Artikel
The Syrinx Protocol: Preoperative diagnostics and surgical management in arachnopathy-associated syringomyelia
Diagnostik und neurochirurgisches Management bei Arachnopathie-assoziierter Syringomyelie
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Veröffentlicht: | 11. April 2007 |
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Gliederung
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Objective: Minimal spinal trauma as the cause of syringomyelia is commonly neglected in the management of this potentially disabling disease. However, the restoration of adequate CSF circulation can lead to a cessation of disease progression. We present an optimized preoperative diagnostic protocol for syringomyelia patients in order to detect the underlying pathology.
Methods: Syringomyelia patients undergo a standardized workup including electrophysiological measurements (SEP and MEP) as well as silent-period testing for the detection of alteration in AD-pain fibres. In addition to routine MRI-diagnostics sagittal cardiac-gated sequences (CINE) and sagittal 3D-constructive-interference-in-steady-state (CISS) sequences, were performed. An indication for neurosurgical intervention emerges if a focal adhesion is detected. The operation aims to decompress the subarachnoid space including an enlarging duroplasty.
Results: 57 patients with syringomyelia prospectively underwent the diagnostic protocol. With the expanded electrophysiological workup, a differentiation between hydromyelia (dilated central canal) and syringomyelia with pathologic changes in the crossing spinal cord tracts can be made. The sensitivities/specificities of the silent-periods for several syringomyelia symptoms (e.g. dysaesthesia, pain) are significantly higher than of SEP/MEP recordings. With the specialized MRI-diagnostics 24% more patients could be diagnosed with the syringomyelia-causing pathology: A spinal arachnoid web, cyst or scar had developed through a former spinal trauma. All treated patients showed an immediate collapse of the syrinx, neurological symptoms did improve; however in most cases long-standing neurological deficits remain unchanged.
Conclusions: Syringomyelia should be seen as a symptom of an underlying arachnoid process, most often caused by a minor spinal trauma with scar formation causing CSF flow obstruction. Neurosurgical detection and restoration of adequate CSF flow can stop the progressive course of the disease.