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Wang J, Alotaibi NM, Samuel N, Ibrahim GM, Fallah A, Cusimano MD. Acquired Chiari Malformation and Syringomyelia Secondary to Space-Occupying Lesions: A Systematic Review. World Neurosurg 2017; 98:800-808.e2. [DOI: 10.1016/j.wneu.2016.11.080] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/12/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
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Sun L, Emich S, Fu W, Chen Z, Hao W, Ling F, Jian F. Retrocerebellar arachnoid cyst resulting in syringomyelia in a patient without tonsillar herniation: successful surgical treatment with reconstruction of CSF flow in the foramen magnum region. Neurosurg Rev 2016; 39:341-6; discussion 347. [DOI: 10.1007/s10143-015-0680-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/01/2015] [Accepted: 08/09/2015] [Indexed: 12/15/2022]
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Del Maestro M, De Paulis D, Ricci A, Di Cola F, Galzio R. Syringobulbia associated with posterior fossa meningioma: a review of the literature. Childs Nerv Syst 2014; 30:1749-52. [PMID: 24898517 DOI: 10.1007/s00381-014-2457-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 05/23/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Syringomyelia can be defined as a degenerative, progressive and chronic spinal cord disease. Its association with tumors of the posterior cranial fossa (PCF) is a rare condition. METHODS The authors report a rare case of syringobulbia consequent to a meningioma originating from PCF in a 17-year-old female, discussing the pathogenetic mechanism of development and the resolution of the syrinx cavity after surgical procedure. RESULTS The postoperative period was uneventful without complications. At 6-month follow-up, MRI revealed complete tumor removal with resolution of the syrinx cavity. CONCLUSIONS In cases of syringomyelia and tonsillar herniation associated with PCF meningioma, the tumor resection allows to eliminate the mass effect and increases the size of the posterior fossa with the progressive ascent of the cerebellar tonsils and the consequent reduction of their downward movement with systolic pulsation. The re-establishment of a normal anatomical condition led to the gradual disappearance of syrinx and hydrocephalus.
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Affiliation(s)
- Mattia Del Maestro
- Department of Life, Health & Environmental Sciences (Me.S.V.A.), University of L'Aquila, L'Aquila, Italy
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Apok V, Constantini S, Roth J. Microsurgical fenestration of retrocerebellar cysts as a treatment for syringomyelia. Childs Nerv Syst 2012; 28:653-6. [PMID: 22147240 DOI: 10.1007/s00381-011-1652-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 11/28/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Vino Apok
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK
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Loukas M, Shayota BJ, Oelhafen K, Miller JH, Chern JJ, Tubbs RS, Oakes WJ. Associated disorders of Chiari Type I malformations: a review. Neurosurg Focus 2012; 31:E3. [PMID: 21882908 DOI: 10.3171/2011.6.focus11112] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A single pathophysiological mechanism of Chiari Type I malformations (CM-I) has been a topic of debate. To help better understand CM-I, the authors review disorders known to be associated with CM-I. The primary methodology found among most of them is deformation of the posterior cranial fossa, usually with subsequent decrease in volume. Other mechanisms exist as well, which can be categorized as either congenital or acquired. In understanding the relationship of such disorders with CM-I, we may gain further insight into the process by which cerebellar tonsillar herniation occurs. Some of these pathologies appear to be true associations, but many appear to be spurious.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada
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Galarza M, López-Guerrero AL, Martínez-Lage JF. Posterior fossa arachnoid cysts and cerebellar tonsillar descent: short review. Neurosurg Rev 2010; 33:305-14; discussion 314. [PMID: 20480382 DOI: 10.1007/s10143-010-0262-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 03/07/2010] [Accepted: 03/08/2010] [Indexed: 01/08/2023]
