Summary
Syringomyelia poses unique challenges for the clinician because of its complex symptomatology, varied pathology, and multiple options for treatment. The purpose of this chapter is to review current knowledge concerning the pathology and pathophysiology of syringomyelia as a foundation for diagnosis and treatment. Conclusions are based on pathological findings in 175 patients coming to autopsy in the years 1955–1993, clinical and magnetic resonance imaging (MRI) findings in a database of 1245 patients (1993–2000), and operative findings in 387 patients undergoing surgical treatment between the years 1994 and 2000. The use of a pathology-based classification of syringomyelia provides a scientific basis for diagnosis and treatment.
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References
Gardner WJ, Goodall RJ (1950) The surgical treatment of Arnold-Chiari malformation in adults. An explanation of its mechanism and importance of encephalography in diagnosis. J Neurosurg 7:199–206
Williams B (1980) On the pathogenesis of syringomyelia: a review. J R Soc Med 73:798–806
Levy WJ, Mason L, Hahn JF (1983) Chiari malformation presenting in adults: a surgical experience in 127 cases. Neurosurgery 12:377–390
Rhoton AL Jr (1976) Microsurgery of Arnold-Chiari malformation in adults with and without hydromyelia. J Neurosurg 45:473–483
Dyste GN, Menezes AH, VanGilder JC (1989) Symptomatic Chiari malformations. An analysis of presentation, management and long-term outcome. J Neurosurg 71:159–168
Pillay PK, Awan IA, Little JR, Hahn JF (1991) Symptomatic Chiari malformation in adults: a new classification based on magnetic resonance imaging with clinical and prognostic significance. Neurosurgery 28:639–645
Park TS, Cail WS, Broaddus WC, et al (1989) Lumboperitoneal shunt combined with myelotomy for treatment of syringomyelia. J Neurosurg 70:721–727
Milhorat TH, Capocelli AL Jr, Anzil AP, et al (1995) Pathological basis of spinal cord cavitation in syringomyelia: analysis of 105 autopsy cases. J Neurosurg 82:802–812
Milhorat TH, Johnson RW, Milhorat RH, et al (1995) Clinicopathological correlations using axial magnetic resonance imaging. Neurosurgery 37:206–213
Milhorat TH (2000) Classification of syringomyelia. Neurosurg Focus 8(3): 1
Milhorat TH, Kotzen RM, Anzil AP (1994) Stenosis of central canal of spinal cord in man: incidence and pathological findings in 232 autopsy cases. J Neurosurg 80:716–722
Eisenberg HM, McLennan JE, Welch K (1974) Ventricular perfusion in cats with kaolin-induced hydrocephalus. J Neurosurg 41:20–28
Oldfield EH, Muraszko K, Shawker TH, et al (1994) Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg 80:3–15
Heiss JD, Patronas N, DeVroom HJ, et al (1999) Elucidating the pathophysiology of syringomyelia. J Neurosurg 91:553–562
Stoodley MA, Brown SA, Brown CJ, et al (1997) Arterial pulsation-dependent perivascular cerebrospinal fluid flow into the central canal in the sheep spinal cord. J Neurosurg 86:686–693
Stoodley MA, Gutschmitz B, Jones NR (1999) Cerebrospinal fluid flow in an animal model of noncommunicating syringomyelia. Neurosurgery 44:1065–1076
Milhorat TH, Nobandegani F, Miller JI, et al (1993) Noncommunicating syringomyelia following occlusion of central canal in rats. Experimental model and histological findings. J Neurosurg 78:274–279
Milhorat TH, Johnson WD, Miller JI, et al (1992) Surgical treatment of syringomyelia based on magnetic resonance imaging criteria. Neurosurgery 31:231–245
Milhorat TH, Chou MW, Trinidad EM, et al (1999) Chiari I malformation redefined. Clinical and radiographic findings in 364 symptomatic patients. Neurosurgery 44:1005–1017
Ball MJ, Dayan AD (1972) Pathogenesis of syringomyelia. Lancet 2:799–801
Aboulker J (1979) La syringomyélie et les liquides intra-rachidiens. Neurochirurgie 25(suppl 1):1–44
Milhorat TH, Girgis PS, Pan J, et al (2001) Bulk flow pathway for cerebrospinal fluid filling of noncommunicating syrinx cavities: an ultrastructural study in rats. J Neurosurg (in press)
Brightman MW (1965) The distribution within the brain of ferritin injected into cerebrospinal fluid compartments. 1. Ependymal distribution. J Cell Biol 26:99–123
Brightman WM (1965) The distribution within the brain of ferritin injected into cerebrospinal fluid compartments. 2. Parenchymal distribution. Am J Anat 117:193–220
Brightman MW (1968) The intracerebral movement of proteins injected into blood and cerebrospinal fluid of mice. Prog Brain Res 29:19–37
Fenstermacher JD, Bradbury MWB, duBoulay G, et al (1980) The distribution of 125J-metrizamide and 125I-diatrizoate between blood, brain and cerebrospinal fluid in the rabbit. Neuroradiology 19:171–180
Williams B (1986) Progress in syringomyelia: a review. Neurol Res 8:139–145
Batzdorf U (1988) Chiari I malformation with syringomyelia: evaluation of surgical therapy by magnetic resonance imaging. J Neurosurg 68:726–730
Klekamp J, Batzdorf U, Samii M, et al (1997) Treatment of syringomyelia associated with arachnoid scarring caused by arachnoiditis or trauma. J Neurosurg 86:233–240
Batzdorf U (1000) Primary spinal syringomyelia: a personal perspective. Neurosurg Focus 8(3):7
Iskander BJ, Hedlund GL, Grabb PA, et al (1998) The resolution of syringohydromyelia wihtout hindbrain herniation after posterior fossa decompression. J Neurosurg 89:212–216
Tubbs RS, Elton S, Grabb P, et al (2001) Analysis of the posterior fossa in children with the Chiari O malformation. Neurosurgery (in press)
Barbaro NM, Wilson CB, Gutin PH, et al (1984) Surgical treatment of syringomyelia: favorable results with syringoperitoneal shunting. J Neurosurg 61:531–538
Peerless SJ, Durward QJ (1982) Management of syringomyelia: a pathophysiological approach. Clin Neurosurg 30:531–576
Wisoff JH, Epstein F (1989) Management of hydromyelia. Neurosurgery 25:562–571
Tator CH, Megura K, Rowed DW (1982) Favorable results with syringosubarachnoid shunts for treatment of syringomyelia. J Neurosurg 56:517–523
Milhorat TH, Johnson WD, Miller JI (1992) Syrinx shunt to posterior fossa cisterns (syringocisternostomy) for bypassing obstructions of the upper cervical theca. J Neurosurg 77:871–874
Milhorat TH, Kotzen RM, Mu HTM, et al (1996) Dysesthetic pain in patients with syringomyelia. J Neurosurg 38:940–947
Milhorat TH (1972) Hydrocephalus and the cerebrospinal fluid. Williams and Wilkins, Baltimore, pp 1–35
Scott RM (1996) Shunt complications In: Wilkins RH, Rengachary SS (eds) Neurosurgery, vol III. McGraw Hill, New York, pp 3655–3664
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Milhorat, T.H., Fox, A., Todor, D.R. (2001). Pathology, Classification, and Treatment of Syringomyelia. In: Tamaki, N., Batzdorf, U., Nagashima, T. (eds) Syringomyelia. Springer, Tokyo. https://doi.org/10.1007/978-4-431-67893-9_2
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DOI: https://doi.org/10.1007/978-4-431-67893-9_2
Publisher Name: Springer, Tokyo
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