Syringobulbia Mark R. Lee, MD, Ph. D Pediatric Neurosurgery Dell Children’s Medical Center
Syringobulbia • Very rare entity • Slit-like fluid cavity in brainstem • Associated with – – Chiari malformation Tumors Tethered cord Idiopathic
Syringobulbia and Chiari Malformation • Strongly associated with Chiari malformation with syringomyelia • But very rare… – 3 -5% of patients with Chiari malformation
Symptoms • • Head and neck pain Snoring Diplopia Sensory disturbances Unsteady gait Dysphagia Paresthesias and numbness
Clinical Findings • Cranial nerve deficits – All patients – Unilateral not uncommon • • Nystagmus Weakness Hyperreflexia Scoliosis
MRI Findings
Treatment • Restore CSF pathways between cranial and spinal compartments • Decompression of craniovertebral junction • Posterior fossa decompression – Suboccipital craniectomy – C 1 laminectomy – Duraplasty (or dural splitting)
Syringobulbia in a pediatric population. Neurosurgery, 2005 Greenlee, Menezes, et. al
Resolution of Syringobulbia
Timing of Syringobulbia Resolution?
What Causes Syringobulbia? • “Always” associated with syringomyelia • Propagation of syringomyelia into brainstem. – “rupture” of cervical syrinx – Extension of dilated central canal • Direct entry of CSF into brainstem – “opening” in floor of 4 th ventricle
“Clefts” in the Brainstem
Syringomyelia and Chiari Malformation
Extension of Syringomyelia into Brainstem
Summary • Syringobulbia is rare • Associated with syringomyelia – ? Extension of syringomyelia • Has cranial nerve dysfunction • Treated with craniovertebral decompression • Outcomes are usually good
Thank You for Your Attention!
Скачать презентацию Syringobulbia Mark R Lee MD Ph D Pediatric
7446441ddf2e8ed578f65c54535ccf31.ppt