RESUMEN
Mortality rate related to posterior fossa tumors resection varies from 1 to 8 percent, according to various authors. It depends on tumor size and its growth characteristics. To determine the physiological acceptability of surgery, physiological significance of vegetative reactions associated with tumors resection has to be assessed. We divide these reactions (centrogenic reactions - CR) into 2 main groups. The first group has a relatively precise morphofunctional structure, similar to the classic reflex arc. They appear due to irritation of local centers or cranial nerves nuclei with mixed motor-vegetative structure. In most cases they are not connected with anatomic damage of CNS structures. The second group of CR is correlated with dysfunction of brain and represents brain s attempt to turn into a new functional state. Their presence should be considered as a functional degradation symptom, which might be even irreversible. Emergence from anesthesia in the operative room is not recommended in this clinical situation. Neurovegetative stabilization should be provided for a period of 6 to 24 hours after tumor resection.
Asunto(s)
Periodo de Recuperación de la Anestesia , Vías Autónomas/fisiopatología , Fosa Craneal Posterior/cirugía , Neoplasias Infratentoriales/cirugía , Complicaciones Posoperatorias , Reflejo/fisiología , Fosa Craneal Posterior/inervación , Fosa Craneal Posterior/fisiopatología , Humanos , Neoplasias Infratentoriales/fisiopatología , Registros Médicos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & controlRESUMEN
BACKGROUND: Posterior fossa syndrome (PFS) is a severe, postoperative complication occurring in about 25 % of pediatric patients undergoing surgery for midline tumors in the posterior fossa. In recent years, MRI-based research elucidated the cause of PFS and shed new light on its putative pathophysiology. This review highlights the major advances arising from research of this topic. RESULTS: Postsurgical damage patterns in patients after posterior fossa surgery show that PFS results from bilateral surgical damage to the proximal efferent cerebellar pathways (pECPs). Surgical pECP disruption has other MRI-detectable effects that are more remote. Patients with PFS tend to develop global supratentorial cortical hypoperfusion, likely representing reversed, cerebello-cerebral diaschisis. Because this hypoperfusion is most prominent in frontal regions, cerebellar mutism may indicate a dominantly frontal lobe dysfunction, hence a peculiar form of speech apraxia. Injury to the pECP also leads to contralateral inferior olivary nucleus degeneration. When bilateral hypertrophic olivary degeneration (HOD) is observed after posterior fossa surgery, affected patients have clinical PFS. Therefore, it is suggested that bilateral HOD may be a sensitive and, in appropriate clinical settings, reliable a posteriori surrogate imaging indicator of bilateral disruption of the pECPs and consequently of PFS. Having such a "validation tool" presents new opportunities to develop better definitions for the phenotypes within the clinical spectrum of PFS. CONCLUSIONS: Anatomical and functional MRI techniques are suitable and valuable tools with which to detect structural changes and pathophysiological processes in the development and evolution of PFS and may be key, integral components of future clinical research endeavors.
Asunto(s)
Cerebelo/patología , Fosa Craneal Posterior/fisiopatología , Imagen por Resonancia Magnética , Mutismo/etiología , Mutismo/patología , Complicaciones Posoperatorias/fisiopatología , Humanos , Neoplasias Infratentoriales/cirugíaRESUMEN
PURPOSE: Transoral odontoidectomy followed by occipito-cervical fixation is a widely used approach to relieve ventral compressions at the craniovertebral junction (CVJ). Despite the large amount of literature on this approach and its complications, no previous reports of odontoid process and clival regeneration following transoral odontoidectomy are present in the English literature. METHODS: We report the case of odontoid process and clival regeneration following transoral odontoidectomy. RESULTS: A 7-year-old boy presented with symptoms of brainstem and upper cervical spinal cord compression due to a complex malformation at the CVJ including a basilar invagination with Chiari malformation. A successful transoral microsurgical endoscopic-assisted odontoidectomy extended to the clivus was performed along with occipito cervical instrumentation and fusion. Clinical and radiological resolution of the CVJ compression was evident up to 2 years post-op, when the child had a relapse of some of the presenting symptoms and the follow-up CT and MRI scans showed a quite complete regrowth of the odontoid process, clival partial regeneration and recurrence of preoperative Chiari malformation. CONCLUSIONS: Besides the need of an accurate complete resection of the periosteum, which apparently was incompletely performed in our case, our experience suggests the need of resection of the odontoid down to the dentocentral synchondrosis and an accurate lateral removal of the bone surrounding the anterior tubercle of the Clivus is advised when an anterior CVJ decompression is required in children presenting a still evident synchondrosis at neuroradiological investigation.
