Proceedings of the Fifty-Fifth Meeting of the British Neuropathological Society Held at the University of Bristol, 21–22 July 1978 (original) (raw)
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Post-traumatic syringomyelia following complete neurological recovery
Spinal cord, 2000
To describe the later neurologic deterioration secondary to the appearance of a post-traumatic syringomyelic cavity, in a patient who, in the initial phase, had an incomplete spinal cord lesion (ASIA C), which improved to ASIA E. A 52-year-old male patient who, at the age of 19 (1965), suffered a spinal cord injury. He presented with a fracture of the sixth and seventh cervical neurological segment at the time of the lesion, evolving to ASIA E. Nine years after the traumatism, he began to feel pain accompanied by a sensory and motor deficit. With the aid of myelography and MRI, the existence of a syringomyelic cavity was detected, which extended from the fourth to the seventh cervical segments. The patient was operated on, on various occasions, placing a syringo-subarachnoid shunt. The neurological status of the patient continued to deteriorate and, at present, he has a complete lesion below the fourth neurological cervical segment with a partially preserved sensitive area up to T1....
Post-Traumatic Syringomyelia: A Case Series
Pakistan Journal Of Neurological Surgery
It is relatively common to occur in a Tertiary Care Neurosurgical setup to get a case of Syringomyelia proximal or distal to a space-occupying lesion (SOL) or site of spinal cord compression. In this case series, we are presenting two cases in which syringomyelia developed after traumatic spinal cord injury. On initial radiological investigations, the first case presented as an old D12 fracture with Post-traumatic syrinx formation but on complete workup for the extent of the syrinx, another lesion was found incidentally in the form of an intradural extramedullary SOL at the level of cervicomedullary junction. The SOL turned out histologically as WHO Grade I Meningioma. The second case presented as syrinx formation after gunshot (fire-arm) penetrating spinal cord injury to the D11-12 vertebrae. Treatment plans of both these patients are presented here in detail along with the literature review.
Journal of Neurosurgery: Spine, 2005
✓ 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.
Surgical treatment of symptomatic subependymoma of the nervous system. Report of five cases
Neurosurgical Review, 1994
Subependymomas are uncommon and relatively benign tumors with a distinctive histological appearance. They are generally asymptomatic and most of them are found incidentally at postmortem examination. These tumors are usually located in the fourth and lateral ventricle, and sometimes in the spinal cord. The authors present a series of 5 pure subependymomas of the central nervous system all of which
Spinal Cord, 1999
A description is given of the syndrome of post-traumatic syringomyelia amongst patients with traumatic spinal injuries seen at the National Spinal Injuries Centre. The diagnosis was made on clinical grounds. It was confirmed wherever possible by neuroradiology prior to surgery; one case was confirmed only at post mortem. The incidence of the condition was found to be in keeping with other large series but, in contrast, no difference was found between the time of onset after injury between complete and incomplete lesions of the spinal cord. The commonest manifestation was pain, followed by sensory loss and rarely motor weakness. In the majority of patients the condition eventually became bilateral and in a significant number the lesion ascended to involve the trigeminal territory. The natural history of the condition was followed, and in all cases the condition gradually progressed. The pathogenesis of the condition is briefly discussed in view of the findings.
Experimental ‘hindbrain related’ syringomyelia: some mechanisms of spinal cord damage
Journal of Neuroscience and Neurological Disorders
The etiology and pathogenesis creates a lot of discussion. Methods: Experimental syringomyelia was induced in 20 anesthetized rabbits by injecting 0.5 ml of 25% kaolin suspension into the cisterna magna. Six rabbits with puncture and injection sterile saline NaCl were used as a control. The animals were sacrifi ced 1, 2, 4 and 6 months after the kaolin injection. Four hydrocephalus rabbits were sacrifi ced in 17 hours after the puncture of lateral ventricle with injection of solution of colloidal gold labeled human albuminum. The sections of the brain and spinal cord were stained with hematoxylin and eosin by Nissle and Marchi methods and with immunogold technique. Retropharyngeal lymph nodes of the animals were examined by electron microscopy. Conclusion: Our observation showed that water hammer effect and internal destruction of the spinal cord may lead to continuous antigen stimulation of regional lymph nodes and play an important role in pathogenesis of experimental syringomyelia. Experimental 'hindbrain related' syringomyelia: some mechanisms of spinal cord damage
Surgical treatment of ?Hindbrain Related? syringomyelia: New data for pathogenesis
Acta Neurochirurgica, 1993
52 patients with "hindbrain related" syringomyelia underwent surgical treatment. All patients underwent primary reconstructive surgery at the craniovertebral junction. Terminal ventriculostomy was performed as the secondary operation in 2 cases. The surgical treatment arrested progression of signs in 33 (63.5%), stabilized disease in 9 (17%) cases. Postoperative deterioration occurred in 8 (15%) cases. Mortality was 4% (2 patients). Percutaneous or intra-operative injection of myodil and gas into the syrinx, as well as CT, revealed the existense of communication with the 4th ventricle in 14 patients. Investigation of cerebrospinal and syrinx fluid revealed increased level of IgG, IgM or IgA in the syrinx fluid in 16 out of 22 patients. Immunohystological examination of pia mater revealed specific staining for IgG. Thus, syrinx formation may be due to synergic action of hydrodynamic and immunopathological mechanisms. Results indicate that early surgical treatment is preferable to patients with hindbrain anomalies and hydromyelia. We consider primary reconstructive operation at the posterior fossa as the preferred surgical management of "hindbrain related" syringomyelia.
