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Yuan C, Guan J, Jian F. Rapid progression of acute cervical syringomyelia: A case report of delayed complications following spinal cord injury. J Spinal Cord Med 2022; 45:155-159. [PMID: 32202488 PMCID: PMC8890579 DOI: 10.1080/10790268.2020.1733336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Context: Post-traumatic syringomyelia treatment usually focuses on restoring normal cerebrospinal fluid (CSF) flow. Herein, the first-reported case of delayed post-traumatic syringomyelia associated with an L2 compression fracture 30 years prior to syringomyelia symptoms that rapidly progressed to the brainstem within 5 months, leading to respiratory and circulatory impairments, is summarized. The improvement in symptoms and significant decrease in size of the syringomyelia/syringobulbia achieved in this patient suggest that the initial treatment of choice in such acute cases should be posterior fossa decompression (PFD). Intradural exploration in order to restore the normal CSF flow at the level of trauma can then be planned in a later time.Findings: A retrospective analysis of clinical manifestations and findings obtained from magnetic resonance (MR) imaging, including pre-operative and post-operative follow-up data acquired 6 months later, provided adequate comparisons of the neurological deficits and syrinx size. Interestingly, serial MR images showed that a cervical syrinx acutely progressed to the brainstem within 5 months. PFD and sectioning of the thick veil completely obstructing the foramen of Magendie resulted in partial resolution of the neurological deficits and syringomyelia regression after surgery.Conclusions: To our knowledge, this is the first case report to summarize the delayed complications of a spinal cord injury and acute syringomyelia progression to the brainstem in a short period. The symptoms were relieved by an emergency PFD, chosen due to the rapid progression of symptoms. An atypical treatment strategy is described for extremely rare cases, but with a good short-term prognosis.
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Affiliation(s)
- Chenghua Yuan
- Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jian Guan
- Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fengzeng Jian
- Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence to: Fengzeng Jian, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing100053, P.R. People’s Republic of China.
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Mahazou I, Choukri M, Parker F, Knafo S. Cerebellar Syringocephaly Following Surgery for Chiari Malformation. Neurology 2021; 97:38-39. [PMID: 33931543 DOI: 10.1212/wnl.0000000000012128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ismaël Mahazou
- From the Department of Neurosurgery, Bicêtre Hospital, AP-HP, University Paris-Saclay, France
| | - Mohamed Choukri
- From the Department of Neurosurgery, Bicêtre Hospital, AP-HP, University Paris-Saclay, France
| | - Fabrice Parker
- From the Department of Neurosurgery, Bicêtre Hospital, AP-HP, University Paris-Saclay, France
| | - Steven Knafo
- From the Department of Neurosurgery, Bicêtre Hospital, AP-HP, University Paris-Saclay, France.
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Menezes AH, Greenlee JDW, Dlouhy BJ. Syringobulbia in pediatric patients with Chiari malformation type I. J Neurosurg Pediatr 2018; 22:52-60. [PMID: 29701558 DOI: 10.3171/2018.1.peds17472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Syringobulbia (SB) is a rare entity, with few cases associated with Chiari malformation type I (CM-I) in the pediatric population. The authors reviewed all pediatric cases of CM-I-associated SB managed at their institution in order to better understand the presentation, treatment, and surgical outcomes of this condition. METHODS A prospectively maintained institutional database of craniovertebral junction abnormalities was analyzed to identify all cases of CM-I and SB from the MRI era (i.e., after 1984). The authors recorded presenting symptoms, physical examination findings, radiological findings, surgical treatment strategy, intraoperative findings, and outcomes. SB cases associated with tumors, infections, or type II Chiari malformations were excluded. RESULTS The authors identified 326 pediatric patients with CM-I who were surgically treated. SB was identified in 13 (4%) of these 326 patients. Headache and neck pain were noted in all 13 cases. Cranial nerve abnormalities were common: vagus and glossopharyngeal nerve dysfunction was the most frequent observation. Other cranial nerves affected included the trigeminal, abducens, and hypoglossal nerves. Several patients exhibited multiple cranial nerve palsies at presentation. Central sleep apnea was present in 6 patients. Syringomyelia (SM) was present in all 13 patients. SB involved the medulla in all cases, and extended rostrally into the pons and midbrain in 2 patients; in 1 of these 2 cases the cavity extended further rostrally to the cerebrum (syringocephaly). SB communicated with the fourth ventricle in 7 of the 13 cases. All 13 patients were treated with posterior fossa decompression with intradural exploration to ensure CSF egress out of the fourth ventricle and through the foramen magnum. The foramen of Magendie was found to be occluded by an arachnoid veil in 9 cases. Follow-up evaluation revealed that SB improved before SM. Cranial nerve palsies regressed in 11 of the 13 patients, and SB improved in all 13. CONCLUSIONS The incidence of SB in our surgical series of pediatric patients with CM-I was 4%, and all of these patients had accompanying SM. The SB cavity involved the medulla in all cases and was found to communicate with the fourth ventricle in 54% of cases. Posterior fossa decompression with intradural exploration and duraplasty is an effective treatment for these patients.