Asunto(s)
Malformación de Arnold-Chiari/cirugía , Regeneración Ósea , Fosa Craneal Posterior/cirugía , Descompresión Quirúrgica/métodos , Apófisis Odontoides/cirugía , Procedimientos Ortopédicos/métodos , Compresión de la Médula Espinal/cirugía , Malformación de Arnold-Chiari/complicaciones , Niño , Fosa Craneal Posterior/fisiopatología , Humanos , Masculino , Apófisis Odontoides/fisiopatología , Recurrencia , Compresión de la Médula Espinal/etiologíaRESUMEN
AIM: The aim of this study was to investigate the incidence, risk factors and developmental outcomes of cerebellar haemorrhage in the extremely preterm infant. METHODS: Over a 4-year period from January 2004, all patients with cerebellar haemorrhage born at 24-27 weeks gestation or with a birthweight < 1000 g were identified from database review. All patients had cranial ultrasound scans including views from the mastoid fontanelle. To verify the incidence, a review of all reports over the 4-year period and a review of all cranial imaging over a 2-year period were carried out. RESULTS: From the data analysed on 339 neonates, five cases of cerebellar haemorrhage were identified, four on ultrasound scan (1.2%) and one on magnetic resonance imaging (1.5% total). Two cases were associated with grade III peri-intraventricular haemorrhage. The cases had diverse maternal, antenatal and post-natal risk factors. The two with associated peri-intraventricular haemorrhage have developmental delay. The cases with isolated cerebellar haemorrhage had good neurodevelopmental outcomes. CONCLUSIONS: A low incidence of cerebellar haemorrhage identified from the mastoid fontanelle was demonstrated. The neurodevelopmental outcome was better than that described in previous reports.
Asunto(s)
Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/etiología , Desarrollo Infantil/fisiología , Nacimiento Prematuro , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/fisiopatología , Fosa Craneal Posterior/irrigación sanguínea , Fosa Craneal Posterior/fisiopatología , Bases de Datos Factuales , Humanos , Recién Nacido , Recien Nacido Prematuro , Auditoría Médica , Nacimiento Prematuro/fisiopatología , UltrasonografíaAsunto(s)
Neoplasias de la Mama , Oftalmoplejía , Anciano de 80 o más Años , Encéfalo , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/fisiopatología , Neoplasias de la Mama/radioterapia , Fosa Craneal Posterior/diagnóstico por imagen , Fosa Craneal Posterior/fisiopatología , Femenino , Humanos , Imagen por Resonancia Magnética , Metástasis de la Neoplasia/diagnóstico , Metástasis de la Neoplasia/radioterapia , Oftalmoplejía/complicaciones , Oftalmoplejía/diagnóstico , Oftalmoplejía/fisiopatología , Oftalmoplejía/radioterapia , RadiografíaRESUMEN
A 27-year-old man presented with diplopia without features of raised intracranial pressure. He had left sixth cranial nerve (CN) palsy. Initial investigations in the form of blood tests, cerebrospinal fluid (CSF) opening pressure including CSF analysis and CT head were normal. He represented with paraparesis after 3 weeks. Examination revealed sixth CN palsy (eye twist) and new left-sided twelfth CN palsy (tongue twist), and hence Godtfredsen syndrome was diagnosed. MRI showed vertebral and clivus metastases. He showed partial response to high dose steroid. The statement 'sixth CN palsy may be a false localising sign' in neurology, should be followed by '....it can also be a true initial sign of clivus mass.'
