1
|
Dien Esquivel MF, Gupta N, Wilson N, O'Brien CA, Gladkikh M, Barrowman N, Bijelić V, Tu A. Pediatric Chiari I malformation: novel and traditional measurements associated with syrinx and surgery. Childs Nerv Syst 2022; 38:2119-2128. [PMID: 35962220 DOI: 10.1007/s00381-022-05644-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/03/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Multiple imaging parameters have been examined to estimate the presence of syrinx and the need for surgery in Chiari I patients (CM1); however, no consistent or definitive criteria have been proposed. The objective of this study was to review existing and identify novel radiological and clinical characteristics of CM1 patients that associate syrinx development and surgical intervention. METHODS Patients with Chiari I malformation diagnosed on imaging between 0 and 18 years were retrospectively reviewed from January 1, 2007 to February 12, 2020. Participants were included if they had a baseline MRI of the head and spine prior to surgical intervention if required. Forty age-matched controls with cranial imaging were identified for comparison. Imaging parameters and clinical symptoms were recorded. RESULTS A total of 122 CM1 patients were included in this study. Of the 122 patients, 28 (23%) had syrinx, and 27 (22%) had surgery. The following imaging parameters associated with syrinx and surgical intervention were identified: midbrain length (P < 0.001; P = 0.032), the obex position (P = 0.002; P < 0.001) and medullary kinking (P = 0.041; P < 0.001). Among the clinical features, the presence of overall pain (P = 0.017; P = 0.042), neck pain (P = 0.005; P = 0.027), and sensory dysfunction (P < 0.001) were found to be strongly associated with syrinx and surgery. CONCLUSION While further investigation is needed, these specific radiological and clinical parameters should be considered when evaluating CM1 patients and may be used to guide further management.
Collapse
Affiliation(s)
- Maria F Dien Esquivel
- University of Ottawa, Ottawa, ON, Canada. .,Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
| | - Neetika Gupta
- University of Ottawa, Ottawa, ON, Canada.,Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Nagwa Wilson
- University of Ottawa, Ottawa, ON, Canada.,Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Christian Alfred O'Brien
- University of Ottawa, Ottawa, ON, Canada.,Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | | | - Nick Barrowman
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Vid Bijelić
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Albert Tu
- University of Ottawa, Ottawa, ON, Canada.,Division of Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Radojicic M, Nistor G, Keirstead HS. Ascending central canal dilation and progressive ependymal disruption in a contusion model of rodent chronic spinal cord injury. BMC Neurol 2007; 7:30. [PMID: 17822568 PMCID: PMC2018707 DOI: 10.1186/1471-2377-7-30] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 09/07/2007] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Chronic spinal cord injury (SCI) can lead to an insidious decline in motor and sensory function in individuals even years after the initial injury and is accompanied by a slow and progressive cytoarchitectural destruction. At present, no pathological mechanisms satisfactorily explain the ongoing degeneration. METHODS Adult female Sprague-Dawley rats were anesthetized laminectomized at T10 and received spinal cord contusion injuries with a force of 250 kilodynes using an Infinite Horizon Impactor. Animals were randomly distributed into 5 groups and killed 1 (n = 4), 28 (n = 4), 120 (n = 4), 450 (n = 5), or 540 (n = 5) days after injury. Morphometric and immunohistochemical studies were then performed on 1 mm block sections, 6 mm cranial and 6 mm caudal to the lesion epicenter. The SPSS 11.5 t test was used to determine differences between quantitative measures. RESULTS Here, we document the first report of an ascending central canal dilation and progressive ependymal disruption cranial to the epicenter of injury in a contusion model of chronic SCI, which was characterized by extensive dural fibrosis and intraparenchymal cystic cavitation. Expansion of the central canal lumen beyond a critical diameter corresponded with ependymal cell ciliary loss, an empirically predictable thinning of the ependymal region, and a decrease in cell proliferation in the ependymal region. Large, aneurysmal dilations of the central canal were accompanied by disruptions in the ependymal layer, periependymal edema and gliosis, and destruction of the adjacent neuropil. CONCLUSION Cells of the ependymal region play an important role in CSF homeostasis, cellular signaling and wound repair in the spinal cord. The possible effects of this ascending pathology on ependymal function are discussed. Our studies suggest central canal dilation and ependymal region disruption as steps in the pathogenesis of chronic SCI, identify central canal dilation as a marker of chronic SCI and provide novel targets for therapeutic intervention.
