Spinal Cord Cysts Research Articles

Cystic spinal cord tumors: magnetic resonance imaging correlated to histopathological findings.

We report the characteristics of magnetic resonance imaging (MRI) of cystic intradural extramedullary spinal cord tumors (cystic neurilemmoma, epidermoid cyst, and enterogenous cyst). T1-weighted MRI enhanced with gadolinium-DTPA clearly demonstrated the rim morphology of these tumors. The comparison between the rim enhancement pattern and histopathological findings offered possible qualitative diagnosis of these cystic spinal cord tumors by MRI.

Scoliosis and associated cystic spinal cord lesion in a dog

Scoliosis and associated cystic spinal cord lesion in a dog

The dialysis patient with cystic bone defects and spinal cord symptoms

The dialysis patient with cystic bone defects and spinal cord symptoms

Results of DREZ coagulations for pain related to plexus lesions, spinal cord injuries and postherpetic neuralgia.

The results of 58 dorsal root entry zone (DREZ) thermocoagulation procedures in 51 patients are reported. The postoperative analgesic effect was judged by the patients as being good (more than 75% pain reduction), fair (25-75% pain reduction) or poor (less than 25% pain reduction). Of the 14 patients who underwent surgery for pain due to cervical root avulsion, 10 (77%) had permanently good (8) or fair (2) pain relief after a mean follow up period of 76 months, another 2 (15%) experienced recurrence to the preoperative level (initially 1 good, 1 fair) after more than 2 and 4 years, respectively. Twenty two paraplegics were operated upon, 3 of whom twice, for intractable pain. After a mean observation time of 54 months, continuing pain relief was reported by 12 (55%) patients (11 good, 1 fair), and one (initially fair) had recurrent pain after 8 months. All 3 (early) re-operations remain successful for an average period of 75 months. Poor results were seen especially in cases of associated spinal cord cysts (5 out of 7), despite combined drainage, and in patients with diffuse pain distribution (5 out of 6). Continuous marked improvement for longer periods (mean follow up: 52 months) after DREZ lesions was reported only by 2 out of 10 patients with postherpetic neuralgia (12 procedures) and by 1 out of 5 with painful states due to radiation-induced brachial plexopathy (2), previous surgery (2) and malignant tumour infiltration of the brachial plexus (1). Three patients died postoperatively due to acute cardiac failure (2) and pulmonary embolism (1). Major complications, especially permanent gait disturbances were observed in 6 patients (12%) following primary procedures and in 2 out of 7 patients after re-operations, most of them suffering from postherpetic neuralgia. Minor neurological deficits were noted in 9 cases (18%). DREZ lesions revealed to be an effective procedure in patients with pain related to root avulsion and paraplegia. In contrast, it seems to be less successful for painful states due to other plexus lesions or postherpetic neuralgia.

Reconstruction of the glial environment of a photochemically induced lesion in the rat spinal cord by transplantation of mixed glial cells.

It is becoming increasingly apparent that the astrocytic environment is critical to the normal development and functioning of the CNS, and that acute injury to the spinal cord causes destruction of glial cells in addition to neurones and axons. The aims of this study were to assess the viability of reconstructing the astrocytic environment of a cystic spinal cord lesion by transplantation of glial cells and to examine the effect of the transplanted cells on meningeal cell invasion and revascularisation of the lesion and on axonal regeneration. Neonatal rat and kitten mixed glial cells and the CG-4 rat O-2A progenitor cell line were transplanted into a lesion produced in the dorsal funiculus of the rat spinal cord by photochemical infarction. The animals were killed 4 weeks after injury, their cords examined with light and electron microscopy and compared with control animals that were injected with medium alone. Transplantation of all three preparations resulted in increased numbers of astrocytes in the area of Wallerian degeneration cranial to the lesion and within the cyst. Mixed glial cell cultures prepared from neonatal rat forebrain contained cells with in vitro characteristics of type-1 astrocytes, and produced dense clusters of astrocytes that were surrounded by meningeal cells, resulting in a fragmented environment in the cyst. In contrast, glial cell cultures prepared from kitten forebrain and the CG-4 cell line produced cells that filled the cyst with a loose network of fine processes and reduced meningeal cell infiltration of the lesion. The CG-4 cell line significantly increased the density of blood vessels in the centre of the lesion and the number of spared axons present dorsal to the lesion, but none of the preparations significantly increased the number of axons regenerating at the caudal end of the lesion. We conclude that O-2A progenitor-derived astrocytes are more suitable for reconstruction of the glial environment of a cystic lesion in the rat spinal cord than 'type-1 like' astrocytes and would therefore be the cell of choice to engineer to produce factors that promote axonal regeneration.

The cystic spinal cord.

The cystic spinal cord.

Development of post-traumatic cysts in the spinal cord of rats subjected to severe spinal cord contusion

To study the development of post-traumatic spinal cord (SC) cysts, and their fine anatomic characteristics, rats were subjected to severe SC contusion. Specimens were analyzed from day 1 to 1 year post-injury. Using conventional light, and transmission and scanning electron microscopy, three stages were typified, namely: necrosis, repair, and stability. The final cell composition and thickness of the cyst walls were not uniform. Astrocytes, fibroblasts, ependymal cells, and collagen fibers were the main constituents. Chronic inflammatory cells were also observed. The neuropathologic characterization of post-traumatic SC cysts could be useful in planning strategies for SC reconstruction at different times post-injury.

