Spinal extradural meningeal cyst has been rarely reported, whose etiologies are assumed to be the communication of cerebrospinal fluid (CSF) between intradural subarchnoid space and cyst due to the congenital defect in dura mater. Although the CSF communication due to this defect can be found, in most case, few cases in which there is a lack of the communication have also been reported. We report a case of the huge extradural meningeal cyst occurring in the thoracolumbar spine (from T10 to L2) where there was a lack of the communication between the intradural subarachnoid space and cyst in a 46-year-old man who presented with symptoms that were indicative of progressive paraparesis and leg pain. The patient underwent laminectomy and cyst excision. On intraoperative findings, the dura was intact and there was a lack of the communication with intradural subarachnoid space. Immediately after the surgery, weakness and leg pain disappeared shortly.
Congenital Abnormalities ; Dura Mater ; Humans ; Laminectomy ; Leg ; Middle Aged ; Paraparesis ; Spine ; Subarachnoid Space

Though several pathogenetic theories concerning the frequent association of Chiari malformation and hydrocephalus with myeloschisis have been suggested, none of them explains all the aspects of the disorder. To investigate whether myeloschisis is the direct cause of Chiari malformation and hydrocephalus or these conditions are the results of another basic event, we observed the morphological changes of the posterior cranial fossa and its components in the chick embryos with surgically induced myeloschisis. To make myeloschistic lesions, we opened the neural tube for a length of 9-11 somites in Hamburger and Hamilton stage 16-19 chick embryos. They were divided into cervicothoracic (C-T) and lumbosacral(L-S) groups according to the area of incision. The embryos were re-incubated until postoperative day 11. In the control group, embryos were incubated with the eggshell window open as their experimental counterparts. The survival rates of each group were as follows; 11% (9 survivors/85 operated embryos), 8% (7/83), and 17% (10/60) in the C-T, L-S and control groups, respectively. Myeloschisis positive rates were 100% in the operated groups and 0% in the control group. The heads of embryos were sectioned along the sagittal plane to observe the morphological changes in the posterior cranial fossa and its components. Of the survivors, five in the C-T group, two in the L-S group and six in the control group were available for light microscopic inspection. In the majority of embryos with myeloschisis, without difference between the C-T and L-S groups, the fourth ventricles were smaller than those of the control group and the subarachnoid spaces in the posterior cranial fossa were also narrower. In embryos with severe changes, the cerebellum displaced downward comparing with that of the control embryos. No evidence of hydrocephalus was present Though not always typical, morphological changes similar to Chiari malformation were observed in chick embryos with surgically induced myeloschisis. It suggests a strong direct causal relationship between the two conditions and supports the theories of derangements in cerebrospinal fluid dynamics rather than those of primary mesenchymal or neural origin as a pathogenetic mechanism of Chiari malformation.
Animal ; Brain/*abnormalities ; Chick Embryo ; Cranial Fossa, Posterior/abnormalities ; Disease Models, Animal ; Hydrocephalus/etiology ; Spinal Cord/*abnormalities ; Subarachnoid Space/abnormalities ; Support, Non-U.S. Gov't

