Symptomatic syringomyelia following surgery to treat retethering of lipomyelomeningoceles

1995 ◽  
Vol 82 (5) ◽  
pp. 752-755 ◽  
Author(s):  
Paul H. Chapman ◽  
David M. Frim
Keyword(s):  
De Novo ◽  
Early Recognition ◽  
Central Canal ◽  
Conus Medullaris ◽  
The Other ◽  
Neurological Deficits ◽  
Content Type ◽  
Minor Degree ◽  
Previously Treated ◽  
A Minor

✓ The authors report the cases of three children in whom symptomatic syringomyelia occurredde novo following an operation to relieve retethering of a previously treated lipomyelomeningocele. No patient had a Chiari malformation. In two cases, magnetic resonance imaging performed before the first operation did not show a syrinx. At the time of surgery to relieve retethering, it was discovered that one of these patients had a minor degree of terminal hydromyelia and the other had a prominent central canal within the conus medullaris. The third patient was initially studied by means of myelography, which gave no indication of a syrinx, and one was not found at the time of the surgery to release the retethering. Neurological deficits appeared abruptly within several months of operation in two children, and insidiously after 12 to 18 months in the other symptomatic individual. In all three cases, the syrinx involved the distal spinal cord adjacent to the site of the lipoma. Treatment consisted of syringosubarachnoid shunting, which arrested the progression of deficits but only partially reversed them. The details of each case are presented and the possible mechanism of syrinx formation discussed. Early recognition and treatment of this unusual but important problem are emphasized.

Histopathology of experimental hematomyelia

1991 ◽  
Vol 75 (6) ◽  
pp. 911-915 ◽  
Author(s):  
Thomas H. Milhorat ◽  
David E. Adler ◽  
Ian M. Heger ◽  
John I. Miller ◽  
Joanna R. Hollenberg-Sher
Keyword(s):  
Spinal Cord ◽  
Tissue Injury ◽  
Central Canal ◽  
Microglial Cells ◽  
Neurological Deficits ◽  
Thoracic Spinal Cord ◽  
Content Type ◽  
Thoracic Spinal ◽  
Cellular Debris ◽  
Dorsal Columns

✓ The pathology of hematomyelia was examined in 35 rats following the stereotactic injection of 2 µl blood into the dorsal columns of the thoracic spinal cord. This experimental model produced a small ball-hemorrhage without associated neurological deficits or significant tissue injury. Histological sections of the whole spinal cord were studied at intervals ranging from 2 hours to 4 months after injection. In acute experiments (2 to 6 hours postinjection), blood was sometimes seen within the lumen of the central canal extending rostrally to the level of the fourth ventricle. Between 24 hours and 3 days, the parenchymal hematoma became consolidated and there was an intense proliferation of microglial cells at the perimeter of the lesion. The cells invaded the hematoma, infiltrated its core, and removed erythrocytes by phagocytosis. Rostral to the lesion, the lumen of the central canal was found to contain varying amounts of fibrin, proteinaceous material, and cellular debris for up to 15 days. These findings were much less prominent in the segments of the canal caudal to the lesion. Healing of the parenchymal hematoma was usually complete within 4 to 6 weeks except for residual hemosiderin-laden microglial cells and focal gliosis at the lesion site. It is concluded that the clearance of atraumatic hematomyelia probably involves two primary mechanisms: 1) phagocytosis of the focal hemorrhage by microglial cells; and 2) drainage of blood products in a rostral direction through the central canal of the spinal cord.

