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Tropeano MP, Rossini Z, Franzini A, Baram A, Creatura D, Raspagliesi L, Pessina F, Fornari M. Predictive Factors of Long-Term Neurologic Outcome and Progression-Free Survival in Intramedullary Spinal Cord Tumors: A 10-year Single-Center Cohort Study and Review of the Literature. World Neurosurg 2024; 187:e94-e106. [PMID: 38608817 DOI: 10.1016/j.wneu.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Intramedullary spinal cord tumors (IMSCTs) are a rare subgroup of neoplasms, encompassing both benign, slow-growing masses, and malignant lesions; radical surgical excision represents the cornerstone of treatment for such pathologies regardless of histopathology, which, on the other hand, is a known predictor of survival and neurologic outcome postsurgery. The present study aims to investigate the relevance of other factors in predicting survival and long-term functional outcomes. METHODS We conducted a review of current literature on functional outcomes of IMSCTs, as well as a 10-years prospective analysis of a wide cohort of patients with diagnosis of IMSCTs who underwent surgical resection at our institution. RESULTS Our series encompasses 60 patients with IMSCTS, among which 36 ependymomas, 6 cavernous angiomas, 5 hemangioblastomas, 6 WHO Grade I-IV astrocytomas, 3 intramedullary spinal metastases and 4 miscellaneous tumors. GTR was achieved in 76,67% of patients, with high preoperative McCormick grade, syringomyelia and changes at neurophysiologic monitoring being the strongest predictors at multivariate analysis (P = 0.0027, P = 0.0017 and P = 0.001 respectively). CONCLUSIONS Consistently with literature, preoperative neurologic function is the most important factor predicting long-term functional outcome (0.17, CI 0.069-0.57 with P = 0.0018), advocating for early surgery in the management of IMSCTs, whereas late complications such as myelopathy and neuropathic pain were present regardless of preoperative function.
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Affiliation(s)
- Maria Pia Tropeano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Zefferino Rossini
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea Franzini
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Ali Baram
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Donato Creatura
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Luca Raspagliesi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maurizio Fornari
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
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Zhang M, Hu Y, Song D, Duan C, Wei M, Zhang L, Lei S, Guo F. Exploring the prognostic differences in patients of Chiari malformation type I with syringomyelia undergoing different surgical methods. Front Neurol 2023; 13:1062239. [PMID: 36686516 PMCID: PMC9846178 DOI: 10.3389/fneur.2022.1062239] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Background The best surgical treatment of Chiari malformation patients with syringomyelia remains controversial, and whether cerebellar tonsillectomy should be performed has not been decided. Objective To evaluate the efficacy of posterior fossa decompression with duraplasty (PFDD) and Posterior fossa decompression with resection of tonsils (PFDRT) in patients of Chiari malformation type I (CM-I) with syringomyelia and explore relevant factors affecting prognosis. Patients and methods We retrospectively analyzed 182 adult patients of CM-I with syringomyelia who underwent PFDD or PFDRT over a 6-year period, and analyzed their clinical manifestations, imaging features, and follow-up data. Clinical outcomes were assessed using the Chicago Chiari Outcome Scale (CCOS), and imaging outcomes were assessed using the syrinx remission rate. Difference comparisons were performed to compare the differences between different surgical groups. Influencing factors associated with outcome were investigated using bivariate analysis and multiple linear regression analysis. Results There were statistically significant differences in CCOS score (p = 0.034) and syrinx remission rates (p = 0.046) between the PFDRT group and the PFDD group after surgery. Regression analysis showed that preoperative motor dysfunction, cerebellar-related symptoms and different surgical methods may have influenced the CCOS score and that brainstem-related symptoms and age may have influenced the syrinx remission rates in the total patient group (p < 0.05). Regression analysis showed that the duration of symptoms, cerebellar-related symptoms and preoperative syrinx diameter may have influenced the CCOS score and that the preoperative cerebellar tonsillar hernia distance may have influenced the postoperative syrinx remission rate in the PFDRT group (p < 0.05). Age and length of hospital stay may have influenced the CCOS score, and brainstem-related symptoms and age may have influenced the syrinx remission rates in the PFDD group (p < 0.05). Conclusion This study showed that the CCOS score in the PFDRT group was better than that in the PFDD group. Preoperative motor dysfunction, cerebellar-related symptoms, and different surgical methods in patients of CM-I with syringomyelia affected postoperative CCOS score. Both the duration of symptoms and the age of the patients should be actively considered as factors influencing prognosis. Symptomatic CM-I patients with syringomyelia should undergo surgical treatment as early as possible.