Though several pathogenetic theories concerning the frequent association of Chiari malformation and hydrocephalus with myeloschisis have been suggested, none of them explains all the aspects of the disorder. To investigate whether myeloschisis is the direct cause of Chiari malformation and hydrocephalus or these conditions are the results of another basic event, we observed the morphological changes of the posterior cranial fossa and its components in the chick embryos with surgically induced myeloschisis. To make myeloschistic lesions, we opened the neural tube for a length of 9-11 somites in Hamburger and Hamilton stage 16-19 chick embryos. They were divided into cervicothoracic (C-T) and lumbosacral(L-S) groups according to the area of incision. The embryos were re-incubated until postoperative day 11. In the control group, embryos were incubated with the eggshell window open as their experimental counterparts. The survival rates of each group were as follows; 11% (9 survivors/85 operated embryos), 8% (7/83), and 17% (10/60) in the C-T, L-S and control groups, respectively. Myeloschisis positive rates were 100% in the operated groups and 0% in the control group. The heads of embryos were sectioned along the sagittal plane to observe the morphological changes in the posterior cranial fossa and its components. Of the survivors, five in the C-T group, two in the L-S group and six in the control group were available for light microscopic inspection. In the majority of embryos with myeloschisis, without difference between the C-T and L-S groups, the fourth ventricles were smaller than those of the control group and the subarachnoid spaces in the posterior cranial fossa were also narrower. In embryos with severe changes, the cerebellum displaced downward comparing with that of the control embryos. No evidence of hydrocephalus was present Though not always typical, morphological changes similar to Chiari malformation were observed in chick embryos with surgically induced myeloschisis. It suggests a strong direct causal relationship between the two conditions and supports the theories of derangements in cerebrospinal fluid dynamics rather than those of primary mesenchymal or neural origin as a pathogenetic mechanism of Chiari malformation.
Animal ; Brain/*abnormalities ; Chick Embryo ; Cranial Fossa, Posterior/abnormalities ; Disease Models, Animal ; Hydrocephalus/etiology ; Spinal Cord/*abnormalities ; Subarachnoid Space/abnormalities ; Support, Non-U.S. Gov't

Posttraumatic syringomyelia may result from a variety of inherent conditions and traumatic events, or from some combination of these. Many hypotheses have arisen to explain this complex disorder, but no consensus has emerged. A 28-year-old man presented with progressive lower extremity weakness, spasticity, and decreased sensation below the T4 dermatome five years after an initial trauma. Magnetic resonance imaging (MRI) revealed a large, multi-septate syrinx cavity extending from C5 to L1, with a retropulsed bony fragment of L2. We performed an L2 corpectomy, L1-L3 interbody fusion using a mesh cage and screw fixation, and a wide decompression and release of the ventral portion of the spinal cord with an operating microscope. The patient showed complete resolution of his neurological symptoms, including the bilateral leg weakness and dysesthesia. Postoperative MRI confirmed the collapse of the syrinx and restoration of subarachnoid cerebrospinal fluid (CSF) flow. These findings indicate a good correlation between syrinx collapse and symptomatic improvement. This case showed that syringomyelia may develop through obstruction of the subarachnoid CSF space by a bony fracture and kyphotic deformity. Ventral decompression of the obstructed subarachnoid space, with restoration of spinal alignment, effectively treated the spinal canal encroachment and post-traumatic syringomyelia.
Adult ; Congenital Abnormalities ; Consensus ; Decompression ; Humans ; Leg ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle Spasticity ; Paresthesia ; Sensation ; Spinal Canal ; Spinal Cord ; Subarachnoid Space ; Syringomyelia

PURPOSE: We performed this study to describe the findings of MR Myelography(MRM) of herniated disc disease, spinal stenosis and spinal tumor and to evaluate the usefulness of the MRM in comparison to MRI. MATERIALS AND METHODS: MRI and MRM were performed in 31 patients with herniated disc disease(12 patients), spinal stenosis(11 patients) and spinal tumor(8 patients). MRI and MRM were done with 1.5-T Signa MR, using fat suppressed heavily T2-weighted fast spin echo technique. We retrospectively analyzed MRM images about the thecal sac indentation, compression or displacement of the nerve root, extent and degree of narrowing of spinal canal, relationship between spinal tumor and spinal cord. MRM findings were compared with MRI in all cases. RESULTS: In 18 herniated disc cases of 12 patients, focal filling defect with cutoff or displacement of the nerve root in eight cases of paracentral herniated disc was seen. Cutoff and displacement of the nerve root were more clearly delineated on MRM than rvlRI. In the patients of spinal stenosis(11 cases), hourglass deformity of the thecal sac or complete spinal block of the subarachnoid space was clearly demonstrated. The extent and severity of spinal stenosis were more accurately evaluated on MRM than MRI. MRM finding of intramedullary tumor(3 cases) was enlargement of spinal cord. Five cases of intradural extramedullary tumor showed intradural filling defect, which caused contralateral displacement of the spinal cord with meniscus sign on inferior margin of the mass. CONCLUSION: MRM shows characteristic findings of herniated disc disease, spinal stenosis and spinal tumor. MRM yields excellent definition of the thecal sac, nerve roots and nerve root sleeves in relation to herniated disc and may be more accurate in evaluation of the degree and extent of spinal stenosis than MRI.
Congenital Abnormalities ; Constriction, Pathologic ; Humans ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging ; Myelography* ; Retrospective Studies ; Spinal Canal ; Spinal Cord ; Spinal Diseases ; Spinal Stenosis ; Subarachnoid Space

