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J Neurol Neurosurg Psychiatry. 2004 May; 75(5): 754–757. doi: 10.1136/jnnp.2003.018671. | PMCID: PMC1763562 |
Theoretical analysis of the pathophysiology of syringomyelia associated with adhesive arachnoiditis H Chang and H Nakagawa Department of Neurological Surgery, Aichi Medical University, Aichi-gun, Japan. Email: chang/at/aichi-med-u.ac.jp Objective: To apply a theoretical model to analyse the derangement of cerebrospinal fluid (CSF) dynamics in syringomyelia associated with adhesive arachnoiditis. Methods: An electrical circuit model of CSF dynamics in the spine was used. With this model, the derangement of CSF dynamics in adhesive arachnoiditis was simulated. The effects of various surgical procedures were then analysed, such as syringo–subarachnoid shunting, subarachnoid bypass, and foramen magnum decompression. Results: When CSF flow in the subarachnoid space was obstructed at a certain point, the pressure inside the spinal cord increased in the segment immediately distal to the blockage. This location of increased pressure corresponded to the preferred site of syrinx formation in adhesive arachnoiditis. Syringo–subarachnoid shunting, subarachnoid bypass, and foramen magnum decompression were all effective at reducing this pressure gradient. Conclusions: Blockage of the spinal subarachnoid CSF pathway produces a relative increase in the pressure inside the spinal cord distal to the blockage point. Repetitive formation of this pressure gradient then induces CSF leakage into the spinal parenchyma, leading to the formation of syringomyelia. Using this model, alternative surgical procedures could be suggested that might be effective in treating this disease. The Full Text of this article is available as a PDF (234K). These references are in PubMed. This may not be the complete list of references from this article. - Batzdorf U, Klekamp J, Johnson JP. A critical appraisal of syrinx cavity shunting procedures. J Neurosurg. 1998 Sep;89(3):382–388. [PubMed]
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