The pathogenesis of syringomyelia associated with lesions at the foramen magnum: a critical review of existing theories and proposal of a new hypothesis

Levine, David N.

doi:10.1016/j.jns.2004.01.014

Cited by 186 publications

(169 citation statements)

References 87 publications

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“…Papers that support an extracellular origin of CSF include those by Klekamp, 17 Levine, 23 Greitz, 10 and Koyanagi and Hougin. 19 The exact mechanism, however, is still debated.…”

Section: Pathophysiologymentioning

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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“…Papers that support an extracellular origin of CSF include those by Klekamp, 17 Levine, 23 Greitz, 10 and Koyanagi and Hougin. 19 The exact mechanism, however, is still debated.…”

Section: Pathophysiologymentioning

confidence: 99%

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

Roy¹,

Slimack²,

Ganju³

2011

FOC

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“…This may result in a combination of mechanical stress on the cord parenchyma and disruption of the blood-brain barrier, which in concert with raised intravascular pressure results in ultrafiltration of crystalloids and accumulation of fluid. [9] The fluid may dissect along planes of weakness within the cord resulting in the pathological appearance of a syrinx.…”

Section: Discussionmentioning

confidence: 99%

Syringomyelia associated with Cervical Spondylosis: A case report

Samancı¹,

Çelik²

2014

Romanian Neurosurgery

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Although cervical spondylosis is an extremely common condition causing spinal cord compression, it is rarely involved in syringomyelia formation.Here we describe a case of syringomyelia associated with cervical spondylosis.Key words: Cervical spondylosis, Surgery, Syringomyelia. Case HistoryA 57-year-old woman presented to our outpatient clinic complaining of left arm pain and weakness, progressing over 2 months. On neurological examination, there was muscle atrophy and dissociated sensory loss in the right arm and hand, and exaggerated reflexes in the upper limbs. The patient was subsequently referred for magnetic resonance imaging (MRI). Sagittal and axial T1 and T2 weighted sequences through the cervical and thoracic spine were performed. This demonstrated degenerative changes at C5-6 with a left foraminal disc protrusion compressing thecal sac. (Figures 1 and 2) An unexpected cord syrinx was noted extending from C5 inferiorly to T1. (Figures 1 and 3

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“…Sometimes, the cavity may extend at the level of the medulla oblongata, causing a syringobulbia [22]. Syringomyelia is most commonly secondary to a Chiari malformation [22].…”

Section: Introductionmentioning

confidence: 99%

“…Sometimes, the cavity may extend at the level of the medulla oblongata, causing a syringobulbia [22]. Syringomyelia is most commonly secondary to a Chiari malformation [22]. Its association with tumors of the posterior cranial fossa (PCF) is a rare condition, with few cases described in literature of epidermoids [11,27], medulloblastomas [21,28], gliomas [28], metastases [28], synovialomas [21], cysts [3,5,8,10,18,29,35], gangliocytomas [24], dysembryoplastic tumors [34], and meningiomas (Table 1) [2,6,7,9,12,13,[19][20][21]28] The authors present a case of syringobulbia secondary to a meningioma of the PCF, reviewing the pertinent literature and discussing surgical management and the potential pathogenetic mechanism.…”

Section: Introductionmentioning

confidence: 99%

Syringobulbia associated with posterior fossa meningioma: a review of the literature

et al. 2014

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Purpose Syringomyelia can be defined as a degenerative, progressive and chronic spinal cord disease. Its association with tumors of the posterior cranial fossa (PCF) is a rare condition. Methods The authors report a rare case of syringobulbia consequent to a meningioma originating from PCF in a 17-yearold female, discussing the pathogenetic mechanism of development and the resolution of the syrinx cavity after surgical procedure. Results The postoperative period was uneventful without complications. At 6-month follow-up, MRI revealed complete tumor removal with resolution of the syrinx cavity. Conclusions In cases of syringomyelia and tonsillar herniation associated with PCF meningioma, the tumor resection allows to eliminate the mass effect and increases the size of the posterior fossa with the progressive ascent of the cerebellar tonsils and the consequent reduction of their downward movement with systolic pulsation. The re-establishment of a normal anatomical condition led to the gradual disappearance of syrinx and hydrocephalus.

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The pathogenesis of syringomyelia associated with lesions at the foramen magnum: a critical review of existing theories and proposal of a new hypothesis

Cited by 186 publications

References 87 publications

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

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

Syringomyelia associated with Cervical Spondylosis: A case report

Syringobulbia associated with posterior fossa meningioma: a review of the literature

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