Paesaggio culturale e turismo sostenibile sull'isola di Hirado in Giappone (original) (raw)
Related papers
Seminars in Spine Surgery, 2006
Syringomyelia is a pathological entity characterized by spinal cord cavitation that often translates into a progressive clinical syndrome ranging from minimal to significant loss of neurological function. Although syringomyelia is often described in the context of a coexisting Chiari malformation, it can be present in a wide spectrum of disease processes. In this article we present a review of the pathophysiology and treatment strategies in syringomyelia. A classification system for this clinical entity is also outlined.
Syringomyelia: A Complication of an Underlying Pathology
Journal of Clinical Medicine …, 2010
Patients with syringomyelia may have diverse etiology and expe-rience a variety of symptoms. This report describes two cases of syringomyelia in patients with different profiles, presentations and pathomechanisms. ... Keywords: Syrigomyelia; Syrinx; ...
Idiopathic syringomyelia: case report and review of the literature
Advances in Functional and Reparative Neurosurgery
Syringomyelia is an uncommon disease that is caused most often by type I Chiari malformation, which develops in the hindbrain, and less frequently by other factors which are not limited to the hindbrain, including trauma, infection, or scoliosis. Idiopathic syringomyelia is rare. We present in this article a patient with idiopathic syringomyelia characterized by hypoesthesia and progressive weakness in the left lower limb. Decompression was attempted by means of laminectomy and a syringoarachnoid shunt. Motor, sensory, and bladder functions were monitored by the change in Japanese Orthopedic Association scores, which increased from 10 points preoperatively to 14 points 30 days postoperatively. This case demonstrates the effectiveness of surgical decompression in a patient with remarkable neurological deficit.
Surgical management of syringomyelia-Chiari complex
European Spine Journal, 2000
Magnetic resonance imaging (MRI) has facilitated the diagnosis of syringomyelia in recent years, providing sharp delineation of syrinxes and accurate identification of malformations at the cranio-cervical junction. What is the mechanism of origin and maintenance of syringomyelia? Syringomyelia cannot be ascribed to a single pathophysiological mechanism, and its etiology and natural history are quite variable. It occurs in relation to intramedullary tumors, compressive myelopathy, spinal trauma, hydrocephalus and anomalies such as the Chiari malformation. Syringomyelia, is most frequently associated with Chiari malformation, and several hypotheses have been proposed to explain its pathophysiology in this particular manifestation.
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.
Spontaneous Resolution of Syringomyelia Without Chiari Malformation-Case Report
Neurologia medico-chirurgica, 2006
A 30-year-old woman presented with a cervical syrinx manifesting as hemihypesthesia. Neuroimaging found no evidence of Chiari malformation or tight cisterna magna. Serial magnetic resonance imaging studies over a 6-year period demonstrated spontaneous and complete resolution of the syrinx accompanied by an asymptomatic clinical course. The natural history of syringomyelia is highly unpredictable. The outcome of surgical treatment for patients with syringomyelia is not always satisfactory, so the indications for surgery are controversial. Spontaneous resolution of syringomyelia unrelated with foramen magnum lesion has various causes. Close follow up of the patient is necessary to monitor for recurrence.
Terminal Syringomyelia: Is It As Innocent As It Seems?-Case Report
Neurologia medico-chirurgica, 2004
A 5-day-old newborn girl presented with cutaneous signs of hypertrichosis, skin dimple, and subcutaneous lipoma in the lumbar region. Magnetic resonance (MR) imaging of the thoracolumbar spine demonstrated spinal dermal sinus, type II split cord malformation, and tethered cord. A small terminal syringeal cavity was also present. Five months after the diagnosis, weakness in dorsal flexion of the bilateral feet and toes was detected. Surgery to untether the cord was performed. Her deficits resolved completely. Nearly 4 years later, she was admitted with weakness in dorsal flexion of the right foot and toe. MR imaging of the spine showed holocord syringomyelia, postoperative changes, and tethered cord. No Chiari malformation was seen. Syringosubarachnoid shunt placement was performed. Terminal syringomyelia is common in cases of occult spinal dysraphism, but the natural history and management remain unclear. Progression, regression, or persistence of terminal syringeal cavity can occur whether untethering is performed or not. Progression of the terminal syrinx occurred after tethered cord release and the enlargement of the cavity involved the entire spinal cord in the present case. Terminal syringomyelia requires close follow up for a long time even in asymptomatic cases. Surgical treatment should be considered in symptomatic cases.
Clinical and neuroimaging features of "idiopathic" syringomyelia
Neurology, 2004
In some adult patients with cervical syringomyelia, MRI studies do not identify primary disease within the foramen magnum or spinal canal. To identify the etiology of this idiopathic type of syringomyelia, clinical features and posterior fossa (PF) measurements from 17 of these patients, 17 patients with Chiari I-type syringomyelia, and 32 control subjects were compared. Idiopathic syringomyelia and Chiari I-type syringomyelia manifested central cervical myelopathy and a small PF with narrow CSF spaces, suggesting that they develop by the same mechanism. Syringomyelia is a polyetiologic disorder characterized by a fluid-filled cyst within the spinal cord. In this report, the term "syringomyelia" is used broadly to include hydromyelia, cystic enlargement of the spinal cord central canal with a preserved ependymal lining, and spinal cord cysts that may or may not connect with the central canal of the spinal cord and are lined primarily by glial fibers. 1 Syringomyelia is associated with conditions that obstruct CSF flow at the foramen magnum or spinal levels, such as Chiari I malformation (CM1), basilar invagination, and arachnoiditis. MRI and pathologic studies indicate that lesions obstructing the subarachnoid space are present in most cases of syringomyelia and that syrinx fluid usually does not communicate with the fourth ventricle in adult patients. 2 Recent clinical and animal research suggests that syringomyelia associated with CM1 results from spinal subarachnoid CSF entering the spinal cord through the perivascular spaces, being propelled by enlarged pulsatile CSF pressure waves that originate from the piston-like motion of the herniated cerebellar tonsils on the spinal subarachnoid space. Excess extracellular fluid accumulates and coalesces into a syrinx. 3 Most cases of syringomyelia are associated with CM1. 2 MRI diagnoses CM1 if the cerebellar tonsils extend 3 to 5 mm below the foramen magnum (FM), 4 although associated features include compression of cerebellar cisterns, decreased posterior fossa (PF) volume,
Magnetic resonance imaging (MRI) in syringomyelia
Acta Neurochirurgica, 1995
Based on an own material of 19 patients with syringomyelia and on the related literature a survey is given on the diagnosis, differential diagnosis, postoperative evaluation and the dynamics of CSF and cyst fluids, using magnetic resonance imaging (MRI).