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Thread: Lee, et al. (2002). Decompression of the spinal subarachnoid space as a solution for syringomyelia without Chiari malformation.

  1. #1

    Lee, et al. (2002). Decompression of the spinal subarachnoid space as a solution for syringomyelia without Chiari malformation.

    • Lee JH, Chung CK and Kim HJ (2002). Decompression of the spinal subarachnoid space as a solution for syringomyelia without Chiari malformation. Spinal Cord 40:501-6. Summary: STUDY DESIGN: Review and analysis of seven cases of syringomyelia treated surgically. OBJECTIVE: To demonstrate the beneficial role of decompressive surgery for the altered cerebrospinal fluid (CSF) flow dynamics in syringomyelia not associated with Chiari I malformation. A comparison between the pre- and post-operative syrinx size and CSF flow in the subarachnoid space was made using cine-mode magnetic resonance imaging (cine-MRI) and then correlated with clinical improvement. SETTING: University Hospital, Seoul, Korea. METHODS: Conventional spinal MRI and cine-MRI were performed in the region of CSF flow obstruction preoperatively in seven patients with syringomyelia not associated with Chiari I malformation. The group consisted of one case of syrinx with post-traumatic compression fracture, one case of post-traumatic arachnoiditis, two cases of holocord syrinx associated with hydrocephalus without Chiari malformation, one case of syrinx with post-traumatic pseudomeningeal cyst, one case of post-laminectomy kyphosis-associated syringomyelia and one case of post-tuberculous arachnoiditis syringomyelia. Based on the preoperative cine-MRI, the types of surgery appropriate to correct the CSF flow obstruction were chosen: decompressive laminectomy-adhesiolysis and augmentation duraplasty in arachnoiditis cases, ventriculoperitoneal shunt for hydrocephalus, cyst extirpation in pseudomeningeal cyst and both anterior and posterior decompression-fusion in the case of post-laminectomy kyphosis. A syrinx-draining shunt operation was performed in three cases; where the syringomyelia was associated with post-traumatic compression fracture refractory to a previous decompression, where hydrocephalus was present in which the decompression by ventriculoperitoneal shunt was insufficient and where post-traumatic arachnoiditis was present in which the decompression was impossible due to diffuse adhesion. Change in syrinx size was evaluated with post-operative MRI in all seven cases and restoration of flow dynamics was evaluated with cine-MRI in three of the cases, two patients with clinical improvement and one patient with no change of clinical status, respectively. RESULTS: Four out of seven patients showed symptomatic improvement after each decompressive operation. In the remaining three cases, reconstruction of the spinal subarachnoid space was not possible due to diffuse adhesion or was not the main problem as in the patient with syrinx associated with hydrocephalus who had to undergo a shunt operation. One of these three patients showed clinical improvement after undergoing syringosubarachnoid shunt. A decrease of syrinx size was observed in only two out of the five patients who showed clinical improvement after treatment. Of these five patients, two patients underwent post-operative cine-MRI and the restoration of normal CSF flow dynamics was noted in both patients. Of the remaining two patients, one underwent post-operative cine-MRI and there was no change in the CSF flow dynamics evident. CONCLUSION: These results suggest that the restoration of CSF flow dynamics between the syrinx and the subarachnoid space by decompressive operation is more effective than simple drainage of the syrinx cavity itself in the treatment of syringomyelia without Chiari malformation. Department of Neurosurgery and Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.

  2. #2
    Dear Dr. Young,

    Thanks for this abstract discussing the use of cine-MRI to evaluate cord tethering and adhesions. I'm trying to find out how useful it is in evaluating possible cervical cord tethering. I don't know how much the value of this test depends on the experience of the neuroradiologists interpreting it, and which centers would be likely to know what to look for.

    Previously I had seen reports of the use of cine-MRI to evaluate borderline Chiari anomalies. There's a bunch of us out here with cord tethering who also have Chiari-like cranial nerve/brainstem symptoms, yet no classic signs of a Chiari on MRI. Some of them have had cine studies that show clear impairment of CSF flow areound the brainstem.

    I will look for more literature on cine-MRI of the spine, and see if this would be something to consider in evaluating my cervical cord. On regular MRI the cervical cord seems to touch the dura for a long stretch. However, it's difficult to tell if it's actually stuck there, since the cord will normally "hug the curve" in the cervical spine, just by geometry.

    Thanks again,

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