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Ciaramitaro P, Migliaretti G, Ferraris M, Garnero A, Morana G, Carucci P, Stura I, Massaro F, Garbossa D. Syringomyelia Associated with Chiari 1 Malformation in Adults: Positive Outcome Predictors after Posterior Fossa Decompression with Duraplasty. J Clin Med 2023; 12:jcm12083019. [PMID: 37109355 PMCID: PMC10143011 DOI: 10.3390/jcm12083019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Syringomyelia (Syr) in patients with Chiari 1 malformation (CM1) may be attributable to abnormal dynamics of cerebrospinal fluid (CSF) in the upper cervical segment; fourth ventricle enlargement has been reported in association with a worse clinical and radiological presentation, independently of the posterior fossa volume. In this study, we analyzed presurgery hydrodynamic markers to evaluate if their changes could be associated with clinical and radiological improvement after posterior fossa decompression and duraplasty (PFDD). As a primary endpoint, we aimed to correlate improvement in the fourth ventricle area with positive clinical outcomes. METHODS In total, in this study, we enrolled 36 consecutive adults with Syr and CM1 who were followed by a multidisciplinary team. All the patients were prospectively evaluated with clinical scales and neuroimaging, including CSF flow, the fourth ventricle area, and the Vaquero Index by using a phase-contrast MRI before (T0) and after surgical treatment (T1-Tlast, with a range of 12-108 months). The CSF flow at the craniocervical junction (CCJ), the fourth ventricle area, and the Vaquero Index changes were statistically analyzed and compared to the clinical and quality of life improvement after surgery. The good outcome prediction ability of presurgical radiological variables was tested. RESULTS Surgery was associated with positive clinical and radiological outcomes in more than 90% of cases. The fourth ventricle area significantly reduced after surgery (T0-Tlast, p = 0.0093), but no significant associations with clinical improvement were found. The presurgical presence of CSF flow at the CCJ was able to predict a good outcome (AUC = 0.68, 95% CI 0.50-0.87 and LH+ = 2.1, IC 95% 1.16-3.07) and was also significantly associated with post-surgical pain relief (rho = 0.61 and p = 0.0144). CONCLUSIONS Presurgery CSF flow at the CCJ is proposed as a radiological marker with the ability to predict a positive outcome after PFDD in adults with syringomyelia and CM1. Measurements of the fourth ventricle area could be useful additional information for evaluating surgical long-term follow-up; further experience on larger cohorts is required to better define the prognostic yield of this radiological parameter.
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Affiliation(s)
- Palma Ciaramitaro
- Neuroscience Department, University of Torino, 10126 Torino, Italy
- CRESSC, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Giuseppe Migliaretti
- Department of Public Health and Paediatric Sciences, University of Torino, 10126 Torino, Italy
| | - Marilena Ferraris
- Diagnostic Imaging Department, AOU Citta' della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Andrea Garnero
- Diagnostic Imaging Department, AOU Citta' della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Giovanni Morana
- Neuroscience Department, University of Torino, 10126 Torino, Italy
- Diagnostic Imaging Department, AOU Citta' della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Paolo Carucci
- Neuroscience Department, University of Torino, 10126 Torino, Italy
- CRESSC, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Ilaria Stura
- Neuroscience Department, University of Torino, 10126 Torino, Italy
| | - Fulvio Massaro
- Neuroscience Department, University of Torino, 10126 Torino, Italy
- Neurosurgery Unit, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Diego Garbossa
- Neuroscience Department, University of Torino, 10126 Torino, Italy
- Neurosurgery Unit, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy
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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
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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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Tokar DM, Savickas ML, Kaut KP. A Test of the Career Construction Theory Model of Adaptation in Adult Workers With Chiari Malformation. JOURNAL OF CAREER ASSESSMENT 2019. [DOI: 10.1177/1069072719867733] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The present study examined the career construction theory (CCT) model of adaptation using a sample of working adults diagnosed with Chiari malformation. Specifically, we tested a mediation model in which adaptivity (i.e., proactivity, openness, and conscientiousness) fosters adaptability, which conditions adapting (i.e., competence need satisfaction at work), which leads to adaptation (i.e., work well-being and subjective well-being). Results of structural equation modeling supported all of the hypothesized direct and indirect relations between CCT constructs, thus providing strong support for the applicability of the model of adaptation among workers with Chiari malformation. Prior to testing the model of adaptation, we examined and found support for the hypothesized hierarchical structure of the Career Adapt-Abilities Scale–Short Form, a recently developed operationalization of career adaptability.
