View Full Version : Dr. Young - drain by tap?
Just wondering if this pseudosyrinx from C-4to C-6 could be drained with a spinal tap needle (yeah, I'm desperate), and, if so, whether it would do any good (help reduce pain.) There's been no mention of tethering in any MRI report, so untethering surgery doesn't appear indicated.
Also, is there anything that can stop the shoulder blades from rubbing whatever bones they rub?
Due to lack of anything else to do, we're thinking of trying Zonegran. Anybody have success with it?
There's a reply to you in Private topics re the MRI question.
Alan
"Was it over when the Germans bombed Pearl Harbor?"
[This message was edited by alan on 06-24-04 at 02:49 PM.]
Bump.
Alan
"Was it over when the Germans bombed Pearl Harbor?"
Wise Young
06-28-2004, 07:04 PM
Alan, I am sorry that I did not see your post earlier. I just left my fax number. I don't know what a pseudosyrinx is. The term pseudosyringomyelia is sometimes used to refer to a neurological syndrome that mimics the changes produced by a syrinx but there is no syrinx. So, the concept of draining a pseudosyrinx does not make sense. However, I remember that you mentioned that you do have a small syringomyelic cyst. A small cyst would be difficult to tap.
Even if you had a big syringomyelic cyst, I doubt that draining it with a spinal needle would help. The cyst would fill up again within a couple of days. A drain put in the cyst might be more effective but generally will plug up within a year and the cyst will reform. An alternative is what Barth Green and his colleagues practice. Sometimes, tethering cannot be clearly seen on MRI's. When they go in, they remove all adhesions that they can find. If they don't find any adhesions, they insert a drain.
As you know, Zonegran is a anti-seizure drug. It might be worth a try but I don't know whether it would help.
Wise.
David Berg
06-28-2004, 08:31 PM
Wise, forgive my ignorance here, but would tethering show any better on a higher resolution scan such as SPECT or PET?
Wise Young
06-29-2004, 05:36 AM
Hi, David. In my experience, both SPECT and PET are low resolutoin scans but they show signals relating to cellular activity (or at least uptake of certain tracers). MRI is currently the highest resolution imaging modality that we have. There are some centers that have 4.7 tesla machines (compared to the typice 1.7 tesla clinical machines). But, even highest resoluton clinical MRI scanners can detect only down to ±100µ whereas adhesions can be smaller. If the spinal cord or a root is resting against the dura, it is often not clear that it is stuck to the dura or not without moving the two structures with respect to each other. That is why some neuroradiology groups take the MRI is two positions and compare them; there are even some who take cine-MRI images (movies) to see if see relative movement of the structures during pulsations of the cord.
Wise.
Dr. Young,
I called the hole a pseudosyrinx, since it apparently isn't a syrinx, but seems to look like a small one. I'd like to just pop the whole mess with a lawn dart. http://sci.rutgers.edu/forum/images/smilies/frown.gif
As I mentioned, despite continuing increases in pain (I'm going to lose my mind one of these days), there's been no change in the area of injury since at least 1996 (2004 scan compared to 2001, which was compared to 1996, which was likely compared to earlier scans, but I don't have that report.) Since it hasn't grown, I thought that might mean no new fluid enters it, so draining it might collapse what little is left of the cord. I think strange thoughts while lying awake at night feeling everything burn - that was one of them. Another was hanging upside down to help straighten my spine.
I'll send you the reports from the latest pictures.
I started the Zonegran today.
Alan
"Was it over when the Germans bombed Pearl Harbor?"
metronycguy
06-30-2004, 06:01 AM
good wished with the zonegran, Alan.
the 25 mg desiprmaine seems to be be working pretty well for me.benefits are outweighing the unwanted side effects so far
I couldn't fall asleep while takiing the Zonegran (even with increased Ativan at night.) So, I can't take it, unless we find a way to sleep with it. Sleep, as little as I get, is the only break I get.
How long did you take Desipramine before noticing it improved things?
Alan
"Was it over when the Germans bombed Pearl Harbor?"