Tags

Type your tag names separated by a space and hit enter

Origin of Syrinx Fluid in Syringomyelia: A Physiological Study.
Neurosurgery. 2019 02 01; 84(2):457-468.N

Abstract

BACKGROUND

The origin of syrinx fluid is controversial.

OBJECTIVE

To elucidate the mechanisms of syringomyelia associated with cerebrospinal fluid pathway obstruction and with intramedullary tumors, contrast transport from the spinal subarachnoid space (SAS) to syrinx was evaluated in syringomyelia patients.

METHODS

We prospectively studied patients with syringomyelia: 22 with Chiari I malformation and 16 with SAS obstruction-related syringomyelia before and 1 wk after surgery, and 9 with tumor-related syringomyelia before surgery only. Computed tomography-myelography quantified dye transport into the syrinx before and 0.5, 2, 4, 6, 8, 10, and 22 h after contrast injection by measuring contrast density in Hounsfield units (HU).

RESULTS

Before surgery, more contrast passed into the syrinx in Chiari I malformation-related syringomyelia and spinal obstruction-related syringomyelia than in tumor-related syringomyelia, as measured by (1) maximum syrinx HU, (2) area under the syrinx concentration-time curve (HU AUC), (3) ratio of syrinx HU to subarachnoid cerebrospinal fluid (CSF; SAS) HU, and (4) AUC syrinx/AUC SAS. More contrast (AUC) accumulated in the syrinx and subarachnoid space before than after surgery.

CONCLUSION

Transparenchymal bulk flow of CSF from the subarachnoid space to syrinx occurs in Chiari I malformation-related syringomyelia and spinal obstruction-related syringomyelia. Before surgery, more subarachnoid contrast entered syringes associated with CSF pathway obstruction than with tumor, consistent with syrinx fluid originating from the subarachnoid space in Chiari I malformation and spinal obstruction-related syringomyelia and not from the subarachnoid space in tumor-related syringomyelia. Decompressive surgery opened subarachnoid CSF pathways and reduced contrast entry into syringes associated with CSF pathway obstruction.

Authors+Show Affiliations

Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland.Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland.Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland.Novant Health Neurosurgery Specialists, Charlotte, North Carolina.Department of Neurosurgery, University of Freiburg, Faculty of Medicine, Freiburg, Germany.Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland.Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland.Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland.Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland.Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29618081

Citation

Heiss, John D., et al. "Origin of Syrinx Fluid in Syringomyelia: a Physiological Study." Neurosurgery, vol. 84, no. 2, 2019, pp. 457-468.
Heiss JD, Jarvis K, Smith RK, et al. Origin of Syrinx Fluid in Syringomyelia: A Physiological Study. Neurosurgery. 2019;84(2):457-468.
Heiss, J. D., Jarvis, K., Smith, R. K., Eskioglu, E., Gierthmuehlen, M., Patronas, N. J., Butman, J. A., Argersinger, D. P., Lonser, R. R., & Oldfield, E. H. (2019). Origin of Syrinx Fluid in Syringomyelia: A Physiological Study. Neurosurgery, 84(2), 457-468. https://doi.org/10.1093/neuros/nyy072
Heiss JD, et al. Origin of Syrinx Fluid in Syringomyelia: a Physiological Study. Neurosurgery. 2019 02 1;84(2):457-468. PubMed PMID: 29618081.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Origin of Syrinx Fluid in Syringomyelia: A Physiological Study. AU - Heiss,John D, AU - Jarvis,Katie, AU - Smith,René K, AU - Eskioglu,Eric, AU - Gierthmuehlen,Mortimer, AU - Patronas,Nicholas J, AU - Butman,John A, AU - Argersinger,Davis P, AU - Lonser,Russell R, AU - Oldfield,Edward H, PY - 2017/06/20/received PY - 2018/02/13/accepted PY - 2018/4/5/pubmed PY - 2020/1/1/medline PY - 2018/4/5/entrez SP - 457 EP - 468 JF - Neurosurgery JO - Neurosurgery VL - 84 IS - 2 N2 - BACKGROUND: The origin of syrinx fluid is controversial. OBJECTIVE: To elucidate the mechanisms of syringomyelia associated with cerebrospinal fluid pathway obstruction and with intramedullary tumors, contrast transport from the spinal subarachnoid space (SAS) to syrinx was evaluated in syringomyelia patients. METHODS: We prospectively studied patients with syringomyelia: 22 with Chiari I malformation and 16 with SAS obstruction-related syringomyelia before and 1 wk after surgery, and 9 with tumor-related syringomyelia before surgery only. Computed tomography-myelography quantified dye transport into the syrinx before and 0.5, 2, 4, 6, 8, 10, and 22 h after contrast injection by measuring contrast density in Hounsfield units (HU). RESULTS: Before surgery, more contrast passed into the syrinx in Chiari I malformation-related syringomyelia and spinal obstruction-related syringomyelia than in tumor-related syringomyelia, as measured by (1) maximum syrinx HU, (2) area under the syrinx concentration-time curve (HU AUC), (3) ratio of syrinx HU to subarachnoid cerebrospinal fluid (CSF; SAS) HU, and (4) AUC syrinx/AUC SAS. More contrast (AUC) accumulated in the syrinx and subarachnoid space before than after surgery. CONCLUSION: Transparenchymal bulk flow of CSF from the subarachnoid space to syrinx occurs in Chiari I malformation-related syringomyelia and spinal obstruction-related syringomyelia. Before surgery, more subarachnoid contrast entered syringes associated with CSF pathway obstruction than with tumor, consistent with syrinx fluid originating from the subarachnoid space in Chiari I malformation and spinal obstruction-related syringomyelia and not from the subarachnoid space in tumor-related syringomyelia. Decompressive surgery opened subarachnoid CSF pathways and reduced contrast entry into syringes associated with CSF pathway obstruction. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/29618081/Origin_of_Syrinx_Fluid_in_Syringomyelia:_A_Physiological_Study_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1093/neuros/nyy072 DB - PRIME DP - Unbound Medicine ER -