Observation between Clinical Outcomes and the Size of the Syrinx with Magnetic Resonance Image

  • Hwang, Ju-Yeon (Department of Neurosurgery, National Medical Center) ;
  • Kim, Young-Jin (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Oh, Seong-Hoon (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Kang, Jae-Kyu (Department of Neurosurgery, National Medical Center) ;
  • Kim, Young-Soo (Department of Neurosurgery, Hanyang University Medical Center)
  • Published : 2006.09.30

Abstract

Objective : This study was conducted to examine the correlation between clinical outcomes and the size of the syrinx in post-operative magnetic resonance imaging[MRI] and symptom duration. Methods : The authors investigated twelve patients who underwent various operations for syringomyelia from January 1995 to December 2003. The authors retrospectively analyzed medical records. pre- and post-operative MRI findings, features and durations of symptoms, and the method of surgical treatments. The clinical outcomes were assessed on Prolo scale at 6 months of post-operative period. Results : Neurologic symptoms did not promptly disappear after the shrinkage of syrinx, but post-operative MRI demonstrated most patients showed reductions in the size of the syrinx. There is no statistical relationship between clinical improvements and decrements of the syrinx size. However, patients who underwent surgical treatment within 2 years from the symptom onset had more favorable outcome than those who had operations after 2 years from the onset of symptoms. Conclusion : Change in the size of the syrinx in post-operative MRI is not directly proportional to favorable clinical outcomes. However, symptom duration before surgical treatment has considerable impact on the clinical outcomes.

