Syringomyelia without hindbrain herniation: tight cisterna magna

2002 ◽  
Vol 96 (2) ◽  
pp. 239-249 ◽  
Author(s):  
Kazuhiko Kyoshima ◽  
Takayuki Kuroyanagi ◽  
Fusakazu Oya ◽  
Yukihiro Kamijo ◽  
Hossam El-Noamany ◽  
...  
Keyword(s):  
Foramen Magnum ◽  
Central Canal ◽  
Foramen Magnum Decompression ◽  
Ventricular Dilation ◽  
Content Type ◽  
Cisterna Magna ◽  
Hindbrain Herniation ◽  
Ventricle Size ◽  
Idiopathic Syringomyelia ◽  
Fine Print

✓ Idiopathic syringomyelia, which is not associated with any definite pathogenic lesions, has been treated mainly by shunting of the syrinx and rarely by craniocervical decompression. The authors report four cases of syringomyelia thought to be idiopathic syringomyelia but treated by craniocervical decompression with favorable results. Syringomyelia was present without hindbrain herniation. In such cases, the subarachnoid space anterior to the brainstem at the level of the foramen magnum is usually open but the cisterna magna is impacted by the tonsils, a condition the authors term “tight cisterna magna.” All patients underwent foramen magnum decompression and C-1 laminectomy, and the outer layer of the dura was peeled off. Further intradural exploration was performed when outflow of cerebrospinal fluid (CSF) from the fourth ventricle was deemed to be insufficient. Postoperatively, improvement in symptoms and a reduction in syrinx size were demonstrated in three patients, and a reduction in ventricle size was shown in two. Syringomyelia associated with tight cisterna magna should not be classified as idiopathic syringomyelia; rather, it belongs to the category of organic syringomyelia such as Chiari malformation. A possible pathogenesis of cavitation is obstruction of the CSF outflow from the foramen of Magendie, and the cavity may be a communicating dilation of the central canal. Ventricular dilation may depend on the extent to which CSF drainage is impaired from the foramina of Luschka. These cavities may respond to craniocervical decompression if it results in sufficient CSF outflow from the foramen of Magendie, even in cases with concomitant hydrocephalus.

Cervical myelopathy due to ossification of the posterior longitudinal longitudinal ligament

1972 ◽  
Vol 37 (6) ◽  
pp. 653-660 ◽  
Author(s):  
Chikao Nagashima
Keyword(s):  
Cervical Myelopathy ◽  
Posterior Margin ◽  
Posterior Longitudinal Ligament ◽  
Foramen Magnum ◽  
Primary Lesion ◽  
Foramen Magnum Decompression ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Longitudinal Strip ◽  
Fine Print

✓ Ten patients who had cervical myelopathy due to ossification of the posterior longitudinal ligament of the cervical spine are described. This disease is characterized by an abnormal longitudinal strip of ossified ligamentous tissue along the posterior margin of vertebrae from C-3 to C-6; the primary lesion appears to be a degeneration of the intervertebral disc. This distinct clinical, radiological, and pathological entity should be included in the differential diagnosis of cervical myelopathy. All 10 patients were treated by extensive decompressive laminectomy and multiple bilateral facetectomies, with or without foramen magnum decompression. The results were favorable, and postoperative myelography demonstrated dorsal migration of the entire dural contents.

Morphological study of experimental syringomyelia with kaolin-induced hydrocephalus in a canine model

1996 ◽  
Vol 84 (6) ◽  
pp. 999-1005 ◽  
Author(s):  
Haruyuki Yamada ◽  
Akira Yokota ◽  
Joji Haratake ◽  
Akio Horie
Keyword(s):  
Morphological Study ◽  
Histopathological Examination ◽  
Foramen Magnum ◽  
Central Canal ◽  
Chiari I Malformation ◽  
Hydrodynamic Theory ◽  
Cervical Cord ◽  
Content Type ◽  
Vascular Insufficiency ◽  
Fine Print

