Klekamp / Samii Syringomyelia

Diagnosis and Treatment
2002
ISBN: 978-3-642-56023-1
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 195 Seiten, eBook

Syringomyelia has fascinated neurologists and neurosurgeons for decades, if not for centuries. The slowly progressing cystic cavitations of the spinal cord have led scientists and clinicians to various pathophysiological hypotheses and treatment strategies. Until recently, no clear concept existed as to what caused a syrinx and how and when a particular patient should be treated. The introduction of magnetic resonance imaging (MRI) has revolutionized our view of syringomyelia. For the first time, we are able to diagnose a syrinx before it produces clinical symptoms, and we can follow the course of the syrinx before and after surgical treatment with a noninvasive method. This has led to a huge amount of information not available to previous scientists. Nevertheless, pathophysiology and treatment are still contro versial. The aim of this book is to give a guideline on how to approach a patient with a syrinx. Based on clinical experience, we have modified our strategies repeatedly in an attempt to improve clinical results. We have developed a treatment concept, evolved out of 20 years of clinical and experimental work, which has proven to be a solid basis for our decision making. Clinical courses, surgical indications, tech niques, and postoperative results are discussed for each of the different pathologies known to be associated with syringomyelia. In this manner, we hope to give a co herent overview on all aspects of syringomyelia, which should help physicians to counsel and treat patients with this fascinating but also potentially devastating dis ease.

Zielgruppe

Research

Autoren/Hrsg.

Klekamp, Jörg

Samii, Madjid

Weitere Mitwirkende

Matthies, C.

Inhaltsverzeichnis

1 Introduction.- 1.1 Definitions of Cord Cavitations.- 1.2 History of Syringomyelia.- 1.2.1 Review of Pathophysiological Hypotheses.- 1.2.1.1 Dysraphic Hypothesis.- 1.2.1.2 Neoplastic Hypothesis.- 1.2.1.3 Inflammatory Hypothesis.- 1.2.1.4 Ischemic Hypothesis.- 1.2.1.5 Hematomyelic Hypothesis.- 1.2.1.6 Secretory Hypothesis.- 1.2.1.7 Transudation Hypothesis.- 1.2.1.8 Hydrodynamic Hypothesis.- 1.2.1.9 Pressure Dissociation Hypothesis.- 1.2.1.10 Transmedullary Hypothesis.- 1.2.1.11 Edema Hypothesis.- References.- 2 The Pathophysiology of Syringomyelia.- 2.1 Anatomical Background.- 2.2 Fluid Movements in the Extracellular and Subarachnoid Spaces.- 2.3 Tethered Cord and Extracellular Space.- 2.4 Pathophysiological Concept.- 2.5 Disorders Associated with Syringomyelia.- References.- 3 Syringomyelia Associated with Diseases at the Craniocervical Junction.- 3.1 Chiari Malformations.- 3.1.1 Clinical Presentation.- 3.1.2 Neuroradiology.- 3.1.2.1 Craniocervical Junction.- 3.1.2.2 Spine and Spinal Cord.- 3.1.3 Neurophysiology.- 3.1.4 Surgical Management.- 3.1.4.1 Hydrocephalus and Chiari Malformation.- 3.1.4.2 Decompression for Chiari I Malformation.- 3.1.4.3 Decompression for Chiari II Malformation.- 3.1.4.4 Basilar Invagination and Chiari Malformation.- 3.1.4.5 Craniocervical Instability and Chiari Malformation.- 3.1.4.6 Degenerative Changes of the Spine and Chiari Malformation.- 3.1.5 Postoperative Outcome.- 3.1.5.1 Complications.- 3.1.5.2 Radiological Results for Chiari I Malformation.- 3.1.5.3 Clinical Results for Chiari I Malformation.- 3.1.5.4 Postoperative Results for Chiari II Malformation.- 3.1.6 Management of Clinical Recurrences of Chiari Malformations.- 3.1.7 Conclusions for Patients with Chiari Malformations.- References.- 3.2 Rhombencephalic Malformations.- 3.2.1 Dandy-Walker Malformation.- 3.2.2 Atresia of Foramina of Luschka and Magendie.- References.- 3.3 Foramen Magnum Arachnoiditis.- 3.3.1 Clinical Presentation.- 3.3.2 Neuroradiology.- 3.3.3 Surgical Management.- 3.3.4 Postoperative Outcome.- References.- 3.4 Intracranial Tumors.- References.- 4 Syringomyelia Associated with Diseases of the Spinal Canal.- 4.1 Syringomyelia Related to Spinal Arachnoid Scarring.- 4.1.1 Clinical Presentation.- 4.1.1.1 Posttraumatic Syringomyelia.- 4.1.1.2 Postinflammatory Syringomyelia.- 4.1.2 Neuroradiology.- 4.1.3 Neurophysiology.- 4.1.4 Surgical Management.- 4.1.4.1 Arachnolysis and Decompression of the Spinal Canal.- 4.1.4.2 Surgical Strategy for Patients with Additional Degenerative Spinal Disease, Kyphotic Angulations, or Spinal Instabilities.- 4.1.4.3 Implantation of a Syrinx Shunt.- 4.1.5 Postoperative Outcome.- 4.1.5.1 Complications.- 4.1.5.2 Radiological Results.- 4.1.5.3 Clinical Results.- 4.1.6 Management of Clinical Recurrences of Spinal Arachnoid Scarring.- 4.1.7 Conclusions for Patients with Spinal Arachnoid Scarring.- References.- 4.2 Syringomyelia Related to Tumors of the Spinal Canal.- 4.2.1 Intramedullary Tumors.- 4.2.1.1 Clinical Presentation.- 4.2.2.2 Neuroradiology.- 4.2.1.3 Surgical Management159.- 4.2.1.4 Postoperative Outcome.- 4.2.2 Extramedullary and Epidural Tumors.- References.- 4.3 Syringomyelia Related to Spinal Dysraphism.- 4.3.1 Clinical Presentation.- 4.3.2 Neuroradiology.- 4.3.3 Surgical Management.- 4.3.4 Postoperative Outcome.- References.- 4.4 Syringomyelia Related to Diseases of the Spine.- 4.4.1 Degenerative Diseases.- 4.4.2 Spinal Scoliosis.- References.