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SUYAMA K, UJIFUKU K, HIRAO T, TAKAHATA H, ITO M, YONEKURA M, NAGATA I. Symptomatic Syringomyelia Associated With a Dermoid Tumor in the Posterior Fossa -Case Report-. Neurol Med Chir (Tokyo) 2009; 49:434-7. [PMID: 19779293 DOI: 10.2176/nmc.49.434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kazuhiko SUYAMA
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kenta UJIFUKU
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Tomohito HIRAO
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Masahiro ITO
- Department of Pathology, Nagasaki Medical Center
| | | | - Izumi NAGATA
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
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Bahuleyan B, Rao A, Chacko AG, Daniel RT. Supracerebellar arachnoid cyst – A rare cause of acquired Chiari I malformation. J Clin Neurosci 2007; 14:895-8. [PMID: 17588761 DOI: 10.1016/j.jocn.2006.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2006] [Revised: 06/25/2006] [Accepted: 06/28/2006] [Indexed: 11/23/2022]
Abstract
Chiari I malformation (CM) associated with a cervico-thoracic syrinx due to supracerebellar arachnoid cyst has not been reported in the literature. We report such a case, managed by fenestration of the arachnoid cyst and foramen magnum decompression (FMD), aiming to reduce the inferiorly directed pressure on the cerebellum and eliminate the craniospinal pressure dissociation respectively. Imaging done post-operatively showed upward displacement of the cerebellar tonsils with a decompressed craniovertebral junction and disappearance of the syrinx.
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Affiliation(s)
- Biji Bahuleyan
- Christian Medical College, Department of Neurological Sciences, Ida Scudder Road, Vellore, Tamil Nadu 632004, India
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Martínez-Lage J, Almagro M, Ros de San Pedro J, Ruiz-Espejo A, Felipe-Murcia M. Regression of syringomyelia and tonsillar herniation after posterior fossa arachnoid cyst excision. Case report and literature review. Neurocirugia (Astur) 2007. [DOI: 10.1016/s1130-1473(07)70286-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Muzumdar D, Ventureyra ECG. Tonsillar herniation and cervical syringomyelia in association with posterior fossa tumors in children: a case-based update. Childs Nerv Syst 2006; 22:454-9. [PMID: 16397818 DOI: 10.1007/s00381-005-0027-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Indexed: 01/05/2023]
Abstract
BACKGROUND Posterior fossa tumors most commonly occur in children. They frequently present with raised intracranial pressure and may have tonsillar herniation. The symptomatology is predominantly directed towards the tumor. The occurrence of syringomyelia in such cases is most unusual. Symptomatic syringomyelia is rare. CASE REPORT We describe a case of a pilocytic astrocytoma of the cerebellum in a 13-year-old girl who presented with clinical features of progressively worsening raised intracranial pressure and secondary tonsillar herniation and cervical syringomyelia. Magnetic resonance (MR) imaging showed a large midline inhomogenously enhancing vermian tumor causing moderate obstructive hydrocephalus. In addition, the cerebellar tonsils herniated down to the C2 level, and there was a centrally located syrinx from C2-T1. The tumor was resected through a suboccipital craniectomy. At follow-up after 3 months, MR imaging demonstrated total resolution of tonsillar herniation and cervical syringomyelia. CONCLUSIONS The occurrence of tonsillar herniation and syringomyelia in association with a slow growing benign tumor like pilocytic astrocytoma of the cerebellum is uncommon. The blockade of normal cerebrospinal fluid circulation pathway at the foramen magnum is the crucial factor. Surgical extirpation of the tumor restores the normal cerebrospinal fluid circulation at the foramen magnum and produces an excellent outcome. The need for an additional surgical procedure for treatment of associated tonsillar herniation and syringomyelia can be avoided. Volumetric assessment of the posterior fossa may provide a better understanding of the pathophysiology of syringomyelia in such patients.
