Cord Cyst Research Articles

Differentiation of intramedullary neoplasms and cysts by MR.

To determine the MR criteria that are effective for differentiating intramedullary neoplasms from syringo- or hydromyelia, we reviewed MR scans made on prototype and commercial imagers of 33 patients with surgically confirmed cord abnormalities, including nine intramedullary neoplasms and 20 cysts (syringo- or hydromyelia). Two radiologists who did not know the clinical and radiologic diagnoses were asked to evaluate the scans with respect to cord expansion, distinctness of the disease margin, homogeneity, and signal intensity. These observations were correlated with the proved diagnoses. The combination of distinct margins and uniform signal intensity equal to that of CSF correlated consistently (88%) with spinal cord cysts. Other combinations were less reliable for diagnosing a cyst or tumor.

上位胸椎々弓切除術後に増強した頚椎前湾により呼吸麻ひを呈した一剖検例

We studied an autopsy case with tetraplegia histopathologically. The case, a 32-year-old male, had the upper thoracic laminectomy for the extirpation of the intramedullary hemangioblastoma in 1972. After the operation, the cervical lordosis increased step by step following the increasing thoracic kyphosis. The myelogram showed compression of the cervical spinal cord by step-formation of the cervical spine. The histopathological findings were a focal necrosis in posterior funiculi and spinal cord cyst near the central canal in C1/2, and mostly necrosis below the level.

Histological classification of spermatic cord cysts in relation to their histogenesis.

Light microscopy study of spermatic cord cysts in 26 men revealed three different histological patterns. First, cysts of probable mesothelial origin (14 cases) with an unilocular aspect: their epithelial cells showed poor cohesion and often appeared sloughed; subepithelial hyalinization or fibrin deposits were frequent. Second, cysts of probable embryonal (mesonephric) origin (8 cases): they were usually multilocular cysts and their epithelial cells showed great cohesion: zones of ciliated columnar epithelium associated with embryonal remnants displaying a similar epithelium were often found; the embryonal remnants and the cyst lumen contained spermatozoa in 2 cases. Third, cysts of doubtful origin (4 cases) showing abundant inflammatory infiltrates, which had destroyed the epithelium; the unilocular pattern observed in 3 cases suggests a mesothelial origin for these cysts, while the multilocular pattern and presence of embryonal remnants in the other case suggest an embryonal origin.

High field, thin section nuclear magnetic resonance imaging of the cervical spine.

The recent development of contiguous thin section (2 mm) imaging utilizing a high field (1.5 tesla magnetic resonance imaging) (MR) system has remarkably improved the precision of spinal cord diagnosis. Imaging was performed using three-dimensional data acquisition which generated twelve contiguous T1-weighted sections. Each section is reconstructed from a true 512 X 512 data matrix. Sixty patients with cervical cord lesions were evaluated with this technique and the results compared with conventional cervical myelography and CT scanning. The normal MRI anatomy of the cervical spinal cord on the thin-section technique shows the medullary gray and white matter. A description of this anatomy will be provided. In cases of syringohydromyelia MRA has demonstrated with accuracy the size and location of spinal cord cavities that were not detected by metrizamide CT scanning. Associated Arnold-Chiari malformations can be clearly delineated. Patients with spinal cord tumors were examined with both the T1-weighted thin-section technique and the T2-weighted multislice technique. Spinal cord cavities and cysts associated with tumors did not as a rule fill with metrizamide. High-field, thin-section studies outlined each of these lesions. The differentiation between intradural and extradural masses can be difficult on MRI and presents one of the limitations of this method in its current state as compared with metrizamide CT scanning. A complete discussion of the MRI findings of a number of pathological entities will be discussed.

MRI of the chronically injured cervical spinal cord.