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Affiliation(s)
- David M. Tokar
- Department of Psychology, University of Akron, Akron, OH, USA
| | - Mark L. Savickas
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Kevin P. Kaut
- Department of Psychology, University of Akron, Akron, OH, USA
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Tokar DM, Kaut KP. Predictors of decent work among workers with Chiari malformation: An empirical test of the psychology of working theory. JOURNAL OF VOCATIONAL BEHAVIOR 2018. [DOI: 10.1016/j.jvb.2018.01.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Mohrman AE, Farrag M, Huang H, Ossowski S, Haft S, Shriver LP, Leipzig ND. Spinal Cord Transcriptomic and Metabolomic Analysis after Excitotoxic Injection Injury Model of Syringomyelia. J Neurotrauma 2017; 34:720-733. [DOI: 10.1089/neu.2015.4341] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ashley E. Mohrman
- Department of Chemical and Biomolecular Engineering, University of Akron, Akron, Ohio
| | - Mahmoud Farrag
- Department of Integrated Biosciences Program, University of Akron, Akron, Ohio
| | - He Huang
- Department of Chemistry, University of Akron, Akron, Ohio
| | - Stephan Ossowski
- Centre for Genomic Regulation, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Stephanie Haft
- Langley Porter Psychiatric Institute, University of California San Francisco, San Francisco, California
| | | | - Nic D. Leipzig
- Department of Chemical and Biomolecular Engineering, University of Akron, Akron, Ohio
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The impact of Chiari malformation on daily activities: A report from the national Conquer Chiari Patient Registry database. Disabil Health J 2015; 8:521-6. [PMID: 25753308 DOI: 10.1016/j.dhjo.2015.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/09/2014] [Accepted: 01/19/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chiari malformation (CM) is characterized by herniation of the cerebellar tonsils into the cervical spine. While ample literature on CM exists for clinical and procedural aspects of the disease, few studies have measured the impact CM has on daily activities. OBJECTIVE The objective of this study was to measure the impact that CM has on daily living activities. METHODS Data was analyzed from 798 CM patients gathered by the national Conquer Chiari Patient Registry database. RESULTS Results indicate CM is associated with negative impact on daily living and physical activities for patients, even those exhibiting mild symptoms. Participants with severe symptoms experience the greatest deficit with regards to daily living such as difficulty walking, driving, housecleaning and food preparation. CONCLUSIONS As 96.1% of CM patients report impact in one or more areas of daily living, CM is classified as a disability according to 42 U.S. CODE § 12101 (Americans with Disabilities Act). The degree of self-reported CM symptom severity is strongly related to the frequency and extent of limitations in both physical and daily activities.
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Smith R, Jones G, Curtis A, Murphy H, Flint G. Are Established Methods of Physiotherapeutic Management for Long-term Neurological Conditions Applicable to 'Orphan' Conditions such as Syringomyelia? PHYSIOTHERAPY RESEARCH INTERNATIONAL 2014; 21:4-21. [PMID: 25475405 DOI: 10.1002/pri.1610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/01/2014] [Accepted: 08/21/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE Syringomyelia is a rare or 'orphan' condition with the potential to cause significant disability and detrimental effects to quality of life. Syringomyelia shares similar symptoms to those common in other long-term neurological conditions, including spinal cord injury and multiple sclerosis. In these more prevalent conditions, physiotherapy is utilized widely and is effective in optimizing physical, psychological and social parameters. Therefore, we theorized that physiotherapy might be transferable to, and beneficial to syringomyelia patients. As a paucity of literature exists in this area, we aimed to evaluate the existing uptake and perceived efficacy of physiotherapy. METHODS An exploratory, mixed methodology was selected to derive sufficient qualitative data for analysis. Specifically designed questionnaires and semi-structured interviews yielded data on uptake and perceived physiotherapy efficacy. One hundred patients from a National Health Service tertiary syringomyelia service were invited to participate. RESULTS The questionnaire and interviews were completed by 49 and 20 patients, respectively. Of the small number of patients receiving physiotherapy, the majority reported beneficial effects on pain modulation and quality of life. Stretching and hydrotherapy were deemed effective for relief of pain and stiffness. Additionally, physiotherapy was reported to provide similar benefits to surgical intervention. DISCUSSION Syringomyelia patients report physiotherapy to provide benefits for symptom management and quality of life. Such findings suggest that established rehabilitation techniques in more common conditions may be transferable to those less prevalent. Uptake of physiotherapy was limited, seemingly because of inadequate information, knowledge and resources. To address these deficiencies, further studies should be planned investigating the effectiveness of physiotherapy modalities, such as hydrotherapy, in parallel or in conjunction with surgery and/or pharmacology. Additionally, syringomyelia could be represented alongside similar pathologies in research trials to initiate further research questions and drivers for funding.
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Affiliation(s)
- Rebecca Smith
- Physiotherapy Department, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Gareth Jones
- Physiotherapy Department, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Alexandra Curtis
- Physiotherapy Department, Guys and St Thomas' NHS Foundation Trust, London, UK
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Defining the line between hydromyelia and syringomyelia. A differentiation is possible based on electrophysiological and magnetic resonance imaging studies. Acta Neurochir (Wien) 2010; 152:213-9; discussion 219. [PMID: 19533016 DOI: 10.1007/s00701-009-0427-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Accepted: 05/22/2009] [Indexed: 02/03/2023]
Abstract
PURPOSE With the frequent use of magnetic resonance imaging (MRI), patients with subtle and diffuse symptoms due to small syrinx cavities increasingly present to neurosurgical care. In this respect, a dilated central canal, hydromyelia, must be separated from patients with true syringomyelia with an underlying disorder, as they do not share clinical and radiological features. We hypothesize that a differentiation of these two entities with distinct diagnostic tools is possible. METHODS To describe the entity of hydromyelia, we excluded all patients from the syringomyelia database (n = 142) with any obvious cause of a syringomyelia, any objective neurological deficits on clinical examination, pathological results on electrophysiological monitoring (SSEP, MEP, silent periods) or a widening of the spinal cord cavity of more than 6 mm on MRI [routine acquisitions with FLAIR, T1/T2-weighted images, Cine and CISS (constructive interference in steady-state) studies]. Life quality was assessed through SF-36 questionnaires and an individualized questionnaire for the clinical history, pain and alternative therapies. RESULTS Forty patients (15 males/25 females) matched the criteria of a hydromyelia. With a mean age of 36.7 years (range 11-62), they almost all presented with pain (79%) or dysaesthesia of the limbs, with some having been an incidental finding (10%). Over a follow-up time of 36.9 months (range 6-93) there was no neurological or radiological deterioration. CONCLUSIONS Patients with a hydromyelia do not share clinical or radiological characteristics with patients harbouring a true syringomyelia. As hydromyelia does not represent a disease with an underlying pathology, no clinical or radiological progression has been seen. With sophisticated diagnostic tools to rule out any pathology this subset of patients can be identified.
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