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Affiliation(s)
- Dattatraya Muzumdar
- Division of Neurosurgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, K1H 8 L1, Ontario, Canada
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Fox B, Muzumdar D, DeMonte F. Resolution of tonsillar herniation and cervical syringomyelia following resection of a large petrous meningioma: case report and review of literature. Skull Base 2005; 15:89-97; discussion 98. [PMID: 16148987 PMCID: PMC1151707 DOI: 10.1055/s-2005-868168] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We describe a case of a large, petrous meningioma associated with tonsillar herniation and cervical syringomyelia. The patient, a 53-year-old woman, had a 6-month history of a dull, aching pain in the occipital region associated with numbness in the right C2 dermatome and left gaze evoked nystagmus. Magnetic resonance imaging (MRI) revealed a large tumor in the right posterior fossa associated with moderate supratentorial hydrocephalus. Secondary tonsillar herniation and cervical syringomyelia extending from C2 to C6 were also identified. The tumor, later confirmed to be a meningioma originating from the petrous region, was resected completely via a retrosigmoid approach. Postoperative MRI demonstrated total resolution of the tonsillar herniation and cervical syringomyelia. The radiological features, potential pathophysiological mechanisms, and treatment strategies are discussed in relation to the recent literature.
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Affiliation(s)
| | - Dattatraya Muzumdar
- Department of Neurosurgery, King Edward VII Memorial Hospital, Parel, Mumbai, India
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas
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Goel A, Cacciola F, Muzumdar DP. Trigeminal neurinoma associated with Chiari malformation and syringomyelia. J Clin Neurosci 2005; 12:608-10. [PMID: 15994079 DOI: 10.1016/j.jocn.2004.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Accepted: 06/07/2004] [Indexed: 10/25/2022]
Abstract
We report a 36 year-old woman who presented with headaches and hypoesthesia of the face. MRI revealed a large dumbbell shaped trigeminal neurinoma extending into both the middle and the posterior cranial fossae. In addition, there was a Chiari I malformation and syringomyelia. Within two months of tumor resection, both the Chiari malformation and the syringomyelia resolved. The association of an intracranial space-occupying lesion with Chiari malformation and syringomyelia is reviewed.
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Affiliation(s)
- A Goel
- Department of Neurosurgery, Seth G.S. Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, India.
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Bejjani GK. Association of the Adult Chiari Malformation and Idiopathic Intracranial Hypertension: more than a coincidence. Med Hypotheses 2003; 60:859-63. [PMID: 12699714 DOI: 10.1016/s0306-9877(03)00064-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There are significant similarities between the Adult Chiari Malformation (ACM) and Idiopathic Intracranial Hypertension (IIH). They include similar demographics, clinical presentation, and response to treatment. There is an eightfold increase in the incidence of significant tonsillar herniation in patients with IIH. Based on these findings and our observation in a subgroup of patients with failed ACM decompression, we suggest that these disorders are interrelated in a group of patients. The physiopathology is that of craniocephalic disproportion, i.e., a disproportion between the skull and the brain, due to a small skull or posterior fossa (like in ACM) and/or an engorged brain (like in IIH). This will occasionally lead to tonsillar ectopia. The craniocephalic disproportion will alter the brain compliance and lead to the symptomatology.
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Affiliation(s)
- Ghassan K Bejjani
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Nomura S, Akimura T, Imoto H, Nishizaki T, Suzuki M. Endoscopic fenestration of posterior fossa arachnoid cyst for the treatment of presyrinx myelopathy--case report. Neurol Med Chir (Tokyo) 2002; 42:452-4. [PMID: 12416571 DOI: 10.2176/nmc.42.452] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 32-year-old man presented with an arachnoid cyst of the posterior fossa manifesting as cervical syringomyelic myelopathy. Magnetic resonance (MR) imaging demonstrated edematous enlargement and T2 prolongation of the cervical spinal cord, indicating a "presyrinx" state. MR imaging showed the inferior wall of the cyst, which disturbed cerebrospinal fluid (CSF) pulsatile movement between the intraspinal and intracranial subarachnoid spaces. The cyst wall was fenestrated with a neuroendoscope. The presyrinx state and the CSF movement improved. Posterior fossa arachnoid cyst, as well as Chiari malformation, can cause CSF flow disturbance at the craniocervical junction and syringomyelia. Endoscopic fenestration is less invasive than foramen magnum decompression and should be the procedure of choice.