Thirteen patients with prior cervical spinal cord injury resulting in quadriplegia were evaluated with magnetic resonance imaging (MRI) long after their initial injury, either because of the relatively recent onset of new and worsening neurologic symptoms or to rule our residual compression on the spinal cord or nerve roots. The results of MRI were compared with delayed metrizamide computed tomography (CT) in 10 cases, and in five of those the results were also compared with intraoperative spinal sonography. It was found that MRI more accurately demonstrated the intramedullary abnormalities in the injured spinal cord than did delayed metrizamide CT because the former could separate myelomalacia from a posttraumatic spinal cord cyst, a differentiation that was frequently difficult with delayed metrizamide CT. T2-weighted spin-echo pulsing sequences with long echo times were particularly useful in evaluating these patients.

MR imaging of syringomyelia and hydromyelia.

The relative effectiveness of plain computed tomography (CT), metrizamide CT, conventional myelography, and magnetic resonance (MR) imaging was compared for the examination of cystic spinal cord lesions. Intramedullary cavities in 18 patients were demonstrated by MR imaging: cavities were uncomplicated in 13 patients, associated with spinal tumors in two, and studied after occipital craniectomy for treatment of Chiari malformation and syringomyelia in two. Cavities were shown by MR imaging in all enlarged spinal cords, but a cavity was shown in only one of four small cords. The rostral limits of the cavities were demonstrated better than were the caudal extensions. Ventricular communication was not demonstrated. Chiari malformation was shown only in cavities that did not involve the medulla. Syringes associated with tumor were indistinguishable from uncomplicated cavities, but the tumor had abnormal signal on long spin-echo sequences in two cases. Cystic cord tumor (one case) had an inhomogeneous appearance. Caudal displacement of the cerebellar hemisphere through the surgical defect associated with compression of the fourth ventricle was shown in two cases after posterior fossa craniectomy. Thirteen patients were studied with metrizamide CT also. MR imaging proved to be as accurate as metrizamide CT in the diagnosis of intramedullary cavities that result in spinal cord enlargement, but it was less sensitive in detecting cavities within normal-sized or diminished spinal cords. It had the advantage that tumor tissue could be distinguished from associated syrinx cavities by differences in signal characteristics; and cerebellar ectopia was evaluated easily on sagittal MR views.

Post-traumatic cystic and non-cystic myelopathy.

Sixty-four patients with suspected cystic myelopathy following spinal cord trauma were examined radiologically. In twenty-seven of these, spinal cord cysts were confirmed at surgery; in five, cysts were excluded by surgery and/or autopsy; the rest were unconfirmed. In water soluble myelography the most frequent sign in those with confirmed cysts was distention of the involved segments of the spinal cord. A less frequent but reliable sign was variation in cord size with position in a paradoxical fashion to the well established changes which occur with air myelography. Focal concentrations of contrast medium were visible within cord substance at CT in two of the patients in whom no cyst was found at surgery or autopsy. Some correlations between clinical features, including rate of progression and results of surgery, and radiological findings are unexpected on the basis of existing theories on pathogenesis.

Intraoperative spinal sonography: adjunct to metrizamide CT in the assessment and surgical decompression of posttraumatic spinal cord cysts

Ten patients with prior spinal cord trauma were examined preoperatively by metrizamide computed tomography (CT) and were studied subsequently by intraoperative spinal sonography. On comparing intraoperative sonography with metrizamide CT, it was found that metrizamide CT tends to overestimate the size and number of posttraumatic cysts, that areas of myelomalacia on metrizamide CT correspond to areas of abnormal echogenicity on intraoperative sonography, and that intracyst septations are seen only on intraoperative sonography. By monitoring the position of the shunting catheter during surgery, intraoperative sonography can assure its proper intramedullary placement and demonstrate the successful decompression of the cyst. If no cyst is found with intraoperative sonography, further surgery is obviated. Intraoperative sonography is recommended for all cases where decompression of cord cysts is planned.

