent UniversityGhentBelgium
| | - I. Gielen
- Department of Veterinary Medical Imaging and Small Animal OrthopedicsFaculty of Veterinary MedicineGhent UniversityGhentBelgium
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Mascitelli JR, Ben-Haim S, Paramasivam S, Zarzour HK, Rothrock RJ, Bederson JB. Association of a Distal Intradural-Extracranial Posterior Inferior Cerebellar Artery Aneurysm With Chiari Type I Malformation. Neurosurgery 2015; 77:E660-5; discussion E665. [PMID: 26308644 DOI: 10.1227/neu.0000000000000870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Distal extracranial posterior inferior cerebellar artery (PICA) aneurysms are very rare lesions and have not been previously reported in association with a Chiari type I malformation (CMI).
CLINICAL PRESENTATION:
A 56-year-old woman with a distal, low-lying, intradural-extracranial PICA aneurysm presented with a subarachnoid hemorrhage and was treated with coil embolization. The patient presented again 1 month later with symptoms of a CMI and was found to have tonsillar herniation and a large syrinx that appeared to be exacerbated by the coil mass. The patient was re-treated with a suboccipital craniectomy, C1-2 laminectomy, aneurysm trapping and excision, end-to-end PICA anastomosis, and expansile duraplasty.
CONCLUSION:
Although just a single case, important teaching points regarding the angiographic appearance of a CMI and treatment options for distal PICA aneurysms that are situated below the foramen magnum can be learned. A low-lying caudal PICA loop should trigger a workup for a CMI. Caution should be taken when using coil embolization for aneurysms in the high cervical spinal canal. Bypass with aneurysm trapping and excision may be a superior treatment option in these cases because the posterior fossa and high cervical canal can be concomitantly decompressed. To our knowledge, this is the only case reported of a distal intradural-extracranial PICA aneurysm associated with a CMI.
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Affiliation(s)
- Justin R. Mascitelli
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sharona Ben-Haim
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Hekmat K. Zarzour
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert J. Rothrock
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua B. Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Schmidt MJ, Laubner S, Kolecka M, Failing K, Moritz A, Kramer M, Ondreka N. Comparison of the Relationship between Cerebral White Matter and Grey Matter in Normal Dogs and Dogs with Lateral Ventricular Enlargement. PLoS One 2015; 10:e0124174. [PMID: 25938575 PMCID: PMC4418575 DOI: 10.1371/journal.pone.0124174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 03/13/2015] [Indexed: 11/18/2022] Open
Abstract
Large cerebral ventricles are a frequent finding in brains of dogs with brachycephalic skull conformation, in comparison with mesaticephalic dogs. It remains unclear whether oversized ventricles represent a normal variant or a pathological condition in brachycephalic dogs. There is a distinct relationship between white matter and grey matter in the cerebrum of all eutherian mammals. The aim of this study was to determine if this physiological proportion between white matter and grey matter of the forebrain still exists in brachycephalic dogs with oversized ventricles. The relative cerebral grey matter, white matter and cerebrospinal fluid volume in dogs were determined based on magnetic-resonance-imaging datasets using graphical software. In an analysis of covariance (ANCOVA) using body mass as the covariate, the adjusted means of the brain tissue volumes of two groups of dogs were compared. Group 1 included 37 mesaticephalic dogs of different sizes with no apparent changes in brain morphology, and subjectively normal ventricle size. Group 2 included 35 brachycephalic dogs in which subjectively enlarged cerebral ventricles were noted as an incidental finding in their magnetic-resonance-imaging examination. Whereas no significant different adjusted means of the grey matter could be determined, the group of brachycephalic dogs had significantly larger adjusted means of lateral cerebral ventricles and significantly less adjusted means of relative white matter volume. This indicates that brachycephalic dogs with subjective ventriculomegaly have less white matter, as expected based on their body weight and cerebral volume. Our study suggests that ventriculomegaly in brachycephalic dogs is not a normal variant of ventricular volume. Based on the changes in the relative proportion of WM and CSF volume, and the unchanged GM proportions in dogs with ventriculomegaly, we rather suggest that distension of the lateral ventricles might be the underlying cause of pressure related periventricular loss of white matter tissue, as occurs in internal hydrocephalus.
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Affiliation(s)
- Martin J. Schmidt
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Justus-Liebig-University-Giessen, Giessen, Germany
- * E-mail:
| | - Steffi Laubner
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Justus-Liebig-University-Giessen, Giessen, Germany
| | - Malgorzata Kolecka
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Justus-Liebig-University-Giessen, Giessen, Germany
| | - Klaus Failing
- Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus Liebig-University-Giessen, Giessen, Germany
| | - Andreas Moritz
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Justus-Liebig-University-Giessen, Giessen, Germany
| | - Martin Kramer
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Justus-Liebig-University-Giessen, Giessen, Germany
| | - Nele Ondreka
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Justus-Liebig-University-Giessen, Giessen, Germany
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