Asunto(s)
Enfermedades del Nervio Abducens/diagnóstico , Enfermedades del Nervio Abducens/tratamiento farmacológico , Enfermedades del Nervio Abducens/fisiopatología , Adulto , Fosa Craneal Posterior/fisiopatología , Diagnóstico Diferencial , Diplopía/fisiopatología , Glucocorticoides/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Masculino , Síndrome , Tomografía Computarizada por Rayos X , Lengua/fisiopatologíaRESUMEN
Several anatomical studies indicate that the intracranial pachimeninges consist of two dural layers joined together, which divide while bordering the venous sinuses, therefore located in an interdural space. We present here an uncommon case of haematoma due to rupture of an infraclinoidal internal carotid artery aneurysm. The dome of the aneurysm leaned against the posterior wall of the cavernous sinus and, following laceration, pierced the inner dural layer and caused its detachment from the periosteal layer, thus determining a truly interdural haematoma which progressively involved the whole posterior fossa. A 42-year-old female was admitted to our institution with a recent history of thunderclap headache and right ophthalmoparesis. Two cerebral computerised scan tomographies performed elsewhere tested negative for subarachnoid haemorrhage. A cerebral magnetic resonance imaging (MRI) showed a thin collection of blood adjacent to the clivus and all along the wall of the posterior fossa and foramen magnum. A right infraclinoid internal carotid artery aneurysm was also diagnosed, subsequently better highlighted on angiography. The patient underwent surgery with aneurysm clipping. Post-operative course was uneventful, and control angiography showed complete exclusion of the aneurysm from blood circulation. The patient was discharged 5 days later. At 3 months follow-up ophthalmoplegia had disappeared, and the patient had fully recovered. The possibility of a truly interdural location, particularly in cases of non-traumatic parasellar or clival haematomas, must be included in the differential diagnosis of posterior fossa extra-axial haemorrhages. MRI is the test of choice for diagnostic purposes.
Asunto(s)
Disección de la Arteria Carótida Interna/etiología , Arteria Carótida Interna/cirugía , Hemorragia Cerebral/etiología , Fosa Craneal Posterior/fisiopatología , Duramadre/fisiopatología , Aneurisma Intracraneal/complicaciones , Adulto , Arteria Carótida Interna/fisiopatología , Disección de la Arteria Carótida Interna/diagnóstico , Disección de la Arteria Carótida Interna/cirugía , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/cirugía , Fosa Craneal Posterior/cirugía , Duramadre/cirugía , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico , Aneurisma Intracraneal/cirugíaRESUMEN
The skull base is an atypical metastatic site for prostate carcinoma. It is usually encountered late in the disease process in patients with known advanced disease. However, skull base involvement causing cranial nerve palsies may rarely be the presenting sign of prostate carcinoma. Such patients may present to a number of specialties including neurosurgery and can pose a diagnostic challenge in the absence of lower urinary tract symptoms. Here, we describe an unusual case of prostate adenocarcinoma presenting as a central skull base tumour with multiple cranial neuropathy.
Asunto(s)
Enfermedades de los Nervios Craneales/patología , Metástasis de la Neoplasia/patología , Neoplasias de la Base del Cráneo/secundario , Anciano , Fosa Craneal Posterior/patología , Fosa Craneal Posterior/fisiopatología , Enfermedades de los Nervios Craneales/diagnóstico , Enfermedades de los Nervios Craneales/etiología , Diagnóstico Diferencial , Resultado Fatal , Humanos , Masculino , Metástasis de la Neoplasia/diagnóstico , Base del Cráneo/patología , Base del Cráneo/fisiopatología , Neoplasias de la Base del Cráneo/diagnósticoAsunto(s)
Encéfalo/patología , Malformaciones Vasculares del Sistema Nervioso Central/patología , Nervio Coclear/patología , Venas Yugulares/anomalías , Venas Yugulares/patología , Acúfeno/patología , Adulto , Presión Sanguínea/fisiología , Encéfalo/irrigación sanguínea , Encéfalo/fisiopatología , Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Malformaciones Vasculares del Sistema Nervioso Central/fisiopatología , Circulación Cerebrovascular/fisiología , Nervio Coclear/fisiopatología , Fosa Craneal Posterior/anomalías , Fosa Craneal Posterior/patología , Fosa Craneal Posterior/fisiopatología , Humanos , Hipertensión Intracraneal/complicaciones , Venas Yugulares/fisiopatología , Imagen por Resonancia Magnética , Masculino , Postura/fisiología , Pulso Arterial , Base del Cráneo/anomalías , Base del Cráneo/patología , Base del Cráneo/fisiopatología , Acúfeno/etiología , Acúfeno/fisiopatologíaRESUMEN
Lhermitte-Duclos disease (LDD) (dysplastic cerebellar gangliocytoma) is a rare disorder of unknown pathogenesis, presenting with signs and symptoms resulting from obstruction of cerebrospinal fluid flow and mass effect in the posterior fossa. Magnetic resonance imaging is the diagnostic modality of choice allowing preoperative diagnosis with characteristic findings. Surgery is the choice of treatment. The typical histopathological findings of LDD are characterized by widening of the molecular layer, absence of the Purkinje cell layer and hypertrophy in the granule cell layer. Herein we report an adolescent girl with LDD diagnosed preoperatively by the conventional and advanced MR techniques.