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Affiliation(s)
- Mingchu Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,International Joint Laboratory of Chiari Malformation, Zhengzhou, Henan, China
| | - Yan Hu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,International Joint Laboratory of Chiari Malformation, Zhengzhou, Henan, China
| | - Dengpan Song
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,International Joint Laboratory of Chiari Malformation, Zhengzhou, Henan, China
| | - Chengcheng Duan
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,International Joint Laboratory of Chiari Malformation, Zhengzhou, Henan, China
| | - Mingkun Wei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,International Joint Laboratory of Chiari Malformation, Zhengzhou, Henan, China
| | - Longxiao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,International Joint Laboratory of Chiari Malformation, Zhengzhou, Henan, China
| | - Shixiong Lei
- Department of Neurosurgery, Beijing Hospital, Beijing, China
| | - Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,International Joint Laboratory of Chiari Malformation, Zhengzhou, Henan, China,*Correspondence: Fuyou Guo ✉
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Seki T, Hamauchi S, Yamazaki M, Hida K, Yano S, Houkin K. Investigation of the Neuropathic Pain Caused by Syringomyelia Associated with Chiari I Malformation. Asian Spine J 2019; 13:648-653. [PMID: 30966726 PMCID: PMC6680027 DOI: 10.31616/asj.2018.0242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/10/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective cohort study. Purpose To investigate the correlation between the syrinx morphology and neuropathic pain caused by syringomyelia associated with Chiari I malformation. Overview of Literature Neuropathic pain caused by syringomyelia is refractory and markedly impairs the patient. Methods We examined 24 patients with neuropathic pain caused by syringomyelia associated with Chiari I malformation. We statistically analyzed the illness duration and age at surgery between patients with and without neuropathic pain. Additionally, we classified the morphology of the syringes into deviated (D), enlarged (E), central (C), and bulkhead (B) types using T2-weighted axial imaging. Moreover, we investigated the correlation between syrinx morphology and neuropathic pain. A Mann–Whitney U-test was performed to compare between the presence or absence of neuropathic pain and the presence or absence of type D syringes. Results The median age at surgery was 27.5 years, and the median illness duration was 24 months. Among the 24 patients, 11 had preoperative neuropathic pain, one of which was free of neuropathic pain during the final follow-up period. Among patients with neuropathic pain, the syringes’ preoperative morphology was type D in nine patients and types E and C in one patient each. No patient exhibited type B morphology. Among patients without neuropathic pain, the preoperative morphology of the syringes was type D in three patients, type E in seven patients, and types C and B in two patients each. For types D and E, a correlation between neuropathic pain and syrinx morphology was observed. Moreover, type D was associated with significant neuropathic pain in both preoperative and postoperative states. Conclusions This study showed a correlation between the morphological features of the syringes and the occurrence of neuropathic pain in patients with syringomyelia associated with Chiari I malformation.
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Affiliation(s)
- Toshitaka Seki
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shuji Hamauchi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masayoshi Yamazaki
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
| | - Shunsuke Yano
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Zhang C, Morozova AY, Abakumov MA, Gubsky IL, Douglas P, Feng S, Bryukhovetskiy AS, Chekhonin VP. Precise Delivery Into Chronic Spinal Cord Injury Syringomyelic Cysts with Magnetic Nanoparticles MRI Visualization. Med Sci Monit 2015; 21:3179-85. [PMID: 26486048 PMCID: PMC4621156 DOI: 10.12659/msm.895624] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/02/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) often results in the deficiency of glia and neurons in cystic cavities. These syringomyelic cysts can prevent axonal regeneration and sprouting. Details of the mechanism of syringomyelic cyst formation are unknown and an effective treatment for overcoming syringomyelic cysts is not available. MATERIAL AND METHODS Ten adult female Wistar rats underwent contusion SCI modeling resulting in syringomyelic cyst formation. A novel method for locating the cysts was developed and employed. MRI safe silver needles were inserted through the erector spinae of anesthetized rats to create a stable reference point. MRI images of the rodent spine were taken with the needles in situ. This information was used to accurately locate the cyst and determine the 3-dimensional entry point coordinates for nanoparticle delivery. Nanoparticles were injected into the cyst during a primary injection of 8 ul and a secondary injection of 8 ul, to prove the procedure can be accurately repeated. RESULTS None of the rats died intra- or post-operatively. The syringomyelic cysts were accurately located with the 3-dimensional entry point coordinates. After nanoparticle delivery twice into each rat, the visualized syringomyelic cyst volume significantly decreased from 5.71±0.21 mm3 to 3.23±0.364 mm3 and to 1.48±0.722 mm3. CONCLUSIONS The present study describes a novel strategy for precise nanoparticle delivery into a syringomyelic cyst, using measurements obtained from MRI images. This strategy may aid in developing a new method for studying chronic spinal cord injury and a novel treatment for syringomyelic cysts.
