scholarly journals On the Pathogenesis of Syringomyelia: A Review

1980 ◽  
Vol 73 (11) ◽  
pp. 798-806 ◽  
Author(s):  
Bernard Williams
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Improvement ◽  
Subarachnoid Space ◽  
Fourth Ventricle ◽  
Central Canal ◽  
Venous Congestion ◽  
Perivascular Spaces ◽  
Spinal Tumours ◽  
Post Traumatic ◽  
Cerebellar Tonsils

Discussion of the pathogenesis of syringomyelia involves considering the origin of the fluid and also the forces which cause that fluid to break down the structure of the cord. When cerebrospinal fluid (CSF) appears to be the destructive element, it commonly enters through a patent central canal running from the fourth ventricle to the inside of the syrinx. In both clinical and experimental situations pressure differences may be measured which suck on the hindbrain, particularly the cerebellar tonsils, producing deformities. These pressure differences may also suck fluid into the syrinx. In other cases, even when a communication does not appear to be patent, the hindbrain abnormalities are usually present and suck effect may usually be demonstrated and its correction be accompanied by clinical improvement. Other sources of fluid within a syrinx include liquefaction of haematomata after traumatic paraplegia and transudation of fluid from intrinsic spinal tumours. Once fluid is present within a cord cavity it may pulsate upwards and downwards in response to fluid movements in the subarachnoid space, the most energetic of which result from venous influences. Such movement, ‘slosh’, may cause the cavities to extend at either end giving rise to upward and downward extension from a post-traumatic cord cyst and sometimes to syringobulbia. Cord ischaemia, venous congestion and transport of fluid along perivascular spaces may all play a part in the maintainance of cord cavities or the progression of the clinical disabilities.

Drainage of cerebral interstitial fluid into deep cervical lymph of the rabbit

1981 ◽  
Vol 240 (4) ◽  
pp. F329-F336 ◽  
Author(s):  
M. W. Bradbury ◽  
H. F. Cserr ◽  
R. J. Westrop
Keyword(s):  
Cerebrospinal Fluid ◽  
Caudate Nucleus ◽  
Subarachnoid Space ◽  
Interstitial Fluid ◽  
Bulk Flow ◽  
Perivascular Spaces ◽  
Csf Analysis ◽  
Intraventricular Injections ◽  
Intracerebral Microinjection ◽  
Do So

Lymph from the jugular lymph trunks of anesthetized rabbits has been continuously collected and radioiodinated albumin (RISA) therein estimated after microinjection of 1 microliter of 131I-albumin into the caudate nucleus, after single intraventricular injections, and during intraventricular infusions. Comparison of lymph at 7 and 25 h after intracerebral microinjection with efflux of radioactivity from whole brain suggests that about 50% of cleared radioactivity goes through lymph. Concentrations, normalized to cerebrospinal fluid (CSF), were much higher in lymph and retropharyngeal nodes after brain injection than after CSF injection or infusion. Also after brain injection, lymph and nodes contained more activity on injected side in contrast to lack of laterality after CSF administration. Calculation suggests that less than 30% of RISA cleared from brain can do so via a pool of well-mixed CSF. Analysis of tissues is compatible with much RISA draining by bulk flow via cerebral perivascular spaces plus passage from subarachnoid space of olfactory lobes into submucous spaces of nose and thus to lymph.

scholarly journals STUDIES ON INFLUENZAL MENINGITIS

1932 ◽  
Vol 55 (2) ◽  
pp. 223-234 ◽  
Author(s):  
Hugh K. Ward ◽  
Joyce Wright
Keyword(s):  
Cerebrospinal Fluid ◽  
Young Children ◽  
Clinical Improvement ◽  
Subarachnoid Space ◽  
Lethal Effect ◽  
Specific Antiserum ◽  
Purulent Meningitis ◽  
Uncommon Disease ◽  
The Brain ◽  
Very High