✓ In this morphological study the authors investigated whether spinal cord cavitation, produced in young mongrel dogs that had been rendered hydrocephalic by cisternal injection of kaolin, consists of a dilated central canal or intramedullary cavities. Hydrocephalus was noted in 50 of 56 dogs treated with kaolin. Of the 50 hydrocephalic young dogs, 29 were shown to have central canal dilation that was prominent at the thoracic level and 21 to have cervical intramedullary cavities in the posterior column and/or the posterior horn. In 11 dogs from the latter group these cavities were demonstrated to have no communication with the central canal. This finding could not be explained by the hydrodynamic theory. On histopathological examination, myelomalacia and hemorrhagic infarction following ventricular shunting were noted adjacent to the cervical cavities, which suggested vascular impairment. A perfusion study revealed insufficient blood flow within the cervical cord at the level of the intramedullary cavities. A close correlation between the vascular insufficiency of the cervical cord and the pressure cone resulting from significant hydrocephalus was observed. The latter may cause cervicomedullary compression at the foramen magnum, affecting the venous drainage of the cervical cord below that level, resulting in intramedullary cavitation. Accordingly, vascular impairment was thought to play a significant role in the development of cervical syrinx formation in our kaolin model. The current results may provide a reasonable explanation for the formation of noncommunicating cervical syringomyelia in Chiari I malformation.

Foramen magnum decompression in an infant with homozygous achondroplasia

1989 ◽  
Vol 70 (1) ◽  
pp. 126-128 ◽  
Author(s):  
Nathan Moskowitz ◽  
Benjamin Carson ◽  
Steven Kopits ◽  
Roy Levitt ◽  
Graeme Hart
Keyword(s):  
Upper Airway ◽  
Early Death ◽  
Foramen Magnum ◽  
Foramen Magnum Decompression ◽  
Thoracic Cage ◽  
Respiratory Compromise ◽  
Content Type ◽  
Surgical Measures ◽  
Cervicomedullary Compression ◽  
Fine Print

✓ Homozygous achondroplasia is a rare yet distinct clinical entity. Most infants succumb to an early death as a result of respiratory compromise due to upper airway obstruction, thoracic cage deformity, and/or cervicomedullary compression. The successful cervicomedullary decompression of a 16-week-old infant with homozygous achondroplasia is described. This report suggests that homozygous achondroplasia is not universally fatal and that these infants are potentially viable if managed by aggressive respiratory and surgical measures.

Relation of age and cerebral ventricle size to central canal in man

1979 ◽  
Vol 51 (1) ◽  
pp. 85-93 ◽  
Author(s):  
Vira Kasantikul ◽  
Martin G. Netsky ◽  
A. Everette James
Keyword(s):  
Central Canal ◽  
Ependymal Cells ◽  
Ciliated Epithelium ◽  
Ventricular Size ◽  
Content Type ◽  
Significant Pathway ◽  
Ventricle Size ◽  
Severe Hydrocephalus ◽  
Csf Absorption ◽  
Fine Print

✓ The central canal of the spinal cord in man with and without hydrocephalus was studied histologically. The lumen was patent in most patients in the first two decades of life. Cells lining the canal in the prenatal and newborn state and in the first decade of life were predominantly pseudostratified ciliated epithelium. In the second decade, the epithelium became simple columnar or cuboidal. The central canal closed in most cases after the age of 20 years, secondary to proliferation of ependymal cells and astrocytes. Mechanisms whereby the number of glial cells increase are considered. The canal was closed in all adults with normal ventricular size, and in 94% of persons with various degrees of hydrocephalus. In the remaining 6% of cases with hydrocephalus, the lining of the canal resembled that seen in the first two decades, and could have acted as a pathway of cerebrospinal fluid (CSF) absorption. Three cases of severe hydrocephalus in the first two decades of life were encountered; the central canal was patent in one, and occluded in two. Based on these data, the canal was not a significant pathway of CSF absorption in most instances of hydrocephalus and in persons with dilated ventricles who were older than 20 years of age.

Myelotomy for control of mass spasms in paraplegia

1976 ◽  
Vol 45 (6) ◽  
pp. 683-691 ◽  
Author(s):  
Shokei Yamada ◽  
Phanor L. Perot ◽  
Thomas B. Ducker ◽  
Isabel Lockard
Keyword(s):  
Gray Matter ◽  
Central Canal ◽  
Motor Power ◽  
Dorsal Midline ◽  
Content Type ◽  
Postural Reflexes ◽  
Voluntary Motor ◽  
Wheel Chair ◽  
Fine Print

✓ A new myelotomy knife is described and a procedure, designed to sever certain reflex connections while preserving as many corticospinal connections as possible, is presented. Through intermittent dorsal midline incisions the gray matter lateral to the central canal is severed bilaterally under the microscope from L-1 to S-1. This procedure relieved mass spasms and hyperactive reflexes in 14 paraplegic or tetraplegic patients, but preserved postural reflexes and whatever voluntary motor power the patients had prior to myelotomy. Before myelotomy all patients were bedridden. Afterward nine patients were able to use a wheel chair and five were able to walk with the use of parallel bars or crutches.