Spinal cord injury: optimization of computerized tomography image factors for accuracy

Computerised tomography (CT) scanning has become an accepted diagnostic method in evaluation of patients with spinal cord injury and has become increasingly important in the assessment of the vertebral column, spinal cord, and brain. Since CT images are graphic representations of generated computer mathematical data viewed with variable window and level selections (display factors), various image representatations are possible and potentially erroneous objective and subjective conclusions from viewing and measuring anatomical findings can result if an appreciation of this potential variability is not understood. Additionally, the CT image can be reconstructed from a variety of mathematical algorithm selections, which can enhance or diminish aspects of tissue contrast (smoothing or edge enhancement). Optimization of these factors, (window and level selection for viewing, and image generation algorithm), is especially important if detection and measurement of objective structures are to be reliable.The authors studied otpimization of algorithm selection and display factors (window and level selection), with a phantom designed to mimic spinal column, spinal cord and subarachnoid space. Varying concentrations of metrizamide in the phantom were scanned.With the G.E. 8800 Scanner, the bone algorithm was found to be the optimum algorithm for optimum spinal cord images if the measured metrizamide CT attenuation number was greater than 150-200. With a metrizamide CT attentua-tion number less than 150 the soft tissue algorithm was optimum. Window centre (level) selection greatly influenced the measurement of cord size, whereas window width did not. The appropriate window centre (level) selection is the mean between the metrizamide CT attenuation number and the cord CT attenuation number.The clinical application of these findings is summarized, and includes: Patients with metrizamide CT studies that require accurate measurement of spinal cord size or measurement of spinal cord cyst size (post-traumatic cystic myelopathy). Significant errors are possible if the formula for appropriate window centre selection is not followed. Additionally, the use of the bone algorithm requires higher contrast for accuracy, thus if metrizamide concentrations are weak, erroneous interpretations are possible. The authors also found that in the presence of metal (rods, screws or plates) the bone algorithm increased artifacts in CT, thus should not be used in this situation but rather the soft tissue algorithm must be used when metal is present to minimize artifacts.

声帯のうしゅ症例の検討

In the present report, a clinical observation on 29 cases of the vocal cord cyst who were treated in Kitasato University Hospital during the period from August 1971 to April 1983.The results were as follows.1. The chief complaint of these patients was hoarseness which was worse than expected from their laryngeal appearances.2. Histopathological study revealed that the most cyst walls consist of the squamous epithelium.3. Mechanical implantation of the squamous epithelium could be considered as one of the causative factors.

Posttraumatic spinal cord cysts: clinical features and characterization with metrizamide computed tomography.

Sixteen patients with posttraumatic spinal cord cysts (PTSCC) were evaluated clinically and studied with metrizamide computed tomography (MCT). These patients presented months to years following a severe spinal cord injury, usually with new or progressively worsening neurological symptoms. The development of the PTSCC was unrelated to the location, type, and severity of injury, or to the time interval from the original injury. MCT showed that these cysts occur most frequently in normal or atrophic cords, they may be multiple, they most frequently are found in the dorsal portion of the cord, and they may vary along their length in width and position within the cord. Knowledge of this radiographic morphology is crucial to the surgical planning. The location of the cysts and the mode of their enlargement are correlated with anatomic features of the spinal cord and changes in cerebrospinal fluid dynamics. Cyst-to-subarachnoid space shunting relieves the majority of symptoms.

Intraoperative ultrasound imaging of the spinal cord: Syringomyelia, cysts, and tumors — A preliminary report

Dynamic intraoperative imaging of the spinal cord was done using a real-time ultrasound scanner. Prior to opening the dura mater the neurosurgeon is able to “explore” the intradural space and with a 7.5 MHz transducer visualize the normal spinal cord, including the central canal and the dentate ligaments. Anterior and posterior spinal arteries may be seen in certain patients. In syringomyelia the fluid-filled cavities may be visualized with ultrasound and drained or shunted with intraoperative ultrasound guidance. Spinal cord cysts or cystic components of tumors can be precisely identified and drained using ultrasound. Intramedullary tumors can be demonstrated sonographically, as can the location and extent of intradural extramedullary tumors and tumors that have both extradural and intradural components. Experience to date with intraoperative imaging of the spinal cord and with the real-time ultrasound scanner is very encouraging, and in the future it should allow for a more precise characterization of and operative approach to lesions of the spinal cord.