1. An acute purulent meningitis due to the invasion of the meninges by Pfeiffer's influenza bacillus is not a very uncommon disease ininfants and young children. It has a very high mortality. 2. Complement is entirely absent in the cerebrospinal fluid of these cases, and bactericidal experiments suggest that the injection of a specific antiserum will have but slight lethal effect on the organisms unless complement is injected at the same time. 3. Treatment with a mixture of specific antiserum and complement led in some cases to a definite clinical improvement, coincident with sterilization and clearing of the cerebrospinal fluid. But after some days, the patients relapsed and died. Autopsy showed localized abscesses in the vicinity of the base of the brain, the lesions being definitely walled off from the general subarachnoid space. In one case, the patient recovered. 4. Since the walls of the abscesses apparently present an insuperable mechanical obstacle to the action of the antiserum and complement, the possibility of preventing the formation of abscesses is discussed. Earlier diagnosis and more rapid sterilization are the most obvious measures. Bactericidal experiments indicate that the proportion of antiserum to complement may be an important factor in bringing about a more rapid elimination of the bacilli.

Pathological basis of spinal cord cavitation in syringomyelia: analysis of 105 autopsy cases

1995 ◽  
Vol 82 (5) ◽  
pp. 802-812 ◽  
Author(s):  
Thomas H. Milhorat ◽  
Anthony L. Capocelli ◽  
Archinto P. Anzil ◽  
Rene M. Kotzen ◽  
Robert H. Milhorat
Keyword(s):  
Spinal Cord ◽  
Subarachnoid Space ◽  
Fourth Ventricle ◽  
Spastic Paraparesis ◽  
Central Canal ◽  
Spinal Cord Tissue ◽  
Content Type ◽  
Age Related ◽  
Spinal Subarachnoid Space ◽  
Fine Print

✓ This report summarizes neuropathological, clinical, and general autopsy findings in 105 individuals with nonneoplastic syringomyelia. On the basis of detailed histological findings, three types of cavities were distinguished: 1) dilations of the central canal that communicated directly with the fourth ventricle (47 cases); 2) noncommunicating (isolated) dilations of the central canal that arose below a syrinx-free segment of spinal cord (23 cases); and 3) extracanalicular syrinxes that originated in the spinal cord parenchyma and did not communicate with the central canal (35 cases). The incidence of communicating syrinxes in this study reflects an autopsy bias of morbid conditions such as severe birth defects. Communicating central canal syrinxes were found in association with hydrocephalus. The cavities were lined wholly or partially by ependyma and their overall length was influenced by age-related stenosis of the central canal. Noncommunicating central canal syrinxes arose at a variable distance below the fourth ventricle and were associated with disorders that presumably affect cerebrospinal fluid dynamics in the spinal subarachnoid space, such as the Chiari I malformation, basilar impression, and arachnoiditis. These cavities were usually defined rostrally and caudally by stenosis of the central canal and were much more likely than communicating syrinxes to dissect paracentrally into the parenchymal tissues. The paracentral dissections of the central canal syrinxes occurred preferentially into the posterolateral quadrant of the spinal cord. Extracanalicular (parenchymal) syrinxes were found typically in the watershed area of the spinal cord and were associated with conditions that injure spinal cord tissue (for example, trauma, infarction, and hemorrhage). A distinguishing feature of this type of cavitation was its frequent association with myelomalacia. Extracanalicular syrinxes and the paracentral dissections of central canal syrinxes were lined by glial or fibroglial tissue, ruptured frequently into the spinal subarachnoid space, and were characterized by the presence of central chromatolysis, neuronophagia, and Wallerian degeneration. Some lesions extended rostrally into the medulla or pons (syringobulbia). Although clinical information was incomplete, simple dilations of the central canal tended to produce nonspecific neurological findings such as spastic paraparesis, whereas deficits associated with extracanalicular syrinxes and the paracentral dissections of central canal syrinxes included segmental signs that were referable to affected nuclei and tracts. It is concluded that syringomyelia has several distinct cavitary patterns with different mechanisms of pathogenesis that probably determine the clinical features of the condition.

