Cervical Portion Of Spinal Cord Research Articles

Observational outcome in surgery for Chiari malformation patients

Chiari malformation is the commonest anomaly of the craniovertebral junction involving both the skeletal as well as the neural structures. It is congenital anomaly of the hindbrain characterised by downward elongation of the brain stem and cerebellum into the cervical portion of spinal cord. Most common presenting symptoms was pain in the nape of neck with sub-occipital headache and weakness. If not intervened early in these cases they may progress to quadriparesis and respiratory failure. This study includes authors experience of 30 surgical corrections of Chiari malformation performed at civil hospital Ahmedabad from 2017 to 2019. The age and sex of the patient, the presence of syrinx, the type of surgical procedure and the clinical outcome were determined post-operatively and on follow up. Cerebro spinal fluid leak and collection were observed in patient who undergone duroplasty only with no leakage in patient undergone syringo-subarachnoid shunt. Overall, tingling/numbness had best improvement showed improvement in 13 out of 16 patients. Power showed improvement in 20 out of 27 patients and pain showed improvement in 18 patients. Wasting, clawing and cerebellar signs and bony deformity showed no improvement in any of the above procedures. Authors can conclude for Chiari malformation decompression with or without duroplasty with additional procedure with post-operative physiotherapy and analgesia is the suitable treatment.

Cerebrospinal Fluid Flowmetry in Pediatric Patients with Chiari Malformation I with Surgical Implications

Chiari malformations include a large spectrum of anomalies of hindbrain formation that appear at different stages of development of the central nervous system. Chiari described these malformations as congenital anomalies of the hindbrain characterized by downward elongation of the brain stem and cerebellum into the cervical portion of spinal cord. Much research regarding Chiari malformation I (CMI) has focused on the cerebrospinal fluid (CSF) dynamics rather than the anatomic relationships of the tonsils and brainstem. The aim of the present study was to measure the peak CSF velocity at the foramen magnum and record the changes after foramen magnum decompression in patients with CMI aged <18years. A total of 39 patients with CMI were included during a 2-year period and were analyzed for peak CSF flow velocity with respect to surgical intervention using predefined magnetic resonance imaging protocols and surgical technique. After foramen magnum decompression, the postoperative mean CSF peak flow velocity showed a statistically significant difference compared with the preoperative value. Decompression of the foramen magnum was associated with decreased CSF peak velocity in patients with CMI.

SU-GG-T-397: Dose-Response Parameters for Thoracic and Cervical Myelopathy After External Radiotherapy

Purpose: The aim of this study is to determine the parameters that describe the dose‐response relations of spinal cord regarding the endpoints of radiation myelopathy in the thoracic and cervical parts. This can be critical information since spinal cord is known for its serial behaviour. Method and Materials: In the present study, the clinical data of 43 patients treated for lungcarcinoma and 248 patients treated for head and neck cancer are analyzed. The two datasets were fitted by the relative seriality model regarding thoracic and cervical spinal cord radiation myelitis. The respective best estimates of the model parameters were determined together with their 68% confidence intervals by applying the maximum likelihood method to fit the clinical data. Results: The parameter values of D 50 = 75.5 Gy , γ = 1.13, s = 36.0, describe the dose‐response relation of thoracic myelopathy, whereas the dose‐response relation of cervical myelopathy can be adequately described by the parameters D 50 = 55.9 Gy , γ = 6.88, s = 0.13. Regarding the cervical radiation myelopathy, 10 of the 12 responders had received a uniform dose in the whole circumference of the irradiated vertebrae (83.3%). Furthermore, only 18 of the 248 patients had received a uniform dose in the anterior and posterior parts of the irradiated vertebrae. 10 of those 18 patients (55.6%) showed complications. Conclusion: The high relative seriality, s value of the thoracic part and the quite low s value of the cervical part are the major findings of the present analysis. According to our observations, when a larger portion of cervical spinal cord was irradiated, considerably more patients showed cervical myelopathy. This indicates that the manifestation of radiation myelitis is clearly related with a dose cutoff and volume effect in the cervical part of spinal cord.

Enhancement of morphine-induced analgesia after repeated injections of methylenedioxymethamphetamine

Repeated administration of methylenedioxymethamphetamine (MDMA) to rats results in long-term depletion of serotonin (5-hydroxytryptamine; 5-HT) in several brain regions. Because of the apparent role of 5-HT in morphine-induced antinociception, the present experiment was designed to determine the effects of repeated MDMA injections on morphine-induced analgesia. Rats (n = 48) received 8 s.c. injections (one every 12 h for 4 days) of MDMA (20 mg/kg) or saline (1.0 ml/kg). Two weeks after the last injection, the groups were divided into 4 subgroups that received either saline, or morphine 2.5, 3.55 or 5.0 mg/kg (s.c.). Nociception was assayed before and after saline or morphine administration by the method of tail immersion in warm water (55 °C). The day after analgesia testing, the animals were sacrifices, brains and spinal cords removed and 5-HT, norepinephrine (NE) and dopamine (DA) levels in various brain and spinal cord regions were assayed. The analgesic effect of morphine was enhanced in rats that had received repeated MDMA injections. MDMA selectively depleted 5-HT in the cortex, hippocampus, striatum, brainstem and in the cervical portion of spinal cord. However, 5-HT levels were not changed in the thoracic and lumbar segments of the spinal cord. Thus, a functional consequence of repeated MDMA administration in rats was to enhance morphine-induced antinociception in association with reductions in brain and cervical spinal cord 5-HT. The fact that MDMA did not deplete 5-HT at lower spinal levels suggests that its neurotoxic action has an anatomical selectivity and may explain why morphine-mediated analgesia was not reduced as has been found with other depletors of 5-HT.

Thirty-One-Year Cure Following Removal of Intramedullary Glioma of Cervical Portion of Spinal Cord

Thirty-One-Year Cure Following Removal of Intramedullary Glioma of Cervical Portion of Spinal Cord