Slitlike syrinx cavities: a persistent central canal

Holly, Langston T.; Batzdorf, Ulrich

doi:10.3171/spi.2002.97.2.0161

Cited by 38 publications

(27 citation statements)

References 18 publications

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“…12,23,26 In general, idiopathic syringes have a different morphology and location, tending to be narrower than CM-associated syringes and not as frequently located in the cervical spine. 3,12,14,18,23 They are usually asymptomatic, incidental findings, and in most cases require no treatment. 12,14,18,23,26 All patients in this series had a syrinx width of at least 3 mm.…”

Section: Discussionmentioning

confidence: 99%

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Syrinx location and size according to etiology: identification of Chiari-associated syrinx

Strahle¹,

Muraszko²,

Garton³

et al. 2015

PED

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OBJECT Syrinx size and location within the spinal cord may differ based on etiology or associated conditions of the brain and spine. These differences have not been clearly defined. METHODS All patients with a syrinx were identified from 14,118 patients undergoing brain or cervical spine imaging at a single institution over an 11-year interval. Syrinx width, length, and location in the spinal cord were recorded. Patients were grouped according to associated brain and spine conditions including Chiari malformation Type I (CM-I), secondary CM (2°CM), Chiari malformation Type 0 (CM-0), tethered cord, other closed dysraphism, and spinal tumors. Syringes not associated with any known brain or spinal cord condition were considered idiopathic. Syrinx characteristics were compared between groups. RESULTS A total of 271 patients with a syrinx were identified. The most common associated condition was CM-I (occurring in 117 patients [43.2%]), followed by spinal dysraphism (20 [7.4%]), tumor (15 [5.5%]), and tethered cord (13 [4.8%]). Eighty-three patients (30.6%) did not have any associated condition of the brain or spinal cord and their syringes were considered idiopathic. Syringes in patients with CM-I were wide (7.8 ± 3.9 mm) compared with idiopathic syringes (3.9 ± 1.0, p < 0.0001) and those associated with tethered cord (4.2 ± 0.9, p < 0.01). When considering CM-I–associated and idiopathic syringes, the authors found that CM-I–associated syringes were more likely to have their cranial extent in the cervical spine (88%), compared with idiopathic syringes (43%; p < 0.0001). The combination of syrinx width greater than 5 mm and cranial extent in the cervical spine had 99% specificity (95% CI 0.92–0.99) for CM-I–associated syrinx. CONCLUSIONS Syrinx morphology differs according to syrinx etiology. The combination of width greater than 5 mm and cranial extent in the cervical spine is highly specific for CM-I–associated syringes. This may have relevance when determining the clinical significance of syringes in patients with low cerebellar tonsil position.

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Section: Discussionmentioning

confidence: 99%

“…3,12,14,18,23 They are usually asymptomatic, incidental findings, and in most cases require no treatment. 12,14,18,23,26 All patients in this series had a syrinx width of at least 3 mm. There is no consensus definition for distinguishing a narrow syrinx from the very common finding of a dilated central canal on imaging.…”

Section: Discussionmentioning

confidence: 99%

Syrinx location and size according to etiology: identification of Chiari-associated syrinx

Strahle¹,

Muraszko²,

Garton³

et al. 2015

PED

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“…The study also found that 50% of the patients had alternate diagnoses for their symptoms. Holly and Batzdorf 13 argued that these slitlike syrinx cavities do not represent true syringomyelia and are possibly even different from a presyrinx-like state. In the literature, there is no uniformity regarding this opinion.…”

Section: Holly and Batzdorfmentioning

confidence: 99%

“…This constellation of symptoms is similar to those described by Holly and Batzdorf. 13 Roser et al 34 suggested that hydromyelia is a congenital condition; in the setting of trauma, syringomyelia could develop. 10 Based on these studies, it is difficult to determine if slitlike syringes, hydromyelia, and IS are truly different entities or simply a continuum on a spectrum.…”

Section: Holly and Batzdorfmentioning

confidence: 99%

Idiopathic syringomyelia: retrospective case series, comprehensive review, and update on management

Roy¹,

Slimack²,

Ganju³

2011

FOC

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Object A syrinx is a fluid-filled cavity within the spinal cord that can be an incidental finding or it can be accompanied by symptoms of pain and temperature insensitivity. Although it is most commonly associated with Chiari malformation Type I, the advancement of imaging techniques has resulted in more incidental idiopathic syringes that are not associated with Chiari, tumor, trauma, or postinfectious causes. The authors present a comprehensive review and management strategies for the idiopathic variant of syringomyelia. Methods The authors retrospectively identified 8 idiopathic cases of syringomyelia at their institution during the last 6 years. A PubMed/Medline literature review yielded an additional 38 articles. Results Two of the authors' patients underwent surgical treatment that included a combination of laminectomy, lysis of adhesions, duraplasty, and syrinx fenestration. The remaining 6 patients were treated conservatively and had neurologically stable outcomes. Review of the literature suggests that an etiology-driven approach is essential in the diagnosis and management of syringomyelia, although conservative management suffices for most cases. In particular, it is important to look at disturbances in CSF flow, as well as structural abnormalities including arachnoid webs, cysts, scars, and a diminutive posterior fossa. Conclusions The precise etiology for idiopathic syringomyelia (IS) is still unclear, although conceptual advances have been made toward the overall understanding of the pathophysiology of IS. Various theories include the cerebellar piston theory, intramedullary pulse pressure theory, and increased spinal subarachnoid pressure. For most patients with IS, conservative management works well. Continued progression of symptoms, however, could be approached using decompressive strategies such as laminectomy, lysis of adhesions, and craniocervical decompression, depending on the level of pathology. Management for patients with progressive neurological dysfunction and the lack of flow disturbance is unclear, although syringosubarachnoid shunting can be considered.

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“…described slit-like syrinx cavities characterized by remnants of the central canal and an asymptomatic clinical course [13]. Therefore, idiopathic syringomyelia has several potential causes, including congenital remnants of the central canal and acquired dilations by a small posterior fossa.…”

Section: Sakushima Et Al Pagementioning

confidence: 99%