Fine Structure of the Lateral Area of the Posterior Rhombencephalic Tela of the Bullfrog, Rana Catesbiana

1980 ◽  
Vol 38 ◽  
pp. 522-523
Author(s):  
J. E. Michaels ◽  
P. A. Tornheim
Keyword(s):  
Cerebrospinal Fluid ◽  
Choroid Plexus ◽  
Subarachnoid Space ◽  
Fourth Ventricle ◽  
Essential Feature ◽  
Ventricular System ◽  
Ependymal Cells ◽  
Open Communication ◽  
Tela Choroidea ◽  
Lateral Area

In mammals, the caudal roof of the fourth ventricle consists of an inner layer of ependymal cells and an outer layer of leptomeningeal cells. It contains specializations in the form of tufts of choroid plexus for the elaboration of cerebrospinal fluid (CSF) as well as gross apertures that permit open communication between the ventricular system and the subarachnoid space, an essential feature for mammalian CSF circulation. In the bullfrog, as in most submammals, the roof of the fourth ventricle contains a rostral rhombencephalic choroid plexus with no gross evidence of fourth ventricular apertures. Communication between the ventricular system and the subarachnoid space in this animal, however, has been demonstrated to occur by way of microscopic openings or pores in the caudal roof of the hindbrain or the posterior rhombencephalic tela choroidea.

Radioisotope evaluation of experimental hydrosyringomyelia

1976 ◽  
Vol 45 (2) ◽  
pp. 181-187 ◽  
Author(s):  
Peter V. Hall ◽  
John E. Kalsbeck ◽  
Henry N. Wellman ◽  
Robert L. Campbell ◽  
Sidney Lewis
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Space ◽  
Central Canal ◽  
Content Type ◽  
Delayed Onset ◽  
Spinal Subarachnoid Space ◽  
Fine Print

✓ Kaolin-induced hydrosyringomyelia in dogs has been investigated by radioisotope ventriculography using both cerebrospinal fluid radioassay and scintigraphy. The hydromyelic central canal can be differentiated from the spinal subarachnoid space by scintigraphy. Serial studies show that hydromyelia arises rapidly to decompress the associated hydrocephalus in surviving animals. Syringomyelia, after a delayed onset, originates from the enlarged central canal. Radioisotope ventriculography may be a useful clinical aid in the diagnosis of hydrosyringomyelia.

The spinal cord central canal in kaolin-induced hydrocephalus

1977 ◽  
Vol 47 (3) ◽  
pp. 397-402 ◽  
Author(s):  
Ansgar Torvik ◽  
V. S. Murthy
Keyword(s):  
Spinal Cord ◽  
Subarachnoid Space ◽  
Fourth Ventricle ◽  
Central Canal ◽  
Content Type ◽  
Spinal Subarachnoid Space ◽  
Individual Variations ◽  
Lower Brain Stem ◽  
Cleft Formation ◽  
Fine Print

✓ In order to study the cause of the great individual variations in kaolin-induced hydrocephalus, the lower brain stem and upper spinal cord were examined histologically in a series of young rabbits that had received injections of kaolin into the cisterna magna. Animals with complete occlusion of the outlets from the fourth ventricle into the subarachnoid space showed only a moderate ventricular dilatation, while cases with marked hydrocephalus also had plugs of kaolin in the caudal part of the fourth ventricle. The intraventricular kaolin was adherent to the roof of the fourth ventricle by strands of connective tissue and it is suggested that the plugs served as valves that initially occluded the opening of the central canal and were then lifted away as the ventricle dilated and the roof moved posteriorly. The animals with marked hydrocephalus also had extensive dilatation of the central canal with cleft formation in the posterior columns. The observations support the concept that in hydrocephalus the central canal may serve as an alternative resorption route for the cerebrospinal fluid through communication with the spinal subarachnoid space.

scholarly journals Fourth ventricle stent placement for treatment of recurrent syringomyelia in patients with type I Chiari malformations

2019 ◽  
Vol 23 (2) ◽  
pp. 164-170 ◽  
Author(s):  
Coleman P. Riordan ◽  
R. Michael Scott
Keyword(s):  
Stent Placement ◽  
Subarachnoid Space ◽  
Fourth Ventricle ◽  
Neurological Complication ◽  
Central Canal ◽  
Senior Author ◽  
Csf Leak ◽  
Type I