Terminal ventriculostomy for syringomyelia

1977 ◽  
Vol 46 (5) ◽  
pp. 609-617 ◽  
Author(s):  
W. James Gardner ◽  
Herbert S. Bell ◽  
Pete N. Poolos ◽  
Donald F. Dohn ◽  
Marta Steinberg
Keyword(s):  
Clinical Course ◽  
Adult Life ◽  
Central Canal ◽  
Conus Medullaris ◽  
Fetal Life ◽  
Filum Terminale ◽  
Content Type ◽  
Fine Print

✓ The clinical course of 12 patients who underwent terminal ventriculostomy for syringomyelia is presented. Opening the central canal at the tip of the conus medullaris is a relatively benign procedure that improves the symptoms of syringomyelia and syringobulbia. This canal normally terminates at the tip of the conus, but in each of the 12 surgical specimens it continued into the filum terminale for distances up to 8 cm. In most cases the tip of the conus was located more caudally than normal, indicating some degree of tethering in fetal life. This belief is supported by the fact that the newborn, whose conus is tethered to a lipoma at the sacral level, may develop syringomyelia in adult life.

Hydrosyringomyelia of the conus medullaris associated with a thoracic meningioma

1981 ◽  
Vol 54 (6) ◽  
pp. 833-835 ◽  
Author(s):  
Russell L. Blaylock
Keyword(s):  
Cerebrospinal Fluid ◽  
Central Canal ◽  
Conus Medullaris ◽  
Content Type ◽  
Fine Print

✓ The case of a 73-year-old woman found to have hydrosyringomyelia associated with a lower thoracic meningioma is reported. Possible mechanisms for the formation of the hydrosyrinx are discussed, with particular attention being paid to the possibility of transmural passage of cerebrospinal fluid into the central canal.

A unified theory of surface roughness

1984 ◽  
Vol 393 (1804) ◽  
pp. 133-157 ◽  
Keyword(s):  
Surface Roughness ◽  
Rough Surface ◽  
Random Noise ◽  
Sampling Interval ◽  
The Other ◽  
Real Surface ◽  
Unified Theory ◽  
Two Dimensional ◽  
Minor Degree ◽  
A Minor

The properties of the peaks and summits of a rough surface are predicted on the assumption that the surface is two-dimensional random noise. The important result is that, in non-dimensional form, the answers depend only to a minor degree on the parameters describing the surface or on the sampling interval used: on the other hand the absolute values are strongly dependent on the sampling interval. Experimental results on a real surface agree remarkably well with the predictions.

Neurological injury and patterns of sacral fractures

1990 ◽  
Vol 72 (6) ◽  
pp. 889-893 ◽  
Author(s):  
Kevin J. Gibbons ◽  
Donald S. Soloniuk ◽  
Nizam Razack
Keyword(s):  
Neurological Deficit ◽  
Medical Center ◽  
Treatment Options ◽  
Central Canal ◽  
Neurological Deficits ◽  
Neurological Injury ◽  
Erie County ◽  
Content Type ◽  
Canal Zone ◽  
Sacral Fractures

✓ To evaluate the morphological and neurological findings in sacral spine injuries, a retrospective study was conducted of all patients admitted to Erie County Medical Center over a 2-year period with the diagnosis of pelvic or sacral injury. Of these 253 patients, 44 were found to have sacral fractures and form the basis of this study. The type of fracture, neurological deficit, treatment, and outcome in these patients were analyzed. The patient population consisted of 25 males and 19 females, with a mean age of 34 years (range 15 to 80 years). The fractures were classified by the degree of involvement of the foramina and central canal. Fractures through the ala sacralis only (Zone I, 25 cases) or involving the foramina but not the central canal (Zone II, seven cases) were less likely to cause nerve injury (24% and 29%, respectively). Fractures involving the central canal (Zone III), both vertical (five cases) and transverse (seven cases), were more likely to cause neurological injury (60% and 57%, respectively). Neurological deficits in Zone I and II injuries were usually unilateral lumbar and sacral radiculopathies. Zone III deficits were usually bilateral and severe; bowel and/or bladder incontinence was present in six of the 12 patients in this group. Deficits generally improved with time; however, operative reduction and internal fixation may have been useful, particularly in patients with unilateral root symptoms. The treatment options are discussed, and previously published series of sacral fractures are reviewed. The authors conclude that the classification of sacral fractures described is useful in predicting the incidence and severity of neurological deficit.