Evaluation of the central canal of the spinal cord in experimentally induced hydrocephalus

1978 ◽  
Vol 48 (6) ◽  
pp. 970-974 ◽  
Author(s):  
A. Everette James ◽  
William J. Flor ◽  
Gary R. Novak ◽  
Ernst-Peter Strecker ◽  
Barry Burns
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Experimental Model ◽  
Alternative Pathway ◽  
Central Canal ◽  
Communicating Hydrocephalus ◽  
Csf Flow ◽  
Content Type ◽  
Histological Appearance ◽  
Fine Print

✓ The central canal of the spinal cord has been proposed as a significant compensatory alternative pathway of cerebrospinal fluid (CSF) flow in hydrocephalus. Ten dogs were made hydrocephalic by a relatively atraumatic experimental model that simulates the human circumstance of chronic communicating hydrocephalus. The central canal was studied by histopathology and compared with 10 normal control dogs. In both groups the central canal of the spinal cord was normal in size, configuration, and histological appearance. In this experimental model dilatation of the canal and increased movement of CSF does not appear to be a compensatory alternative pathway.

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.

Ultrastructure of the human posttraumatic syrinx

1989 ◽  
Vol 71 (2) ◽  
pp. 239-243 ◽  
Author(s):  
Kesava K. V. Reddy ◽  
Marc R. Del Bigio ◽  
Garnette R. Sutherland
Keyword(s):  
Central Canal ◽  
Ependymal Cells ◽  
Electron Microscopic ◽  
Content Type ◽  
Microscopic Features ◽  
Cell Processes ◽  
Ultrastructural Appearance ◽  
Posttraumatic Syringomyelia ◽  
Communicating Syringomyelia ◽  
Fine Print

✓ Although posttraumatic syringomyelia is a well-established clinicopathological entity, there is a paucity of information on the ultrastructural features of this condition. This study documents the light and electron microscopic features of posttraumatic syringes obtained from two patients who underwent surgical cordectomy. The syringes were lined largely by cell processes of astrocytes. Small regions near the caudal end were lined by flattened ependymal cells that lacked surface specializations. These were thought to represent remnants of the central canal ependyma. The ultrastructural appearance of the syrinx was similar to that of the communicating syringomyelia as well as the periventricular changes that accompany hydrocephalus. The authors conclude that the changes represent the nonspecific sequelae of a distensile force within the syrinx cavity.

Stenosis of the central canal of the spinal cord following inoculation of suckling hamsters with reovirus type I

1994 ◽  
Vol 81 (1) ◽  
pp. 103-106 ◽  
Author(s):  
Thomas H. Milhorat ◽  
René M. Kotzen
Keyword(s):  
Spinal Cord ◽  
Adult Life ◽  
Central Canal ◽  
Early Years ◽  
Type I ◽  
Content Type ◽  
Human Spinal Cord ◽  
Reovirus Type ◽  
Infectivity Titer ◽  
Fine Print

✓ The central canal of the human spinal cord is partially or completely occluded in the vast majority of individuals by the early years of adult life. The authors describe an experimental lesion following virus-induced ependymitis that bears a striking resemblance to the condition in man. Suckling hamsters were inoculated with 0.06 ml of 10−3 infectivity titer of reovirus type I between the 2nd and 5th days of life. The pathological events consisted of necrotizing ependymitis, healing of the ependyma by gliovascular scarring, and obstruction of narrow bottlenecks such as the central canal. Histological findings were characterized by disorganization of the ependyma, formation of ependymal rosettes and microtubules, subependymal gliovascular scarring, and intracanalicular gliosis. These features are the same as those encountered clinically and provide strong evidence that stenosis of the central canal in man is a pathological lesion involving ependymal injury and scarring.

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.

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