Keywords

References

  1. Armonda RA, Citrin CM, Foley KT, Ellenbogen RG : Quantitative cinemode magnetic resonance imaging of Chiari I malformations : an analysis of cerebrospinal fluid dynamics. Neurosurgery 35 : 214-224, 1994 https://doi.org/10.1227/00006123-199408000-00006
  2. Arruda JA, Costa CM, Tella Jr OI : Results of the treatment of syringomyelia associated with Chiari malformation : analysis of 60 cases. Arq Neuropsiquiatr 62 : 237-244, 2004 https://doi.org/10.1590/S0004-282X2004000200009
  3. Attal N, Parker F, Tadie M, Aghakani N, Bouhassira D : Effects of surgery on the sensory deficits of syringomyelia and predictors of outcome : a long term prospective study. J Neurol Neurosurg Psychiatry 75 : 1025-1030, 2004 https://doi.org/10.1136/jnnp.2003.026674
  4. Axel L, Dougherty L : MR imaging of motion with spatial modulation of magnetization. Radiology 171 : 841-845, 1989 https://doi.org/10.1148/radiology.171.3.2717762
  5. Barbaro NM, Wilson CB, Gutin PH, Edward MB : Surgical treatment of syringomyelia. Favorable results with syringoperitoneal shunting. J Neurosurg 61 : 531-538, 1984 https://doi.org/10.3171/jns.1984.61.3.0531
  6. Bogdanov EI, Mendelevich EG : Syrinx size and duration of symptoms predict the pace of progressive myelopathy : retrospective analysis of 103 unoperated cases with craniocervical junction malformations and syringomyelia. Clin Neurol Neurosurg 104 : 90-97, 2002 https://doi.org/10.1016/S0303-8467(01)00189-5
  7. Edelman RR, Mattle HP, Kleefield J, Silver MS : Quantification of blood flow with dynamic MR imaging and presaturation bolus tracking. Radiology 171 : 551-556, 1989 https://doi.org/10.1148/radiology.171.2.2704823
  8. Ergun R, Akdemir G, Gezici AR, Tezel K, Beskonakli E, Ergungor F, et al : Surgical management of syringomyelia-Chiari complex. Eur Spine J 9 : 553-557, 2000 https://doi.org/10.1007/s005860000157
  9. Gamache FW Jr, Ducker TB : Syringomyelia : a neurological and surgical spectrum. J Spinal Disord 3 : 293-298, 1990
  10. Gardner WJ : Hydrodynamic mechanisms of syringomyelia : its relationship to myelocele. J Neurol Neurosurg Psychiatry 28 : 247-257, 1965 https://doi.org/10.1136/jnnp.28.3.247
  11. Grant R, Hadley DM, Lang D, Condon B, Johnston R, Bone I, et al : MRI measurement of syrinx size before and after operation. J Neurol Neurosurg Psychiatry 50 : 1685-1687, 1987 https://doi.org/10.1136/jnnp.50.12.1685
  12. Hida K, Iwasaki Y, Koyanagi I, Sawamura Y, Abe H : Surgical indication and results of foramen magnum decompression versus syringosubarachnoid shunting for syringomyelia associated with Chiari I malformation. Neurosurgery 37 : 673-679, 1995 https://doi.org/10.1227/00006123-199510000-00010
  13. Hofmann E, Warmuth-Metz M, Bendszus M, Solymosi L : Phase-contrast MR imaging of the cervical CSF and spinal cord : volumetric motion analysis in patients with Chiari I malformation. AJNR Am J Neuroradiol 21 : 151-158, 2000
  14. Holly LT, Batzdorf U : Management of cerebellar ptosis following craniovertebral decompression for Chiari I malformation. J Neurosurg 94 : 21-26, 2001 https://doi.org/10.3171/jns.2001.94.1.0021
  15. Iskandar BJ, Hedlund GL, Grabb PA, Oakes WJ : The resolution of syringohydromyelia without hindbrain herniation after posterior fossa decompression. J Neurosurg 89 : 212-216, 1998 https://doi.org/10.3171/jns.1998.89.2.0212
  16. Kang MS, Park IS, Lee CH, Jung JM : Syringomyelia associated with posterior fossa arachnoid cyst. Case report. J Korean Neurosurg Soc 33 : 313-316, 2003
  17. Kim YS, Kim KN, Jin BH, Chung TS, Yoon DH, Cho YE, et al : The evaluation of prognosis in syringomyelia using SPAMM-MRI. J Korean Neurosurg Soc 28 : 13-20, 1999
  18. Lee BC, Zimmerman RD, Manning JJ, Deck MD : MR imaging of syringomyelia and hydromyelia. AJR Am J Roentgenol 144 : 1149-1156, 1985 https://doi.org/10.2214/ajr.144.6.1149
  19. Lesoin F, Petit H, Thomas III CE, Viaud C, Baleriaux D, Jomin M : Use of the syringoperitoneal shunt in the treatment of syringomyelia. Surg Neurol 25 : 131-136, 1986 https://doi.org/10.1016/0090-3019(86)90280-6
  20. Milhorat TH, Johnson WD, Miller JI, Bergland RM, Hollenberg-sher J : Surgical treatment of syringomyelia based on magnetic resonance imaging criteria. Neurosurgery 31 : 231-245, 1992 https://doi.org/10.1227/00006123-199208000-00008
  21. Nakamura M, Chiba K, Nishizawa T, Maruiwa H, Matsumoto M, Toyama Y : Retrospective study of surgery-related outcomes in patients with syringomyelia associated with Chiari I malformation : clinical significance of changes in the size and localization of syrinx on pain relief. J Neurosurg 100 : 241-244, 2004
  22. Phillips TW, Kindt GW : Syringoperitoneal shunt for syringomyelia : a preliminary report. Surg Neurol 16 : 462-466, 1981 https://doi.org/10.1016/0090-3019(81)90248-2
  23. Pillay PK, Awad IA, Hahn JF : Gardner's hydrodynamic theory of syringomyelia revisited. Cleve Clin J Med 59 : 373-380, 1992 https://doi.org/10.3949/ccjm.59.4.373
  24. Pojunas K, Williams AL, Daniels DL, Haughton VM : Syringomyelia and hydromyelia : magnetic resonance evaluation. Radiology 153 : 679- 683, 1984 https://doi.org/10.1148/radiology.153.3.6494463
  25. Sherman JL, Barkovich AJ, Citrin CM : The MR appearance of syringomyelia : new observations. AJNR Am J Neuroradiol 7 : 985-995, 1986
  26. Suzuki M, Davis C, Symon L, Gentili F : Syringoperitoneal shunt for treatment of cord cavitation. J Neurol Neurosurg Psychiatry 48 : 620-627, 1985 https://doi.org/10.1136/jnnp.48.7.620
  27. Tator CH, Meguro K, Rowed DW : Favorable results with syringosubarachnoid shunts for treatment of syringomyelia. J Neurosurg 56 : 517- 523, 1982 https://doi.org/10.3171/jns.1982.56.4.0517
  28. Terae S, Miyasaka K, Abe S, Abe H, Tashiro K : Increased pulsatile movement of the hindbrain in syringomyelia associated with the Chiari malformation : cine-MR with presaturation bolus tracking. Neuroradiology 36 : 125-129, 1994 https://doi.org/10.1007/BF00588077
  29. Vaquero J, Martinez R, Salazar J, Santos H : Syringosubarachnoid shunt for treatment of syringomyelia. Acta Neurochir (Wien) 84 : 105-109, 1987 https://doi.org/10.1007/BF01418834
  30. Vaquero J, Martinez R, Arias A : Syringomyelia-Chiari complex : magnetic resonance imaging and clinical evaluation of surgical treatment. J Neurosurg 73 : 64-68, 1990 https://doi.org/10.3171/jns.1990.73.1.0064
  31. Williams B : The distending force in the production of communicating syringomyelia. Lancet 2 : 189-193, 1969
  32. Williams B : A critical appraisal of posterior fossa surgery for communicating syringomyelia. Brain 101 : 223-250, 1978 https://doi.org/10.1093/brain/101.2.223
  33. Wisoff JH, Epstein F : Management of hydromyelia. Neurosurgery 25 : 562-571, 1989 https://doi.org/10.1227/00006123-198910000-00009