Intraoperative measurement of spinal cord blood flow in syringomyelia

Young, William F.; Tuma, Ronald F.; O’Grady, Timothy

doi:10.1016/s0303-8467(00)00082-2

Cited by 14 publications

(8 citation statements)

References 37 publications

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“…This feature has been used to perform spinal cord blood flow studies in experimental, as well in clinical settings. 45,46 The hemorrhagic area, which was analyzed by DAB staining, was already maximal at 20 min post-injury at both the injury epicenter and the penumbra, which indicates the sudden character of post-traumatic hemorrhage in the SCI. 47,48 Microvascular spasm is known to develop as a result of the toxic effects of blood, 49 although the physical trauma to vessels themselves also might induce spasm.…”

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confidence: 99%

Intravenous Infusion of Magnesium Chloride Improves Epicenter Blood Flow during the Acute Stage of Contusive Spinal Cord Injury in Rats

Muradov

Hagg

2013

Journal of Neurotrauma

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Vasospasm, hemorrhage, and loss of microvessels at the site of contusive or compressive spinal cord injury lead to infarction and initiate secondary degeneration. Here, we used intravenous injection of endothelial-binding lectin followed by histology to show that the number of perfused microvessels at the injury site is decreased by 80-90% as early as 20 min following a moderate T9 contusion in adult female rats. Hemorrhage within the spinal cord also was maximal at 20 min, consistent with its vasoconstrictive actions in the central nervous system (CNS). Microvascular blood flow recovered to up to 50% of normal volume in the injury penumbra by 6 h, but not at the epicenter. A comparison with an endothelial cell marker suggested that many microvessels fail to be reperfused up to 48 h post-injury. The ischemia was probably caused by vasospasm of vessels penetrating the parenchyma, because repeated Doppler measurements over the spinal cord showed a doubling of total blood flow over the first 12 h. Moreover, intravenous infusion of magnesium chloride, used clinically to treat CNS vasospasm, greatly improved the number of perfused microvessels at 24 and 48 h. The magnesium treatment seemed safe as it did not increase hemorrhage, despite the improved parenchymal blood flow. However, the treatment did not reduce acute microvessel, motor neuron or oligodendrocyte loss, and when infused for 7 days did not affect functional recovery or spared epicenter white matter over a 4 week period. These data suggest that microvascular blood flow can be restored with a clinically relevant treatment following spinal cord injury.

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confidence: 99%

Intravenous Infusion of Magnesium Chloride Improves Epicenter Blood Flow during the Acute Stage of Contusive Spinal Cord Injury in Rats

Muradov

Hagg

2013

Journal of Neurotrauma

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“…At the 18-month follow-up, the patient still exhibited mild motor deficits. It was therefore hypothesized that the pre-existing syringomyelia may have been the reason underlying this long-term damage (25). Pressure on spinal cord parenchyma, secondary to syringomyelia cavity expansion, may have contributed to the spinal cord dysfunction, particularly since intra-syrinx fluid is typically characterized by high viscosity and pressure (26).…”

Section: Discussionmentioning

confidence: 99%

Conus medullaris ganglioneuroma with syringomyelia radiologically mimicking ependymoma: A case report

Wang

Dai

2015

Oncology Letters

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Abstract. Ganglioneuromas are rare, benign, well-differentiated tumors of the conus medullaris. Approximately 20 cases of spinal cord ganglioneuroma, and only 1 case of mixed chemodectoma-ganglioneuroma of the conus medullaris have been previously reported. The present study presents the case of a 38-year-old man with a histopathological diagnosis of conus medullaris ganglioneuroma. The patient presented with hypoesthesia in the lower limbs, muscle atrophy of the right lower limb and dysuria. Magnetic resonance imaging analysis led to a diagnosis of ependymoma. Histopathological analysis of the excised mass revealed typical, well-differentiated ganglion cells, consistent with a ganglioneuroma. The mass was associated with a neighboring syringomyelia. At an 18 month follow-up the patient had recovered, although some remaining difficulty in walking and urinating remained. The aim of the present report was to raise awareness that when ganglioneuromas present in unusual locations, analogous radiological findings may mislead investigators to consider more common pathologies and thus result in misdiagnosis. The present case demonstrates the importance of considering the potential differential diagnoses for neural tissue neoplasms.

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“…2) This dynamic compression is a source of repetitive trauma, which results in vascular insufficiency of the affected spinal cord. 1,2) Marked improvements in rSCBF were observed immediately after drainage of the syrinx in patients with syringomelia, 22,38) based on laser Doppler flowmetry (LDF) during syrinx shunting. 22) LDF allows real-time monitoring of regional blood flow and can be used intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…10,11) rSCBF data in humans has also been obtained perioperatively. 22,38) Our technique can be performed at the same time as routine pre-and postoperative MR imaging. When a patient deteriorates clinically but shows no radiological changes, the possibility of changes in the perfusion of the spinal cord should be assessed, which may provide valuable information to clarify the pathophysiology of the spinal cord with myelopathy.…”

Section: Discussionmentioning

confidence: 99%

Perfusion-Weighted Magnetic Resonance Imaging of the Spinal Cord in Cervical Spondylotic Myelopathy

Uemura

Matsumura

Isobe

et al. 2006

Neurol. Med. Chir.(Tokyo)

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Principles of echo shifting with a train of observations was used to perform magnetic susceptibilityweighted magnetic resonance imaging with bolus-tracking in 14 patients with spondylotic myelopathy to assess changes in perfusion parameters of the spinal cord before and after decompression surgery for cervical spondylotic myelopathy. The mean transit time (MTT), bolus arrival time (T0), and time to peak (TTP) were obtained from regions of interest (ROIs) and assessed as the ratio between the spinal cord and the pons (MTT index ＝ MTT ROI /MTT pons , T0 index ＝ T0 ROI /T0 pons , TTP index ＝ TTP ROI / TTP pons ). The patients were divided into two groups according to percentage improvement on the Neurosurgical Cervical Spine Scale. The MTT index in patients with good recovery (AE50%) was significantly reduced. The T0 index and TTP index showed no significant change in both groups. Reduction of MTT index may indicate improved perfusion of the spinal cord following surgery for cervical spondylotic myelopathy.

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Intraoperative measurement of spinal cord blood flow in syringomyelia

Cited by 14 publications

References 37 publications

Intravenous Infusion of Magnesium Chloride Improves Epicenter Blood Flow during the Acute Stage of Contusive Spinal Cord Injury in Rats

Intravenous Infusion of Magnesium Chloride Improves Epicenter Blood Flow during the Acute Stage of Contusive Spinal Cord Injury in Rats

Conus medullaris ganglioneuroma with syringomyelia radiologically mimicking ependymoma: A case report

Perfusion-Weighted Magnetic Resonance Imaging of the Spinal Cord in Cervical Spondylotic Myelopathy

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