Collapse
Affiliation(s)
- Milan Radojicic
- Reeve-Irvine Research Center, Department of Anatomy and Neurobiology, University of California at Irvine, 2111 Gillespie Neuroscience Research Facility, Irvine, CA, 92697-4292, USA
- 4000 Civic Center Drive, Suite 206, San Rafael, CA 94903, USA
| | - Gabriel Nistor
- Reeve-Irvine Research Center, Department of Anatomy and Neurobiology, University of California at Irvine, 2111 Gillespie Neuroscience Research Facility, Irvine, CA, 92697-4292, USA
| | - Hans S Keirstead
- Reeve-Irvine Research Center, Department of Anatomy and Neurobiology, University of California at Irvine, 2111 Gillespie Neuroscience Research Facility, Irvine, CA, 92697-4292, USA
| |
Collapse
|
4
|
Chang HS, Nakagawa H. Theoretical analysis of the pathophysiology of syringomyelia associated with adhesive arachnoiditis. J Neurol Neurosurg Psychiatry 2004; 75:754-7. [PMID: 15090573 PMCID: PMC1763562 DOI: 10.1136/jnnp.2003.018671] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To apply a theoretical model to analyse the derangement of cerebrospinal fluid (CSF) dynamics in syringomyelia associated with adhesive arachnoiditis. METHODS An electrical circuit model of CSF dynamics in the spine was used. With this model, the derangement of CSF dynamics in adhesive arachnoiditis was simulated. The effects of various surgical procedures were then analysed, such as syringo-subarachnoid shunting, subarachnoid bypass, and foramen magnum decompression. RESULTS When CSF flow in the subarachnoid space was obstructed at a certain point, the pressure inside the spinal cord increased in the segment immediately distal to the blockage. This location of increased pressure corresponded to the preferred site of syrinx formation in adhesive arachnoiditis. Syringo-subarachnoid shunting, subarachnoid bypass, and foramen magnum decompression were all effective at reducing this pressure gradient. CONCLUSIONS Blockage of the spinal subarachnoid CSF pathway produces a relative increase in the pressure inside the spinal cord distal to the blockage point. Repetitive formation of this pressure gradient then induces CSF leakage into the spinal parenchyma, leading to the formation of syringomyelia. Using this model, alternative surgical procedures could be suggested that might be effective in treating this disease.
Collapse
Affiliation(s)
- H S Chang
- Department of Neurological Surgery, Aichi Medical University, Aichi-gun, Japan.
| | | |
Collapse
|
5
|
Abstract
OBJECT The authors review their experience in the diagnosis and management of 32 patients with slitlike syrinx cavities. METHODS There were 18 men and 14 women with a mean age of 40 years. Presenting symptoms that prompted magnetic resonance (MR) imaging evaluation were mechanical spinal pain (13 patients), radicular pain (seven patients), paresthesia (six patients), numbness (five patients), and muscle spasm (one patient). In 12 patients neurological examination demonstrated normal status, and in the remainder only minimal sensory or motor abnormalities were found. The mean diameter of the syrinx cavity was 2 mm (range 1-5 mm), and on average it covered three vertebral levels. The cavities were limited to the cervical region in 16 patients, the thoracic in 12, and both regions in four patients. The mean follow-up time for changes in clinical condition and repeated MR imaging features were 38 and 32 months, respectively. Thirty-one patients were treated nonoperatively, and one was treated surgically. During the follow-up period clinical improvement was documented in six patients, worsened status in seven, and no change was demonstrated in the clinical status of 19 patients. None of the syrinx cavities changed in size. In 16 patients medical workup revealed alternative diagnoses that were determined to be the true causes of each patient's symptoms. CONCLUSIONS Slitlike cavities likely do not represent true syringomyelia but rather remnants of the central canal detected in a small percentage of adults. Review of the authors' experience indicates that these cavities are asymptomatic and are unlikely to change in size. They can be considered an incidental finding, and in many of these patients another condition explaining the patient's symptoms may be found.
Collapse
Affiliation(s)
- Langston T Holly
- Division of Neurosurgery, University of California at Los Angeles Medical Center, 90095-6901, USA
| | | |
Collapse
|