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Affiliation(s)
- Chao Zhang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
- Department of Medicinal Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
| | - Anna Y. Morozova
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
| | - Maxim A. Abakumov
- Department of Medicinal Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Ilya L. Gubsky
- Department of Medicinal Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Patricia Douglas
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Shiqing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Andrey S. Bryukhovetskiy
- Center for Biomedical Technologies, Federal Research and Clinical Center for Specialized Types of Medical Assistance and Medical Technologies of The Federal Medical Biological Agency, Moscow, Russian Federation
| | - Vladimir P. Chekhonin
- Department of Medicinal Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
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Martin BA, Labuda R, Royston TJ, Oshinski JN, Iskandar B, Loth F. Spinal subarachnoid space pressure measurements in an in vitro spinal stenosis model: implications on syringomyelia theories. J Biomech Eng 2011; 132:111007. [PMID: 21034148 DOI: 10.1115/1.4000089] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Full explanation for the pathogenesis of syringomyelia (SM), a neuropathology characterized by the formation of a cystic cavity (syrinx) in the spinal cord (SC), has not yet been provided. It has been hypothesized that abnormal cerebrospinal fluid (CSF) pressure, caused by subarachnoid space (SAS) flow blockage (stenosis), is an underlying cause of syrinx formation and subsequent pain in the patient. However, paucity in detailed in vivo pressure data has made theoretical explanations for the syrinx difficult to reconcile. In order to understand the complex pressure environment, four simplified in vitro models were constructed to have anatomical similarities with post-traumatic SM and Chiari malformation related SM. Experimental geometry and properties were based on in vivo data and incorporated pertinent elements such as a realistic CSF flow waveform, spinal stenosis, syrinx, flexible SC, and flexible spinal column. The presence of a spinal stenosis in the SAS caused peak-to-peak cerebrospinal fluid CSF pressure fluctuations to increase rostral to the stenosis. Pressure with both stenosis and syrinx present was complex. Overall, the interaction of the syrinx and stenosis resulted in a diastolic valve mechanism and rostral tensioning of the SC. In all experiments, the blockage was shown to increase and dissociate SAS pressure, while the axial pressure distribution in the syrinx remained uniform. These results highlight the importance of the properties of the SC and spinal SAS, such as compliance and permeability, and provide data for comparison with computational models. Further research examining the influence of stenosis size and location, and the importance of tissue properties, is warranted.
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Affiliation(s)
- Bryn A Martin
- Integrative Bioscience Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
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Surgical outcomes of foramen magnum decompression for syringomyelia associated with Chiari I malformation: relation between the location of the syrinx and body pain. J Orthop Sci 2010; 15:299-304. [PMID: 20559796 DOI: 10.1007/s00776-010-1462-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 02/05/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND There have been few reports about the relation between the morphology of syrinxes and body pain in syringomyelia associated with Chiari I malformation. To investigate this phenomenon, the relation between the location of the syrinx and body pain before and after foramen magnum decompression (FMD) were evaluated. METHODS The subjects were 20 patients with Chiari I malformation associated with syringomyelia who underwent FMD. The morphology of the syrinxes was classified into three types - enlarged type, which was a distended syrinx at the central spinal cord; deviated type, which was a deviated syrinx posterolaterally within the spinal cord; central type, which was a small syrinx at the central canal of the spinal cord - based on axial magnetic resonance imaging (MRI). Preoperative and postoperative clinical symptoms and the body pain were evaluated by the Japanese Orthopaedic Association (JOA) score and a visual analogue scale (VAS) prospectively. RESULTS Preoperative and postoperative JOA scores showed no statistically significant differences between the three syrinx types. Intensity of body pain evaluated by the VAS showed that patients with a deviated-type syrinx on pre- and postoperative MRI tended to be associated with more intense pain than the other two types. CONCLUSIONS It was indicated that pain before and after surgery is more intense when the syrinx is deviated toward the spinal dorsal horn as seen on MRI.
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Park C, Kang BT, Yoo JH, Park HM. Syringomyelia in three small breed dogs secondary to Chiari-like malformation: clinical and diagnostic findings. J Vet Sci 2009; 10:365-7. [PMID: 19934606 PMCID: PMC2807277 DOI: 10.4142/jvs.2009.10.4.365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Three small breed dogs were referred for the evaluation of neurologic deficits. Upon physical and neurologic examination, all dogs displayed hyperesthesia, pain, and neck stiffness. Magnetic resonance imaging was performed on the brain and spinal cord, and all three dogs presented Chiari- like malformations and syringomyelia. These dogs were treated with prednisolone and furosemide, and showed rapid improvement of clinical signs. Chiari malformations and syringomyelia were not improved because of congenital disorders. This case report demonstrates the clinical and diagnostic features of Chiari-like malformations and syringomyelia in three small breed dogs.
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Affiliation(s)
- Chul Park
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
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Rusbridge C, Greitz D, Iskandar BJ. Syringomyelia: Current Concepts in Pathogenesis, Diagnosis, and Treatment. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb02884.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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