The authors operated 17 cases out of 28 intracranial arachnoid cysts experienced from July, 1972 to August, 1981. The clinical analysis and surgical experiences were summarized as follows. The supratentorial cysts were 67.9% and the infratentorial cysts were 32.1% of the intracranial arachnoid cysts. The predilection sites were middle cranial fossa of the supratentorial(60.7%) and the inferior midline of the infratentorial(17.9%). 2) The middle fossa arachnoid cysts were prominent in males under the age of 20. 3) The common complicating lesions in the supratentorial arachnoid cysts were chronic subdural hematoma(23.5%) and subdural hygroma(5.9%). Hydrocephalus was usually combined with the infratentorial arachnoid cyst(66.7%). 4) The most frequent symptom was headache(75%) with similar frequency in both supratentorial and infratentorial lesions. In the supratentorial cysts, headache was also complained with highest frequency even in cases without increased intracranial pressure(61.5%). The main clinical features of arachnoid cysts were headache, signs of increased intracranial pressure, other neurologic deficits and seizure in order of frequency. 5) Cranial deformities on the plain X-ray films were observed in 70.6% of middle fossa cysts. The brain CT scan provided a definite diagnostic information, while the cerebral angiography offered clues for differential diagnosis. 6) The authors selected the direct intracranial approach as a curative measure in most cases and the essential step in this procedure was thought to establish a communication between the cyst and the basal cistern or adjacent subarachnoid space. But in a few special cases such as deep-seated cysts or extensively large ones, a cystoperitoneal shunt was a more preferable procedure. The infratentorial cysts with hydrocephalus almost always required ventriculoperitoneal shunt in our cases. We considered it is very important to perform periodic follow-up brain CT scan to detect a recurrence of cyst or recollection of C.S.F., postoperative complications and persistent hydrocephalus.
Arachnoid ; Arachnoid Cysts* ; Brain ; Cerebral Angiography ; Congenital Abnormalities ; Cranial Fossa, Middle ; Diagnosis, Differential ; Headache ; Humans ; Hydrocephalus ; Intracranial Pressure ; Male ; Neurologic Manifestations ; Postoperative Complications ; Recurrence ; Seizures ; Subarachnoid Space ; Tomography, X-Ray Computed ; Ventriculoperitoneal Shunt ; X-Ray Film