OBJECTIVEIn patients with syringomyelia and type I Chiari malformation (CM-I) who have required reoperation because of persistent, recurrent, or expanding syrinx, the senior author placed a stent from the fourth ventricle to the cervical subarachnoid space in hopes of promoting circulation of CSF out of the ventricle and away from the central canal of the spinal cord. This study was undertaken to determine the long-term success of this operative stratagem in eliminating the syrinx, as well as to document the complications that occurred following stent placement. The technique utilized for placement of fourth ventricle stents is presented.METHODSThe surgical database of the senior author was reviewed to identify all patients who underwent stent placement at a reexploration of a suboccipital decompression for a CM-I conducted for a recurrent or ineffectively treated syringomyelia. The clinical and radiological data of these patients were analyzed to determine long-term efficacy and complications of the procedure.RESULTSFourteen patients (average age 10.7 ± 5.2 years, range 2.6–20.1 years) were identified who met these inclusion criteria. They each presented with recurrent, residual, or expanding syringomyelia following a prior decompression for a CM-I. The reoperation with stent placement was complicated by late stent dislodgement and recurrence or persistence of the syrinx in 2 patients (14%) and by neurological deficit in 1 patient (7%). There was 1 perioperative CSF leak (7%). In 1 other patient (7%), the stent dislodged after surgery but required no further intervention, as the syrinx remained collapsed. Two patients (14%) required late reoperation for stent replacement when syrinxes recurred. At the most recent imaging follow-up, the stent was positioned appropriately in 12 patients (86%; average follow-up 6.9 years, range 0.5–18.1 years), and the recurrent or residual syrinx was eliminated or reduced in size by 75% or greater in 13 patients (93%).CONCLUSIONSThe placement of a stent from the fourth ventricle to the cervical subarachnoid space was a highly effective treatment for patients with recurrent, residual, or expanding syringomyelia following an initial decompression of an associated CM-I. The sole neurological complication in this series was related to lysis of arachnoid scar rather than stent placement itself, but inability to maintain fixation of the stent in situ led to further surgery to replace the stent in 2 patients.

scholarly journals Management of hydrocephalus in the patient with myelomeningocele: an argument against third ventriculostomy

2004 ◽  
Vol 16 (2) ◽  
pp. 1-3 ◽  
Author(s):  
Arthur E. Marlin
Keyword(s):  
Cerebrospinal Fluid ◽  
Patient Population ◽  
Fourth Ventricle ◽  
Signs And Symptoms ◽  
Central Canal ◽  
Third Ventriculostomy ◽  
Csf Diversion

The majority of children with myelomeningocele will have associated hydrocephalus. The management of hydrocephalus can be one of the most trying problems in this patient population. Cerebrospinal fluid (CSF) diversion will be required in these children for the remainder of their lives. Blockage of the outlets of the fourth ventricle and communication of the fourth ventricle with the central canal provides a mechanism for compensation. The signs and symptoms of CSF diversion malfunction, either shunt or third ventriculostomy, can be quite subtle. The objective indications of these malfunctions are less available after third ventriculostomy than when using mechanical shunting. The ease with which the diagnosis of malfunction can be made becomes the major advantage of mechanical shunting over third ventriculostomy.

Arterial pulsation—dependent perivascular cerebrospinal fluid flow into the central canal in the sheep spinal cord

1997 ◽  
Vol 86 (4) ◽  
pp. 686-693 ◽  
Author(s):  
Marcus A. Stoodley ◽  
Sally A. Brown ◽  
Christopher J. Brown ◽  
Nigel R. Jones
Keyword(s):  
Cerebrospinal Fluid ◽  
Central Canal ◽  
Perivascular Spaces ◽  
Arterial Pulse ◽  
Csf Flow ◽  
Central Gray Matter ◽  
Content Type ◽  
Cerebrospinal Fluid Flow ◽  
Arterial Pulsation ◽  
Central Gray

✓ The impetus for the enlargement of syringes is unknown. The authors hypothesize that there is a flow of cerebrospinal fluid (CSF) from perivascular spaces into the central canal and that the flow is driven by arterial pulsations. Using horse-radish peroxidase as a tracer, the CSF flow was studied in normal sheep, in sheep with damped arterial pulsations, and in sheep with lowered spinal subarachnoid pressure. The CSF flow from perivascular spaces into the central canal was demonstrated in the normal sheep, and two patterns of flow were identified: 1) from perivascular spaces in the central gray matter; and 2) from perivascular spaces in the ventral white commissure. Flow into the central canal was also observed in the sheep with lowered spinal subarachnoid pressure, but not in those with reduced arterial pulse pressure. This study provides evidence that CSF flow from perivascular spaces into the central canal is dependent on arterial pulsations. Arterial pulsation—driven CSF flow may be the impetus for the expansion of syringes.

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