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Affiliation(s)
- Sadahiro Nomura
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan.
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Abstract
With the widespread use of newer neuroimaging techniques and modalities, significant tonsillar herniation is being diagnosed in more than 0.5% of patients, some of whom are asymptomatic. This puts the definition of the adult Chiari malformation to the test. The author provides a historical review of the evolution of the definition of the adult Chiari malformation in the neurosurgery, radiology, and pathology literature.
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Affiliation(s)
- G K Bejjani
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Sheehan JM, Jane JA. Resolution of Tonsillar Herniation and Syringomyelia after Supratentorial Tumor Resection: Case Report and Review of the Literature. Neurosurgery 2000. [DOI: 10.1227/00006123-200007000-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Sheehan JM, Jane JA. Resolution of tonsillar herniation and syringomyelia after supratentorial tumor resection: case report and review of the literature. Neurosurgery 2000; 47:233-5. [PMID: 10917368 DOI: 10.1097/00006123-200007000-00050] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE The pathophysiological features of syringomyelia are not yet entirely understood. We present a case of a supratentorial mass causing tonsillar herniation and syringomyelia. CLINICAL PRESENTATION A 51-year-old woman underwent magnetic resonance imaging for evaluation of progressive headaches. A large parieto-occipital mass was revealed. Herniation of the cerebellar tonsils and a cervical syrinx were also noted. INTERVENTION A craniotomy was performed without incident. After tumor resection, the tonsils ascended and the syrinx resolved in a 1-year period. CONCLUSION This case highlights the importance of tonsillar herniation in the pathogenesis of syringomyelia. "Acquired" Chiari malformations and syringomyelia attributable to supratentorial masses may be treated by mass resection alone, without the need for foramen magnum decompression.
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Affiliation(s)
- J M Sheehan
- Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, USA
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Siringomielia cervical, descenso amigdalar y tumor cerebral. Neurocirugia (Astur) 1999. [DOI: 10.1016/s1130-1473(99)70976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Paré LS, Batzdorf U. Syringomyelia persistence after Chiari decompression as a result of pseudomeningocele formation: implications for syrinx pathogenesis: report of three cases. Neurosurgery 1998; 43:945-8. [PMID: 9766325 DOI: 10.1097/00006123-199810000-00125] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE We present the cases of three patients in whom pseudomeningocele (PSM) formations after posterior fossa decompression of hindbrain herniations (Chiari I malformations) were associated with persistence of syringomyelia. The physiological importance of correcting this complication has not been previously described. CLINICAL PRESENTATION We identified three patients who developed suboccipital PSMs after undergoing posterior fossa decompression for hindbrain herniations and syringomyelia. All three patients experienced persistence of their symptoms and their syringomyelia, despite adequate posterior fossa decompression. TECHNIQUE Subsequent exploration revealed cerebrospinal fluid leaking either from the dural suture line (one patient) or from perforations found within the bed of a polyglactin mesh dural graft (two patients). Correction of the PSM resulted in resolution of both the syringomyelia and the symptoms in all three patients. DISCUSSION The persistence of syringomyelia in the presence of a PSM may be the result of dissipation of the cerebrospinal fluid systolic pressure wave into the distensible PSM cavity. This phenomenon suggests that the cerebrospinal fluid pressure exerted on the spinal cord surface favors resolution of the syrinx cavity.
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Affiliation(s)
- L S Paré
- Division of Neurosurgery, University of California, Los Angeles Medical Center, 90095-6901, USA
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