Primary spinal syringomyelia

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

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✓ In the present review the author describes the different types of syringomyelia that originate from abnormalities at the level of the spinal cord rather than at the craniovertebral junction. These include posttraumatic and postinflammatory syringomyelia, as well as syringomyelia associated with arachnoid cysts and spinal cord tumors. The diagnosis and the principles of managing these lesions are discussed, notably resection of the entity restricting cerebrospinal fluid flow. Placement of a shunt into the syrinx cavity is reserved for patients in whom other procedures have failed or who are not candidates for other procedures.

Article Information

Address reprint requests to: Ulrich Batzdorf, M.D., Department of Neurosurgery, UCLA Medical Center, Box 956901, Los Angeles, California 90095-6901. email: ubatzdorf@mednet.ucla.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Representative T2-weighted MR images. Left: Sagittal cervical image demonstrating a typical fusiform cavity, a residual focus of central canal, at C6–7. Subsequent C6–7 anterior discectomy and interbody fusion did not alter the appearance of this cavity during a 5-year follow-up period. Right: Axial thoracic image revealing the typical central, round appearance of such central canal cavities.

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    Left: Sagittal T1-weighted MR image revealing posttraumatic syringomyelia in a 20-year-old man who became paraplegic following a motor vehicle accident; associated compression fractures of the thoracic spine from T-4 to T-7 are present. Center and Right: Sagittal T2-weighted MR images revealing postinflammatory syringomyelia in a 40-year-old woman with a 3-year history of meningitis before presenting with syringomyelia.

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    Computerized tomography myelogram of thoracic spine demonstrating the abrupt change in cord diameter at the level of an arachnoid cyst.

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    Contrast-enhanced T1-weighted MR image revealing an intramedullary tumor at C4–6 with an associated syrinx cavity extending both rostrally and caudally. The cavity collapsed completely after gross-total excision of this ependymoma.

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    Bar graphs showing outcome related to pathological entity (upper) and surgical procedure (lower). Ant = anterior; arach = arachnoid; congen/teth = congenital tethering; decomp = decompression; inflamm = inflammatory; resid cc = residual central canal; subarachn = subarachnoid.

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