Cerebral Vasospasm After Transsphenoidal Resection of Pituitary Macroadenomas

2012 ◽  
Vol 71 (suppl_1) ◽  
pp. ons173-ons181 ◽  
Author(s):  
Ajit S. Puri ◽  
Gabriel Zada ◽  
Hekmat Zarzour ◽  
Edward Laws ◽  
Kai Frerichs
Keyword(s):  
Cerebral Vasospasm ◽  
De Novo ◽  
Early Recognition ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Significant Risk ◽  
Neurological Deficits ◽  
Delayed Cerebral Vasospasm ◽  
Neurological Morbidity ◽  
Pituitary Macroadenomas ◽  
Transsphenoidal Resection

Abstract BACKGROUND: Delayed ischemic events due to vasospasm are a well-known complication of aneurysmal subarachnoid hemorrhage (SAH). Severe vasospasm in other neurosurgical settings is not as well recognized. Delay in diagnosis and treatment of vasospasm in such settings may be associated with significant neurological morbidity. OBJECTIVE: To present three cases of symptomatic delayed cerebral vasospasm after transsphenoidal resection of pituitary macroadenomas. METHODS: Transsphenoidal resection in all cases was complicated by peritumoral hemorrhage with extension into the subarachnoid space. Two of the 3 patients required re-operation to evacuate the hematoma in the tumor bed because of progressive worsening neurological deficits. RESULTS: All 3 patients developed vasospasm of the intracranial vessels, starting as early as postoperative day 5 and appearing as late as postoperative day 10. Comparisons to the non-vascular pre-operative magnetic resonance imaging studies confirmed the “de-novo” nature of the vasospasm based on the caliber of the flow voids. CONCLUSION: Transsphenoidal surgery complicated by peritumoral hemorrhage is associated with a significant risk of neurological morbidity because of delayed cerebral vasospasm. Early recognition and management according to guidelines used for postaneurysmal SAH may help to improve outcomes in these patients.

Surgical hemostasis

1979 ◽  
Vol 51 (2) ◽  
pp. 137-146 ◽  
Author(s):  
Charles A. Owen ◽  
E. J. Walter Bowie
Keyword(s):  
Blood Transfusion ◽  
Disseminated Intravascular Coagulation ◽  
Surgical Procedure ◽  
Early Recognition ◽  
Coagulation Factors ◽  
The Other ◽  
Screening Tests ◽  
Bleeding Tendency ◽  
Content Type ◽  
Fine Print

✓ Every surgical procedure taxes the hemostatic defenses of the patient. If his hemostatic mechanism is sound, he is unlikely to have a bleeding problem during or after an operation, unless, of course, a suture or clip slips off. Two classes of patients do present bleeding problems to the surgeon. One group has a pre-existing bleeding tendency, the other acquires it during or after the operation. The recognition of patients with severe hemostatic disabilities, such as hemophilia, presents no problem since the patient is aware of the disease. The mild bleeder is less likely to be detected by screening tests than by adroit questioning. The major hemostatic defect that may develop during an operation, or shortly thereafter, is disseminated intravascular coagulation. This syndrome, always secondary, may accompany shock, mismatched blood transfusion, septicemia, or extensive malignancy. Its prevention or early recognition is much easier than treatment after circulating platelets and some coagulation factors have been consumed and fibrinolysis is destroying fibrin and fibrinogen.