Asunto(s)
Neoplasias Cerebelosas/patología , Cerebelo/patología , Fosa Craneal Posterior/patología , Síndrome de Hamartoma Múltiple/patología , Adolescente , Neoplasias Cerebelosas/diagnóstico por imagen , Neoplasias Cerebelosas/fisiopatología , Cerebelo/diagnóstico por imagen , Cerebelo/fisiopatología , Fosa Craneal Posterior/fisiopatología , Femenino , Cuarto Ventrículo/diagnóstico por imagen , Cuarto Ventrículo/patología , Cuarto Ventrículo/fisiopatología , Síndrome de Hamartoma Múltiple/diagnóstico por imagen , Síndrome de Hamartoma Múltiple/fisiopatología , Cefalea/etiología , Humanos , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/patología , Hidrocefalia/fisiopatología , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/patología , Hipertensión Intracraneal/fisiopatología , Imagen por Resonancia Magnética , Espectroscopía de Resonancia Magnética , Procedimientos Neuroquirúrgicos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Ataxia/complicaciones , Ataxia/diagnóstico , Meningitis Aséptica/complicaciones , Meningitis Aséptica/diagnóstico , Quiste Dermoide/complicaciones , Quiste Dermoide/diagnóstico , Fosa Craneal Posterior/fisiopatología , Fosa Craneal Posterior/cirugía , Ataxia/fisiopatología , Ataxia , Meningitis Aséptica/fisiopatología , Meningitis AsépticaRESUMEN
BACKGROUND: Controversy still exists about the best management modality for congenital arachnoid cyst. Shunting procedures have been one of the treatment options offered to patients with this condition. Although arachnoid cysts shunting have been associated with a variety of clinical conditions, its relationship with flattened prepontine cistern has not been described. CASE DESCRIPTION: We describe two children with congenital arachnoid cyst managed with cystoperitoneal shunt, both of whom were later discovered to have developed flattened prepontine cistern and imaging findings of overcrowding of the posterior cranial fossa. CONCLUSION: These cases demonstrate that flattening of the prepontine cisterns and acquired posterior cranial fossa overcrowding may be a potential fall out in patients with cystoperitoneal shunt due to an arachnoid cyst.
Asunto(s)
Quistes Aracnoideos/cirugía , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Fosa Craneal Posterior/cirugía , Hidrocefalia/cirugía , Puente/cirugía , Espacio Subaracnoideo/cirugía , Quistes Aracnoideos/patología , Quistes Aracnoideos/fisiopatología , Fosa Craneal Posterior/patología , Fosa Craneal Posterior/fisiopatología , Encefalocele/etiología , Encefalocele/patología , Encefalocele/fisiopatología , Femenino , Humanos , Hidrocefalia/etiología , Hidrocefalia/patología , Lactante , Imagen por Resonancia Magnética , Masculino , Procedimientos Neuroquirúrgicos/efectos adversos , Puente/patología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/fisiopatología , Espacio Subaracnoideo/patología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
An enlarged cisterna magna can be identified during routine ultrasound screening in the second half of pregnancy. It is important to be able to give an accurate prognosis. We evaluated the developmental outcome of these children. A total of 29 fetuses with a large cisterna magna identified in utero were compared to 35 children with a normal fetal ultrasound. The children were evaluated by the Gesell Developmental Schedules and the Peabody Developmental Motor Scale. The study group showed a significantly worse performance in the Gesell test. However, the overall performance for both groups was within normal limits. Four children in the study group had a borderline developmental quotient. Both groups performed similarly in the Peabody test. Walking age was significantly delayed in the study group. Children with an enlarged cisterna magna may be at risk for mild developmental delay. In cases of nonisolated enlargement of the cisterna magna, the outcome may be guarded.