Late sequelae of spinal cord trauma. Myelographic and surgical correlation.

Eighteen patients with posttraumatic paraplegia were examined myelographically at 2 months to 30 years after the injury, and the findings correlated with surgical exploration. The following six myelographic patterns were seen: 1) tethered cord and subarachnoid adhesions; 2) proximal cord cysts; 3) loculated subarachnoid cysts; 4) proximal cord atrophy; 5) extradural fibrosis; and 6) complete obliteration of the subarachnoid space at the level of trauma due to extradural fibrosis and/or bone encroachment on the vertebral canal. Myelography with or without computerized tomography (CT) accurately reflected the gross pathological process. The examination is indicated prior to surgical intervention: the structural lesion in four patients extended two or more vertebral levels above the site of the original bone injury and was not easily predictable preoperatively. When combined with CT, myelography allowed evaluation of the transverse anatomy of the vertebral canal and its contents; it was especially useful when the canal was narrowed or distorted by bone and soft tissue. Water-soluble contrast media provided a more detailed evaluation of the spinal cord and subarachnoid space, and were the preferred agents. If a posttraumatic syrinx is suspected, these are the agents of choice.

On the pathogenesis of syringomyelia: a review.

Discussion of the pathogenesis of syringomyelia involves considering the origin of the fluid and also the forces which cause that fluid to break down the structure of the cord. When cerebrospinal fluid (CSF) appears to be the destructive element, it commonly enters through a patent central canal running from the fourth ventricle to the inside of the syrinx. In both clinical and experimental situations pressure differences may be measured which suck on the hindbrain, particularly the cerebellar tonsils, producing deformities. These pressure differences may also suck fluid into the syrinx. In other cases, even when a communication does not appear to be patent, the hindbrain abnormalities are usually present and suck effect may usually be demonstrated and its correction be accompanied by clinical improvement. Other sources of fluid within a syrinx include liquefaction of haematomata after traumatic paraplegia and transudation of fluid from intrinsic spinal tumours. Once fluid is present within a cord cavity it may pulsate upwards and downwards in response to fluid movements in the subarachnoid space, the most energetic of which result from venous influences. Such movement, ‘slosh’, may cause the cavities to extend at either end giving rise to upward and downward extension from a post-traumatic cord cyst and sometimes to syringobulbia. Cord ischaemia, venous congestion and transport of fluid along perivascular spaces may all play a part in the maintainance of cord cavities or the progression of the clinical disabilities.

Familial communicating syringomyelia

Classical cervical syringomyelia was found in 3 members of one family. All 3 underwent air myelogram, and a Chiari malformation type I and postural collapse of the spinal cord was found in each case. An affected 7-year-old boy was discovered after a clinical and radiological survey of 8 first-degree relatives on the basis of mild scoliosis, pyramidal tract signs in the lower limbs and enlarged sagittal diameter of the cervical canal. One other member had basilar impression of the skull but no neurological abnormalities. No positive correlation was found between either the size of the cystic cord enlargement or descent of the ectopic tonsils with the duration or severity of the neurological findings. Suboccipital decompressive craniotomy and upper cervical laminectomy in one case was followed by improvement in strength and sensation 1 year later. Progression in familial syringomyelia appears to occur through a mechanism identical to that in the sporadic form and surgery is therefore also indicated. In affected families, routine survey of close relatives for abnormal neurological signs, and radiological evidence of scoliotic deformity of the spine, enlarged cervical canal and bone abnormalities at the craniovertebral junction may prove valuable for early detection. A dominantly inherited, genetically determined malformation seems to be the probable mechanism of inheritance in this family.

