Klekamp (2002). The pathophysiology of syringomyelia - historical overview and current concept.

Wise Young · 01-17-2003, 12:02 AM

• Klekamp J (2002). The pathophysiology of syringomyelia - historical overview and current concept. Acta Neurochir (Wien) 144:649-64. Summary: Various ideas and hypotheses have been brought forward to explain the development of syringomyelia in the past two centuries. None of them offers a sufficient basis to serve as a concept for the treatment of all affected patients. Apart from a discussion of the different hypotheses this paper proposes a new pathophysiological concept based on clinical, experimental and literature studies. Syringomyelia is understood as a state of chronic interstitial edema of the spinal cord due to accumulation of extracellular fluid (ECF). This accumulation is caused by a cascade of events starting with obstruction of cerebrospinal fluid (CSF) flow and/or spinal cord tethering which ultimately alter ECF flow and increase ECF volume. Treatment should be targeted against the pathological process which causes CSF flow obstruction and cord tethering to inhibit this pathophysiological process at a decisive point. Klinikum Hannover Nordstadt, Department of Neurosurgery, Haltenhoffstr. 41, 30167 Hannover, Germany.

Kirsten · 01-21-2003, 07:32 PM

Dear Dr. Young,

Thanks for posting this abstract. I've read several of Dr. Kleklamp's papers on syringomyelia, and they were critical in helping me understand the link between tethering and eventual syrinx formation.

I wish this information was making its way more quickly into the rest of medicine. I get the sense that most people in the medical community still think what I thought about a year ago - that syringomyelia is either a passive hollowing-out of the cord after cell death (as from trauma), or some sort of weird, unexplained anomaly, perhaps congenital. I definitely knew what the classic symptoms of a syrinx were, but had no idea that it might be a sign of another underlying spinal abnormality.

Dr. Kleklamp's papers explain how a syrinx can form from a kind of back-up of CSF flow within the cord - finally clarifying the link between tethering, arachnoid adhesions, other instraspinal abnormalities and eventual syringomyelia. This was completely new to me when I found one of his papers a year ago, and fundamentally changed the way I looked at the spinal nervous system as a single, interconnected unit.

I know there's an NIH-linked clinical trial underway, funded by the National Institute of Neurological Disorders and Stroke (NINDS), in which patients with syringomyelia are evaluated for an underlying cause (in particular, intradural scarring). The idea is to see if better results can be obtained by addressing the underlying abnormality as well as by relieving pressure within the syrinx. A previous arm of the trial focused more on patients with syringomyelia caused by a Chiari anomaly. I'm sure you already know about this study, but I'll add on the link here too:

Syringomyelia clinical trial

Thanks again,
Kirsten

[This message was edited by Kirsten on 01-22-03 at 09:33.]

01-17-2003, 12:02 AM	#1
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,988	Klekamp (2002). The pathophysiology of syringomyelia - historical overview and current concept. • Klekamp J (2002). The pathophysiology of syringomyelia - historical overview and current concept. Acta Neurochir (Wien) 144:649-64. Summary: Various ideas and hypotheses have been brought forward to explain the development of syringomyelia in the past two centuries. None of them offers a sufficient basis to serve as a concept for the treatment of all affected patients. Apart from a discussion of the different hypotheses this paper proposes a new pathophysiological concept based on clinical, experimental and literature studies. Syringomyelia is understood as a state of chronic interstitial edema of the spinal cord due to accumulation of extracellular fluid (ECF). This accumulation is caused by a cascade of events starting with obstruction of cerebrospinal fluid (CSF) flow and/or spinal cord tethering which ultimately alter ECF flow and increase ECF volume. Treatment should be targeted against the pathological process which causes CSF flow obstruction and cord tethering to inhibit this pathophysiological process at a decisive point. Klinikum Hannover Nordstadt, Department of Neurosurgery, Haltenhoffstr. 41, 30167 Hannover, Germany.

Thread Tools
Show Printable Version Email this Page
Display Modes
Switch to Linear Mode Hybrid Mode Switch to Threaded Mode

01-21-2003, 07:32 PM	#2
Kirsten Junior Member Join Date: Jan 2003 Posts: 7	Dear Dr. Young, Thanks for posting this abstract. I've read several of Dr. Kleklamp's papers on syringomyelia, and they were critical in helping me understand the link between tethering and eventual syrinx formation. I wish this information was making its way more quickly into the rest of medicine. I get the sense that most people in the medical community still think what I thought about a year ago - that syringomyelia is either a passive hollowing-out of the cord after cell death (as from trauma), or some sort of weird, unexplained anomaly, perhaps congenital. I definitely knew what the classic symptoms of a syrinx were, but had no idea that it might be a sign of another underlying spinal abnormality. Dr. Kleklamp's papers explain how a syrinx can form from a kind of back-up of CSF flow within the cord - finally clarifying the link between tethering, arachnoid adhesions, other instraspinal abnormalities and eventual syringomyelia. This was completely new to me when I found one of his papers a year ago, and fundamentally changed the way I looked at the spinal nervous system as a single, interconnected unit. I know there's an NIH-linked clinical trial underway, funded by the National Institute of Neurological Disorders and Stroke (NINDS), in which patients with syringomyelia are evaluated for an underlying cause (in particular, intradural scarring). The idea is to see if better results can be obtained by addressing the underlying abnormality as well as by relieving pressure within the syrinx. A previous arm of the trial focused more on patients with syringomyelia caused by a Chiari anomaly. I'm sure you already know about this study, but I'll add on the link here too: Syringomyelia clinical trial Thanks again, Kirsten [This message was edited by Kirsten on 01-22-03 at 09:33.]