Abnormalities in spinal cord ultrastructure in a rat model of post-traumatic syringomyelia
Fluids and Barriers of the CNS
Background Syringomyelia is a serious complication of spinal cord trauma, occurring in approximately 28% of spinal cord injuries. Treatment options are limited and often produce unsatisfactory results. Post-traumatic syringomyelia (PTS) is presumably related to abnormalities of cerebrospinal fluid (CSF) and interstitial fluid hydrodynamics, but the exact mechanisms are unknown. Methods Transmission electron microscopy (TEM) was used to investigate in detail the interfaces between fluid and tissue in the spinal cords of healthy Sprague–Dawley rats (n = 3) and in a rat model of PTS (n = 3). PTS was induced by computer-controlled impact (75 kDyn) to the spinal cord between C6 and C8, followed by a subarachnoid injection of kaolin to produce focal arachnoiditis. Control animals received a laminectomy only to C6 and C7 vertebrae. Animals were sacrificed 12 weeks post-surgery, and spinal cords were prepared for TEM. Ultra-thin spinal cord sections at the level of the injury were counterst...
Posttraumatic syringomyelia: a technical note
Turkish Neurosurgery, 2013
AIM: Previous studies have not identified a preferred surgical technique to treat posttraumatic syringomyelia. Both syringopleural shunting and arachnoidolysis are used in neurosurgery practice for the surgical treatment of posttraumatic syringomyelia. In this study, we present a new technique designed to achieve a better outcome following surgery. MATERIAL and METHODS: A 33-year-old man, who exhibited pain and spasticity below the thoracic region after a traffic accident that occurred 16 years ago, was treated with a new technique. He also had paraparesis and urinary incontinency before the surgery. The initial cervicothoracic Magnetic Resonance Imaging (MRI) scans showed the development of a syrinx in the T4-5 region. A syringopleural shunt and bilateral subarachnoid to subarachnoid catheters from proximal to distal zones of the syrinx were performed under surgical microscope. RESULTS: The operative time was 90 minutes, and the blood loss was approximately 100 mL. The patient was mobilized on postoperative day 2 and was discharged 4 days after surgery with mild improvement of his preoperative symptoms. Postoperative MRI scans revealed partial regression at 6 months and complete decompression of the syrinx at 3 years follow-up without any clinical symptoms. CONCLUSION: This is a report of minimal-access insertion combining syringopleural with subarachnoid-subarachnoid bypass shunt insertion. This minimally invasive technique seems to be an effective and safe method.
Post-traumatic syringomyelia: a review
Journal of Clinical Neuroscience, 2003
More than a quarter of spinal cord injured patients develop syringes and many of these patients suffer progressive neurological deficits as a result of cyst enlargement. The mechanism of initial cyst formation and progressive enlargement are unknown, although arachnoiditis and persisting cord compression with disturbance of cerebrospinal fluid flow appear to be important aetiological factors. Current treatment options include correction of bony deformity, decompression of the spinal cord, division of adhesions, and shunting. Long-term improvement occurs in fewer than half of patients treated. Imaging evidence of a reduction in syrinx size following treatment does not guarantee symptomatic resolution or even prevention of further neurological loss. A better understanding of the causal mechanisms of syringomyelia is required to develop more effective therapy.