Asunto(s)
Cisterna Magna/anomalías , Fosa Craneal Posterior/anomalías , Discapacidades del Desarrollo/epidemiología , Malformaciones del Sistema Nervioso/epidemiología , Espacio Subaracnoideo/anomalías , Quistes Aracnoideos/diagnóstico por imagen , Quistes Aracnoideos/epidemiología , Quistes Aracnoideos/fisiopatología , Enfermedades Cerebelosas/diagnóstico por imagen , Enfermedades Cerebelosas/epidemiología , Enfermedades Cerebelosas/fisiopatología , Cerebelo/anomalías , Cerebelo/diagnóstico por imagen , Cerebelo/fisiopatología , Preescolar , Cisterna Magna/diagnóstico por imagen , Cisterna Magna/fisiopatología , Trastornos del Conocimiento/diagnóstico por imagen , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/fisiopatología , Comorbilidad , Fosa Craneal Posterior/diagnóstico por imagen , Fosa Craneal Posterior/fisiopatología , Síndrome de Dandy-Walker/diagnóstico por imagen , Síndrome de Dandy-Walker/epidemiología , Síndrome de Dandy-Walker/fisiopatología , Discapacidades del Desarrollo/diagnóstico por imagen , Discapacidades del Desarrollo/fisiopatología , Evaluación de la Discapacidad , Femenino , Feto , Humanos , Lactante , Masculino , Malformaciones del Sistema Nervioso/diagnóstico por imagen , Malformaciones del Sistema Nervioso/fisiopatología , Pruebas Neuropsicológicas , Valor Predictivo de las Pruebas , Embarazo , Pronóstico , Espacio Subaracnoideo/diagnóstico por imagen , Espacio Subaracnoideo/fisiopatología , Ultrasonografía Prenatal/métodosAsunto(s)
Encefalopatías/tratamiento farmacológico , Encéfalo/efectos de los fármacos , Circulación Cerebrovascular/efectos de los fármacos , Hernia/tratamiento farmacológico , Solución Salina Hipertónica/administración & dosificación , Equilibrio Hidroelectrolítico/efectos de los fármacos , Encéfalo/fisiopatología , Encefalopatías/fisiopatología , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/normas , Circulación Cerebrovascular/fisiología , Fosa Craneal Posterior/patología , Fosa Craneal Posterior/fisiopatología , Hernia/fisiopatología , Humanos , Oxígeno/metabolismo , Oxígeno/farmacología , Recuperación de la Función/efectos de los fármacos , Recuperación de la Función/fisiología , Medición de Riesgo , Solución Salina Hipertónica/efectos adversos , Resultado del Tratamiento , Equilibrio Hidroelectrolítico/fisiologíaRESUMEN
BACKGROUND: Spinal intramedullary lipoma extending to the posterior fossa is very rare in children. We made a revision of the literature and report the diverse opinions and surgical procedures. CASE DESCRIPTION: We report the case of a 16-month-old male infant who was operated on in the Pediatric Neurosurgical Unit of our hospital; his clinical and surgical outcome are related. CONCLUSION: Intramedullary lipoma of the spinal cord with intracranial extension in infancy is a very rare pathology reported in the literature. Our patient was treated with decompression and subtotal removal; he had a critical postoperative course but was recovering slowly after that. Most authors prefer incomplete resection because these lesions do not have a clear-cut margin. Another neurosurgeon performed a decompression only, without resection. Some authors performed the surgical treatment before symptom progression. Another surgeon reported that the surgical indication is debatable when the neurologic manifestations are poor or absent. The surgical indication and the strategy for treatment are controversial and they depend on the clinical situations of the patients.