Surgical management of spinal cord cysts

A new surgical method, myelocyst-peritoneal shunt, has been performed on a small series of patients with congenital and acquired spinal cord cysts. In all cases, the progressive deterioration of neurological function ceased and all patients had slight to significant objective and/or subjective improvement in neurological function. The technical method is described along with individual case reports. Due to the short length of follow-up, the small number of operations, and the tendency for spinal cord cysts to spontaneously improve, the author discussed only potential advantages and disadvantages of this procedure as compared to prior spinal cord cyst operations. The creation of an in vitro human module spinal cord cyst by means of this operation has made it possible for the author to perform more basic ongoing investigation into the pathophysiology of spinal cord cysts and other similar disorders.

Isotope scanning of spinal cord cysts.

Isotope scanning of spinal cord cysts.

Gas Myelography and Percutaneous Puncture in the Diagnosis of Spinal Cord Cysts.

HomeRadiologyVol. 89, No. 4 PreviousNext Announcements and Book Reviews - Book ReviewsGas Myelography and Percutaneous Puncture in the Diagnosis of Spinal Cord Cysts.Published Online:Oct 1 1967https://doi.org/10.1148/89.4.755bMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractBy Gunnar Westberg. Acta radiol., Suppl. 252. Paper, Sw. Kr. 30:-. Pp. 67, with 39 figures. Stockholm, Sweden, Acta radiol., 1966.Although gas meylography was first introduced in the U.S.A., there is little doubt that the Swedish Neuroradiologic School under the leadership of Erik Lindgren has perfected this diagnostic technic. As is true for other radiological fields, the Swedish pre-eminence has come about because of different factors. In the opinion of this reviewer, however, the centralization of the clinical material represents the most important circumstance. Between 1937 and 1963, 3,200 gas myelographic procedures were performed in the roentgen department at the Sera-fimerlasarettet, a figure which hardly can be matched in any other center in the world. Many of these procedures were carried out by relatively few radiologists, this fact obviously allowing the accumulation of a high degree of experience and skill by the investigators. Successive refinements have thus been produced: Lindgren established the basic technic; Oden demonstrated the value of tomography for better visualization of the normal and pathologic spinal cord, and now Westberg, in this Supplementum of Acta radiologica, presents clear evidence that the gas myelographic diagnosis of the cystic nature of spinal cord expanding lesions is possible in a large number of cases.The observation that the size of the cord in a patient with an intramedullary cyst varied with positioning during gas myelography spurred Westberg to review the gas myelograms on file and to modify the myelographic technic to most suitably put in evidence fluid fluctuation phenomena in cystic cord lesions. Percutaneous puncture of the cysts, when such diagnosis is made at myelography, represents a further development. The modification of the gas meylographic technic proposed and tested in 125 cases by Westberg in the Neuroradiologic Department of the Karolinska Sjukhuset takes maximum advantage of the intrathecal gas-fluid reciprocal distribution with the different positioning of the patient on a tilting table. By elevating and lowering the head and feet of the patient it is possible to obtain optimal filling with gas of the various sections of the spinal subarachnoid space and thus to examine the entire spinal cord. Two very appealing features of the modified Westberg technic are the use of the lumbar puncture alone (many investigators are reluctant to carry out a suboccipital puncture) and the fact that gas pressures higher than 20 mm Hg are not necessary as in other recently suggested gas-myelographic methods. Tomography is used extensively, and maximum reliance is based on the lateral views of the cord as in the other technics of negative contrast myelograms.Article HistoryPublished in print: Oct 1967 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 89, No. 4 Metrics Altmetric Score PDF download

Chapter III: Myelographic Observations in Spinal Cord Cysts

Chapter III: Myelographic Observations in Spinal Cord Cysts

Chapter IV: Percutaneous Puncture of Spinal Cord Cysts

Chapter IV: Percutaneous Puncture of Spinal Cord Cysts