Ependymal cells line the surface of cerebral ventricles. They do not regenerate after they are fully matured and have a limited response to injury. In hydrocephalus, the expansile force of the ventricular wall is applied to ependymal cells and causes cell deformity to some degree. As it is known that the intermediate filaments of a cell act as a framework that resists changes in cellular shape, there may be some detectable changes of intermediate filaments of ependymal cells in hydrocephalus. In developing ependymal cells, it is also unclear if there are any changes to intermediate filaments in hydrocephalus. Developing ependymal cells are known to lose their immunoreactivity to glial fibrillary acidic protein (GFAP), a kind of intermediate filaments which exist in some neuroglial cells. We experimentally induced congenital and postnatal hydrocephalus and investigated the changes of immunore-activity against GFAP as well as the ultrastuctures of rat ependymal cells in both types of hydrocephalus. To induce congenital hydrocephalus, 40 mg/kg of ethylenethiourea (ETU) was orally administered to pregnant rats on the 15th day after conception. Tissues taken from fetuses on the 17th day, from newborn rats immediately after birth, and from rats of 1 week and 2 weeks after birth were obtained and processed for immunohistochemistry for GFAP and electron microscopy. Postnatal hydrocephalus was induced by injecting kaolin suspension into the subarachnoid space of 15-day-old rats. Ependymal tissues were obtained and processed for immunohistochemistry and electron microscopy after 1 and 2 weeks following injection. The results were as follows; 1. Congenital hydrocephalus was induced more consistently and extensively than postnatal hydrocephalus. 2. In congenital hydrocephalus, GFAP-reactive ependymal cells were found in lateral ventricles of 1-week and 2-week-old rats, while in control and postnatal hydrocephalic groups, GFAP-reactive ependymal cells were not found. GFAP-reactive cells tended to be found in clusters. 3. Electron microscopy showed ependymal cells in congenital hydrocephalus had a less marked flattening figure, scarce apical cilia, often widened regions in the intercellular gap, spaces in subependymal tissue, and different figures in mitochondria. Above all, intermediate filaments, including GFAP, increased and were irregularly arranged in ependymal cell cytoplasm in congenital hydrocephalus. Therefore, in congenitally-induced hydrocephalus, the ependymal cells appeared to have a greater responsiveness to expansile force and remained in a more premature state than postnatally-induced hydrocephalus.
Animals ; Cerebral Ventricles ; Cilia ; Congenital Abnormalities ; Cytoplasm ; Ethylenethiourea ; Fertilization ; Fetus ; Glial Fibrillary Acidic Protein ; Humans ; Hydrocephalus ; Immunohistochemistry ; Infant, Newborn ; Intermediate Filaments* ; Kaolin ; Lateral Ventricles ; Microscopy, Electron ; Mitochondria ; Neuroglia ; Parturition ; Rats* ; Subarachnoid Space

We have retrospectively analyzed the clinical and radiological outcome in 22 cervical spondylotic myeloradiculopathy patients who underwent combined front anterior decompression and fusion) and back (open door laminoplasty) surgery between Mar. 1991 and Jan. 1995. Clinical symptoms were evaluated by Japanese Orthopaedic Association(JOA) score and the recovery rate. Plain radiogram and MIR were taken before and after surgery, and then the cervical curvature, change of body to canal ratio and the A-P compression ratio of the cord were measured and compared to the clinical symptoms. Results : The mean JOA score increased from 10.1±3.3 preoperatively to 14.7±1.4 at the final follow-up with a mean recovery rate of 64.4%. No patients deteriorated as a result of the combined procedure. Post-op. radiograms showed an increasement of body to ratios (average 0.69±0.09 pre-op. to 1.0±0.13 post-op.) and maintenance or recovery of cervical Lordosis. On MRI, the A-P compression ratios of the cord were increased with recovery of subarachnoid space after the operation in most cases (average 38.4±7.6 pre-op. to 55.7±7.2 post-op.). Conclusion : This combined procedure safely and effectively resulted in decompression of the spinal cord and good functional recovery in patients with 1) anterior and posterior pathology, 2) narrow spinal canal and large spondylotic bar or herniated disc encroaching the spinal canal more than 5mm, 3) narrow spinal canal and kyphotic deformity, 4) narrow spinal canal and segmental instability, 5) multisegmental cord compression and severe radiculopathy.
Animals ; Asian Continental Ancestry Group ; Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Lordosis ; Magnetic Resonance Imaging ; Pathology ; Radiculopathy ; Retrospective Studies ; Spinal Canal ; Spinal Cord ; Subarachnoid Space