Neurospine

The Physiological Occlusion of the Central Canal May Be a Prerequisite for Syringomyelia Formation: Chuan Jiang, Xinyu Wang, Chunli Lu, Qian Li, Longbing Ma, Wei Li, Shengyu Cui, Kang Li, Xiang Wang, Yuxin Feng, Fengzeng Jian; Neurospine 2023;20(4):1346-1357. Published online December 31, 2023; DOI: https://doi.org/10.14245/ns.2346834.417

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The Physiological Occlusion of the Central Canal May Be a Prerequisite for Syringomyelia Formation

Neurospine. 2023;20(4):1346-1357. Published online December 31, 2023

DOI: https://doi.org/10.14245/ns.2346834.417

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The Physiological Occlusion of the Central Canal May Be a Prerequisite for Syringomyelia Formation

Neurospine. 2023;20(4):1346-1357. Published online December 31, 2023

DOI: https://doi.org/10.14245/ns.2346834.417

Objective
Syringomyelia is a common central nervous system disease characterized by the dilation of the central canal (CC). Regarding the pathogenesis of syringomyelia, cerebrospinal fluid (CSF) circulation obstruction in the subarachnoid space (SAS) of the spinal cord has been widely accepted. However, clinical and animal studies on obstructing the CSF in SAS failed to form syringomyelia, challenging the theory of SAS obstruction. The precise pathogenesis remains unknown.
Methods
We utilized an extradural compression rat model to investigate the pathogenesis underlying syringomyelia. Magnetic resonance imaging enabled detection of syringomyelia formation. To assess CSF flow within the SAS, Evans blue was infused into the cisterna magna. Histological analysis allowed morphological examination of the CC. Furthermore, CSF flow through the CC was traced using Ovalbumin Alexa-Flour 647 conjugate (OAF-647). Scanning electron microscopy (SEM) enabled visualization of ependymal cilia.
Results
The findings showed that the dura mater below the compression segment exhibited lighter coloration relative to the region above the compression, indicative of partial obstruction within the SAS. However, the degree of SAS occlusion did not significantly differ between syringomyelia (SM-Y group) and those without (SM-N group). Intriguingly, hematoxylin and eosin staining and CSF tracing revealed occlusion of the CC accompanied by reduced CSF flow in the SM-Y group compared to SM-N and control groups. SEM images uncovered impairment of ependymal cilia inside the syringomyelia.
Conclusion
CC occlusion may represent a physiological prerequisite for syringomyelia formation, while SAS obstruction serves to initiate disease onset. The impairment of ependymal cilia appears to facilitate progression of syringomyelia.

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Migration of an Intracranial Subdural Hematoma to the Spinal Subdural Space: A Case Report: O Ik Kwon, Dong Wuk Son, Young Ha Kim, Young Soo Kim, Soon Ki Sung, Sang Weon Lee, Geun Sung Song; Korean J Spine 2015;12(3):207-209. Published online September 30, 2015; DOI: https://doi.org/10.14245/kjs.2015.12.3.207

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Migration of an Intracranial Subdural Hematoma to the Spinal Subdural Space: A Case Report

Korean J Spine. 2015;12(3):207-209. Published online September 30, 2015

DOI: https://doi.org/10.14245/kjs.2015.12.3.207

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Migration of an Intracranial Subdural Hematoma to the Spinal Subdural Space: A Case Report

Korean J Spine. 2015;12(3):207-209. Published online September 30, 2015

DOI: https://doi.org/10.14245/kjs.2015.12.3.207

A 57-year-old man complained of severe lower back pain and radicular pain in both legs for 1 week after falling from a ladder. Magnetic resonance imaging (MRI) of the spine showed a subdural hematoma (SDH), which was surgically removed. The patient had no back pain or the radicular leg pain at 2 weeks post-surgery. However, he complained of diffuse headaches upon follow-up. Brain computed tomography (CT) and MRI revealed an intracranial SDH, which was immediately removed by surgery. During his 1-year follow-up, he reported that the pain had resolved without recurrence. Simultaneous spinal and intracranial SDH are rare and no standard treatment exists for this condition. This case suggests that it is possible that an intracranial SDH can migrate into the cerebrospinal fluid (CSF) space through an arachnoid tear. CSF circulation allows the intracranial SDH to enter subarachnoid spaces encasing the spinal cord. In order to prevent irreversible damage, surgical intervention should be considered for case of spinal SDH with progressive neurological deficits.

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