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Affiliation(s)
- Arnold H Menezes
- 1Department of Neurosurgery, University of Iowa Carver College of Medicine.,2Department of Neurosurgery, University of Iowa Stead Family Children's Hospital
| | - Jeremy D W Greenlee
- 1Department of Neurosurgery, University of Iowa Carver College of Medicine.,3Department of Neurosurgery, Iowa Neuroscience Institute, University of Iowa; and
| | - Brian J Dlouhy
- 1Department of Neurosurgery, University of Iowa Carver College of Medicine.,4Department of Neurosurgery, Pappajohn Biomedical Institute, University of Iowa, Iowa City, Iowa
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Yuh WT, Kim CH, Chung CK, Kim HJ, Jahng TA, Park SB. Surgical Outcome of Adult Idiopathic Chiari Malformation Type 1. J Korean Neurosurg Soc 2016; 59:512-7. [PMID: 27651871 PMCID: PMC5028613 DOI: 10.3340/jkns.2016.59.5.512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The pathophysiology of idiopathic Chiari malformation (CM) type 1 is disturbance of free cerebrospinal fluid (CSF) flow and restoration of normal CSF flow is the mainstay of treatment. Additional migration of the medulla oblongata in pediatric patients is referred to as CM type 1.5, but its significance in adult patients is unknown. This study is to compare surgical outcomes of adult idiopathic CM type 1.5 with that of type 1. METHODS Thirty-eight consecutive adult patients (M : F=11 : 27; median, 33.5; range, 18-63) with syringomyelia due to idiopathic CM type 1 were reviewed. Migration of the medulla oblongata was noted in 13 patients. The modified McCormick scale (MMS) was used to evaluate functional status before and one year after surgery. All patients underwent foramen magnum decompression and duroplasty. Factors related to radiological success (≥50% decrease in the diameter of the syrinx) were investigated. The follow-up period was 72.7±55.6 months. RESULTS Preoperative functional status were MMS I in 11 patients and MMS II in 14 of CM type 1 and MMS I in 8 and II in 5 of CM type 1.5. Of patients with MMS II, 5/14 patients in group A and 3/5 patients in group B showed improvement and there was no case of deterioration. Radiological success was achieved in 32 (84%) patients and restoration of the cisterna magna (p=0.01; OR, 46.5) was the only significant factor. CONCLUSION Migration of the medulla oblongata did not make a difference in the surgical outcome when the cisterna magna was restored.
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Affiliation(s)
- Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Korea
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Menezes AH, Greenlee JDW, Longmuir RA, Hansen DR, Abode-Iyamah K. Syringohydromyelia in association with syringobulbia and syringocephaly: case report. J Neurosurg Pediatr 2015; 15:657-61. [PMID: 26030334 DOI: 10.3171/2014.11.peds14189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case of a 14-year-old boy with holocord syringohydromyelia extending into the brainstem, cerebral peduncle, internal capsule, and cerebral cortex. At the posterior fossa exploration, an opaque thickened arachnoid with occlusion of the foramen of Magendie was encountered. Careful documentation of postoperative regression of the syringocephaly, syringobulbia, and syringohydromyelia was made. The pathophysiology is discussed.