Asunto(s)
Tronco Encefálico/patología , Fosa Craneal Posterior/patología , Lipoma/patología , Invasividad Neoplásica/patología , Neoplasias de la Médula Espinal/patología , Médula Espinal/patología , Tronco Encefálico/fisiopatología , Tronco Encefálico/cirugía , Vértebras Cervicales/cirugía , Fosa Craneal Posterior/fisiopatología , Fosa Craneal Posterior/cirugía , Craneotomía , Descompresión Quirúrgica , Fístula/etiología , Hemiplejía/etiología , Humanos , Lactante , Laminectomía , Lipoma/fisiopatología , Lipoma/cirugía , Imagen por Resonancia Magnética , Masculino , Microcirugia , Invasividad Neoplásica/fisiopatología , Procedimientos Neuroquirúrgicos , Hueso Occipital/cirugía , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/fisiopatología , Cuadriplejía/etiología , Procedimientos de Cirugía Plástica , Médula Espinal/fisiopatología , Médula Espinal/cirugía , Neoplasias de la Médula Espinal/fisiopatología , Neoplasias de la Médula Espinal/cirugía , Resultado del TratamientoRESUMEN
INTRODUCTION: Hiccups as the only presenting symptom in neurosurgical practice is uncommon. CASE HISTORY: We report a case of a 22-year-old man who was evaluated for a 9-month history of intractable hiccups. He was diagnosed with a case of Chiari malformation type I. DISCUSSION: Surgical decompression improved the symptoms of the patient. The cause and pathogenesis of hiccups are discussed. CONCLUSION: Chiari malformation should be considered in patients with intractable hiccups, who are otherwise asymptomatic for any neurological problems.
Asunto(s)
Malformación de Arnold-Chiari/complicaciones , Diafragma/fisiopatología , Hipo/etiología , Siringomielia/complicaciones , Malformación de Arnold-Chiari/patología , Malformación de Arnold-Chiari/fisiopatología , Tronco Encefálico/patología , Tronco Encefálico/fisiopatología , Fosa Craneal Posterior/patología , Fosa Craneal Posterior/fisiopatología , Descompresión Quirúrgica , Diafragma/inervación , Hipo/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Procedimientos Neuroquirúrgicos , Recurrencia , Centro Respiratorio/patología , Centro Respiratorio/fisiopatología , Médula Espinal/patología , Médula Espinal/fisiopatología , Siringomielia/patología , Siringomielia/fisiopatología , Insuficiencia del Tratamiento , Resultado del Tratamiento , Adulto JovenRESUMEN
Most cases of "idiopathic" trigeminal neuralgia are thought to originate from vascular compression of the trigeminal root entry zone. In this case, we describe a young man presenting with the symptoms of trigeminal neuralgia associated with a prepontine (clival) arachnoid cyst.
Asunto(s)
Quistes Aracnoideos/complicaciones , Quistes Aracnoideos/patología , Puente/patología , Nervio Trigémino/patología , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/patología , Quistes Aracnoideos/fisiopatología , Fosa Craneal Posterior/patología , Fosa Craneal Posterior/fisiopatología , Diagnóstico Diferencial , Progresión de la Enfermedad , Humanos , Imagen por Resonancia Magnética , Masculino , Puente/fisiopatología , Espacio Subaracnoideo/patología , Espacio Subaracnoideo/fisiopatología , Nervio Trigémino/fisiopatología , Neuralgia del Trigémino/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: Presyrinx is a reversible state of spinal cord edema caused by alterations in CSF flow dynamics. Only three pediatric cases have been reported previously. We describe the clinical and radiologic features of presyrinx in six pediatric patients. METHODS: We electronically searched pediatric spine MRI reports generated at our institution from January 1995 to April 2007 for the keyword "presyrinx" and identified six patients with this radiologic diagnosis. We reviewed the neuroimaging studies and medical records for information regarding symptoms, treatment, and outcome. RESULTS: Of six patients identified with presyrinx, four had a Chiari I malformation and two had a Chiari II malformation. The MRI characteristics of the presyrinx included T2 prolongation, mild indistinct T1 prolongation, and cord enlargement without frank cavitation. Cine phase-contrast MRI studies were performed in three patients and showed severely diminished or absent CSF flow at the foramen magnum. Five patients underwent surgical decompression. All three patients with postoperative spine imaging showed restoration of CSF flow and resolution of the presyrinx. Symptoms of chronic or acute myelopathy attributable to the presyrinx were present in two patients. These symptoms resolved postoperatively. CONCLUSIONS: Chiari I and II malformations obstructing CSF flow at the craniocervical junction may cause presyrinx in children. Presyrinx should be considered in the differential diagnosis of chronic or acute myelopathy in patients at risk for abnormal CSF flow dynamics.