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Experimental syringomyelia

The relationship between intraventricular and intrasyrinx pressures

Peter Hall, Michael Turner, Steven Aichinger, Phillip Bendick, and Robert Campbell

T he idea that the pathophysiology of syringomyelia is related to congenital or acquired anomalies of the craniocervical junction with interference of cerebrospinal fluid (CSF) flow is accepted by many neurosurgeons. Unfortunately, no single surgical approach, whether posterior fossa decompression, ventricular shunting, myelotomy, or terminal ventriculostomy, has produced uniformly successful results in these patients. Underlying the limitations of our clinical management is an incomplete knowledge of the mechanisms responsible for enlargement of the syrinx

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Antonio Santoro, Roberto Delfini, Gualtiero Innocenzi, Claudio Di Biasi, Guido Trasimeni, and Gianfranco Gualdi

S yringomyelia is a malformation marked by the presence of a cavity within the spinal cord. 8 In 75% of cases, it is associated with Arnold-Chiari type I malformation. 17 Several theories on the pathogenesis of syringomyelia 2, 3, 12, 25, 27 have been put forward but those that have gained widest credence are the hydrodynamic theory of Gardner 12 and the cerebrospinal fluid (CSF) dissociation theory of Williams. 27 Diagnostic imaging has made the identification of syringomyelia and malformations of the craniovertebral junction much easier. 5, 9, 10, 23

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Acute presentations of syringomyelia

Report of three cases

Eric L. Zager, Robert G. Ojemann, and Charles E. Poletti

T he traditional definition of syringomyelia is a chronic, progressive degenerative disorder of the spinal cord characterized by dissociated sensory loss and brachial amyotrophy with pathological evidence of central cord cavitation. 1 In its most severe form, neuropathic joints and painless ulcers may develop. The clinical features of the syndrome are highly variable, usually with an insidious onset, a course of many years, and an unpredictable pace of progression. In the most comprehensive discussion of this topic in the literature, Barnett, et al. , 5

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Primary spinal syringomyelia

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2005

Ulrich Batzdorf

P rimary spinal syringomyelia can be defined as syringomyelia that exists in the absence of an abnormality at the level of the foramen magnum, the most common form of which is CTE. Chiari malformation is the generally used eponym, comprising a small number of anatomical subtypes. There are similarities in the underlying pathophysiology of syringomyelia developing in the presence of CTE and primary spinal syringomyelia. At present our understanding is that in both of these conditions there is a partial obstruction of the subarachnoid space; in the case of CTE

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Surgical treatment of syringomyelia

Favorable results with syringoperitoneal shunting

Nicholas M. Barbaro, Charles B. Wilson, Philip H. Gutin, and Michael S. B. Edwards

T he natural history of syringomyelia is highly variable. Some patients improve or stabilize without surgery, while others deteriorate even with the most aggressive intervention. 2, 3, 18 Several different operations have been advocated for the treatment of syringomyelia, including posterior fossa decompression with 2, 4, 9, 10 or without 8, 9, 19, 23, 28, 29 closure of a patent central canal, laminectomy with syringostomy, syrinx to subarachnoid (SSA) shunting, 25, 28, 30 terminal ventriculostomy, 11 ventriculoatrial shunting, 16 and syringoperitoneal

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Jörg Klekamp

I n the past it was believed that posttraumatic syringomyelia was the result of a severe spinal cord injury and that it developed from an area of myelomalacia after resorption of intramedullary blood and breakdown products of destroyed cord tissue. 7 Although treatment was based on syrinx shunting to various compartments for decades, modern treatment principles follow different concepts, which have mainly evolved since the introduction of MRI in the 1980s. Current concepts recognize and treat the pathophysiology of syringomyelia, which is related to

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Chiari malformation and syringomyelia

JNSPG 75th Anniversary Invited Review Article

Langston T. Holly and Ulrich Batzdorf

,” a condition in which some manifestations of the typical Chiari anomaly, notably syringomyelia, result from a process of cranial CSF flow impairment at the craniocervical junction other than tonsillar descent, such as membrane formation. 70 The justification for using the term “Chiari” is that surgical treatment for these patients is similar to that used for Chiari type I abnormalities. FIG. 1. Sagittal T2-weighted MR image of a 32-year-old woman with Chiari type 1.5 anomaly who presented with severe headaches, spastic quadriparesis, and significant bulbar

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Chiari I malformation with syringomyelia

Evaluation of surgical therapy by magnetic resonance imaging

Ulrich Batzdorf

T he advent of new imaging techniques in the past decade (in particular, computerized tomographic scanning with injection of water-soluble contrast medium and magnetic resonance (MR) imaging) has greatly facilitated the diagnosis of Chiari I malformation and associated syringomyelia. Indeed, MR imaging has now become the optimal technique, since it is noninvasive and permits simultaneous studies of the brain, craniocervical junction, and spinal cord. 2 As a result, this disease complex, once thought to be quite rare, is now being diagnosed with increased

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John D. Heiss, Nicholas Patronas, Hetty L. DeVroom, Thomas Shawker, Robert Ennis, William Kammerer, Alec Eidsath, Thomas Talbot, Jonathan Morris, Eric Eskioglu, and Edward H. Oldfield

W ith a prevalence of 8.4 cases per 100,000 population, approximately 21,000 Americans have syringomyelia, a disorder in which a cyst forms within the spinal cord, resulting in myelopathy. 6 Symptoms of paralysis, sensory loss, and chronic pain commonly develop during the second through fifth decades of life. The natural history of syringomyelia is typically one of gradual, stepwise neurological deterioration extending over many years. 5 Syringomyelia is usually associated with an inferior position of the cerebellar tonsils through the foramen magnum: the

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Umesh S. Vengsarkar, Venilal G. Panchal, Parimal D. Tripathi, Sushil V. Patkar, Alok Agarwal, Paresh K. Doshi, and Manmohan M. Kamat

T hecoperitoneal shunting is now a well-established technique for treating communicating hydrocephalus. It has also proved its usefulness in cases of cerebrospinal fluid (CSF) rhinorrhea, to arrest an intractable CSF leak, and in benign intracranial hypertension to prevent impending loss of vision. We have found this technique rewarding in three consecutive cases of syringomyelia treated between January and April, 1990, and would like to place our experience on record for future evaluation of the technique. All three patients presented clinically with a