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Affiliation(s)
| | | | - Reid A Longmuir
- 2Department of Ophthalmology, Division of Neuro-Ophthalmology, University of Iowa Hospitals and Clinics, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Kijsirichareanchai K, Limsuwat C, Mankongpaisarnrung C, Nantsupawat N, Nugent K. Chiari Syndrome and Respiratory Failure. J Intensive Care Med 2013; 29:260-8. [DOI: 10.1177/0885066613485213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Patients with failed extubation requiring reintubation have increased morbidity and mortality. This situation may reflect the severity of the underlying disorder or may reflect an undiagnosed condition that was not apparent at the time of the initial intubation. Methods: Case report and literature review. Results: A 49-year-old man developed acute hypercapneic respiratory failure during an episode of community-acquired pneumonia. This patient failed extubation 4 times. Routine neurological evaluation, including computed tomography of the head, was within normal limits. A magnetic resonance imaging revealed a severe Chiari malformation type I. The patient eventually required tracheostomy and prolonged mechanical ventilation. We identified 28 cases with Chiari malformations (CM) in the medical literature, who presented with respiratory failure. The mean age was 29.5 years, 46% of the cases were male, 50% had an associated syringomyelia, and 64% required a decompressive surgery. Twenty-five percent had recurrent symptoms postsurgery. Conclusions: Patients with CMs can have repeated extubation failures. Some of these patients have normal neurological examinations and studies and are not identified until they have an MRI study. Clinicians need to consider this possibility in patients who are difficult to wean.
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Affiliation(s)
| | - Chok Limsuwat
- Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA
| | | | - Nopakoon Nantsupawat
- Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA
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Clinical course of incidental syringomyelia without predisposing pathologies. J Clin Neurosci 2012; 19:665-8. [DOI: 10.1016/j.jocn.2011.07.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 07/08/2011] [Accepted: 07/12/2011] [Indexed: 11/19/2022]
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Romero-Pinel L, Fernández S, Torres A, Majós C, Ferran E, Martínez-Yélamos S, Martínez-Matos JA. Syringomyelia extending to the corona radiata. J Neurol 2006; 253:817-8. [PMID: 16619128 DOI: 10.1007/s00415-006-0115-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Revised: 12/01/2005] [Accepted: 12/16/2005] [Indexed: 11/27/2022]
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Botelho RV, Bittencourt LRA, Rotta JM, Tufik S. Adult Chiari malformation and sleep apnoea. Neurosurg Rev 2005; 28:169-76. [PMID: 15909232 DOI: 10.1007/s10143-005-0400-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Revised: 09/01/2004] [Accepted: 10/25/2004] [Indexed: 10/25/2022]
Abstract
Chiari malformation (CM) is primarily characterised by herniation of the cerebellar tonsils through the foramen magnum. Clinically, two main types of CM represent the vast majority of cases: type I (in adults) and type II (in infants). CM may result in neuronal impairment of the brainstem, upper spinal cord and cranial nerves. Part of the afferent and efferet systems and the central respiratory controlling system are located in the cranium-cervical transition and may be damaged in these pathologies, leading to respiratory disorders, such as respiratory failure and death. The ventilatory responses to exogenous and endogenous stimuli, such as responses to hypoxia and hypercapnia, are usually diminished, and apnea may be manifested and detected during sleep, allowing for the diagnosis. This study is a review of the relationship between sleep apnoea and adult CM.
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Doughty KE, Tubbs RS, Webb D, Oakes WJ. Delayed Resolution of Chiari I-associated Hydromyelia after Posterior Fossa Decompression: Case Report and Review of the Literature. Neurosurgery 2004; 55:711. [PMID: 16933383 DOI: 10.1227/01.neu.0000134548.16165.9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
The expected time interval for resolution of hydromyelia after Chiari I decompression is lacking in the literature. This case report highlights one instance of delayed resolution of Chiari-induced hydromyelia.
CLINICAL PRESENTATION:
We report an adolescent girl with a Chiari I malformation and hydromyelia.
INTERVENTION:
A suboccipital craniectomy and C1 laminectomy with intradural exploration and duraplasty were performed. Serial imaging at 1 and 2 years after posterior cranial fossa decompression with duraplasty demonstrated no change in the size of the hydromyelia. At 3 years after surgery and before reoperation for continued hydromyelia, repeat magnetic resonance imaging demonstrated significant diminution of the fluid cavity. If this hydromyelia did resolve as a result of surgery, the interval for radiological observation clearly needs to be reconsidered.
CONCLUSION:
Unfortunately, this is an area in which the literature is lacking. With this case as a nidus, studies are now necessary to determine the range of time necessary for Chiari I malformation-related hydromyelia to resolve.
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Affiliation(s)
- Kyle E Doughty
- Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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