Spinal cord arteriovenous malformations with significant intramedullary components

1983 ◽  
Vol 59 (3) ◽  
pp. 471-478 ◽  
Author(s):  
Philip Cogen ◽  
Bennett M. Stein
Keyword(s):  
Arteriovenous Malformations ◽  
The Other ◽  
Neurological Deficits ◽  
Content Type ◽  
Postoperative Course ◽  
Microsurgical Techniques ◽  
Spinal Arteriovenous Malformations ◽  
High Degree ◽  
Fine Print

✓ Few neurosurgeons have stressed the occurrence, manifestations, and resectability of intramedullary spinal arteriovenous malformations (AVM's). In six of 17 patients in the authors' series of operable spinal AVM's, the lesions had major intramedullary components. Three of these six patients presented with subarachnoid hemorrhage, and all had catastrophic neurological deficits which gradually improved. The hemorrhages appeared to originate from large venous varices lying adjacent to the intramedullary portion of the AVM. The mechanism explaining the sudden neurological deficit in the other three patients was presumed to be thrombosis within the venous varices associated with their AVM's. The reliability of the various radiographic procedures in identifying the intramedullary components of these AVM's is discussed. These malformations may be removed totally with a high degree of safety using microsurgical techniques. The postoperative course in this series of patients was gratifying in terms of improvement of neurological deficits. Postoperative angiography was not performed on all of these patients. However, the follow-up period averaged 5 years.

Endovascular treatment of intracerebral arteriovenous malformations: experience in 49 cases

1991 ◽  
Vol 75 (2) ◽  
pp. 228-233 ◽  
Author(s):  
Dominique Fournier ◽  
Karel G. TerBrugge ◽  
Robert Willinsky ◽  
Pierre Lasjaunias ◽  
Walter Montanera
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Malformations ◽  
Multidisciplinary Treatment ◽  
Treatment Protocol ◽  
Therapeutic Embolization ◽  
The Other ◽  
Neurological Deficits ◽  
Content Type ◽  
Results Of Treatment ◽  
Delayed Hemorrhage

✓ The authors report the results of treatment in 49 consecutive patients with brain arteriovenous malformations (AVM's) who underwent therapeutic embolization with liquid adhesive agents between 1984 and 1988 at the Toronto Western Hospital. Thirty-three patients had no other treatment and were followed up with angiography at 2 years and clinically from 2 to 6 years. Of the other 16 patients, 10 had adjunctive radiosurgery and six underwent surgical resection following embolization. Seven (14%) of the 49 patients had a morphological cure effected by embolization as evidenced on their 2-year follow-up angiograms; these have remained clinically stable. Twelve patients developed neurological deficits after embolization; eight (16% of the series) were transient and four (8%) were permanent. Two patients (4%) had a delayed hemorrhage after incomplete obliteration of their malformations. Endovascular treatment resulted in clinical improvement in 15 (33%) of the other 46 patients. None of the patients who initially presented with hemorrhage had a rebleed following embolization. It is concluded that endovascular treatment with liquid embolic material can be an integral part of the multidisciplinary treatment protocol for patients with brain AVM's.

Bifocal myxopapillary ependymoma of the terminal filum: the end of a spectrum?

2003 ◽  
Vol 98 (3) ◽  
pp. 288-289 ◽  
Author(s):  
Paul Hallacq ◽  
François Labrousse ◽  
Nathalie Streichenberger ◽  
Dan Lisii ◽  
Georges Fischer
Keyword(s):  
Cauda Equina ◽  
Conus Medullaris ◽  
The Other ◽  
Myxopapillary Ependymoma ◽  
Content Type ◽  
Neuroectodermal Tumors ◽  
Fourth Decade ◽  
Age Range ◽  
Simultaneous Discovery ◽  
Fine Print

✓ Myxopapillary ependymomas represent the most frequent type of ependymomas found at the conus medullaris—cauda equina-terminal filum level. They are neuroectodermal tumors mainly observed during the fourth decade of life. Pediatric cases have been rarely described at an age range of 10 to 13 years. Myxopapillary ependymomas are typically solitary tumors involving the terminal filum. Simultaneous discovery of two tumors located both on the terminal filum has been reported once. The pathogenesis of this focal ependymoma located at the same embryological level, on the terminal filum, is uncertain; it may represent one end of a spectrum, the other end being the giant ependymoma of the terminal filum.

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