Implications of focal spinal cord lesions following trauma: evaluation with magnetic resonance imaging.

In a series of 15 patients who underwent early and follow up magnetic resonance imaging following spinal cord injury, those with focal spinal cord abnormalities such as cord contusion or haematoma had worse neurological outcomes, and most developed spinal cord cysts, showing as well-defined areas of CSF intensity within the cord on T1 weighted images. Patients with cord oedema initially, had better outcomes, with the development of residual areas of myelomalacia. These observations suggest that patients with focal initial spinal cord abnormalities may have an increased risk of developing posttraumatic spinal cord cysts, which may be associated with the development of delayed neurological deterioration.

Cystic cord lesions and neurological deterioration in spinal cord injury: operative considerations based on magnetic resonance imaging.

In a retrospective review of 94 consecutive patients with past spinal cord injury referred for magnetic resonance imaging (MRI) for the evaluation of new neurological symptoms, 59% were found to have cystic spinal cord lesions. Twelve of these patients underwent surgical cyst drainage, half having presented with increased myelopathy, and half with ascent of the neurological level. All of the operated cysts were greater than 2 cm in diameter (mean 15.8 cm), and 4 had areas of signal void indicating turbulent flow. All 12 patients had clinical improvement following surgery. The future prospective use of MRI in patients with longstanding spinal cord injury may prove valuable in the identification of patients with syrinx formation, at risk of developing neurological deterioration, who may benefit from early cyst drainage. At present, however, the decision to operate on these patients should be based primarily on clinical criteria.

Post-traumatic spinal cord cysts evaluated by magnetic resonance imaging

In order to determine a more accurate prevalence of post-traumatic spinal cord cysts (PTSCC) in spinal cord injured (SCI) patients, we retrospectively reviewed magnetic resonance scans from symptomatic imaging and asymptomatic SCI patients. We found the incidence of PTSCC to be 51% in our patient population. The only symptom that correlated to the presence of a cyst was spasticity. The cyst develops at the site of injury and appears to be a common sequela of SCI. We believe that conservative treatment is indicated in most patients with a PTSCC.

MR-imaging of chronic spinal cord injury. Association with neurologic function

Twenty-two para- and tetraplegic patients with chronic spinal cord injuries were examined with magnetic resonance imaging (MRI). The clinical course in the entire rehabilitation period was recorded and an attempt was made to associate the functional status of the patients with the morphologic findings on MRI. Small and large spinal cord cysts and syringomyelia, cord atrophy, and spinal stenosis were found. Additionally, in a number of patients regions of increased signal intensity within the cord, interpreted as myelomalacia, and obliteration of the intradural extramedullary space, interpreted as arachnopathy, were noted. The large number (13/22) of cystic lesions in our patients was unexpected. It was in contrast to the rate reported in autopsy studies of paraplegics which note only few cysts. Whereas a direct association of morphologic findings with neurologic symptoms and the clinical course was difficult, it was found that patients with large cysts and spinal cord atrophy generally showed no tendency to improve in spite of the measures taken during the rehabilitation period. It is difficult to decide whether the initial trauma with cord hemorrhage is limiting the chance of neurological improvement or if a sequence of events leading from hemorrhage to gliosis and cystic necrosis is the determining factor.

Photochemically induced cystic lesion in the rat spinal cord: I. Behavioral and morphological analysis

The present study describes the production of a spinal cord lesion which is initiated by vascular occlusion resulting from the interaction between the photosensitizing dye erythrosin B and an argon laser beam. The lesion has characteristics similar to those of the central cavity thought to lead to the production of post-traumatic syringomyelia (PTS) in humans. The present study examines the behavioral and morphological characteristics of this injury over a 28-day period. Histological analysis revealed a cavity extending from the dorsal horns to lamina VIII, with some lateral and ventral pathways being spared. The cavity volume reached a maximum 7 days after lesion induction. Behavioral changes were assessed using six different tests of motor and reflex function (motor function, climbing, waterbath, inclined plane, withdrawal to pain, and withdrawal to extension). Lesioned animals exhibited flaccid paralysis for 3–5 days, which resolved afterward. The photochemically induced cavity should provide a reproducible model for examining the effects of cystic spinal cord injury on locomotor and reflex function.

Pain and spinal cysts in paraplegia: Treatment by drainage and DREZ operation

About 10% of paraplegics suffer from intractable pain. The onset of pain may be immediate or delayed for months to several years after the injury. The delayed onset of pain is highly suggestive of the development of a spinal cyst. This is a report of 18 paraplegics who developed a delayed onset of intractable pain who were found at the time of surgery to have associated spinal cord cysts. Treatment consisted of the dorsal root entry zone (DREZ) operation in addition to evacuation of the cyst. Burning pain was the most common complaint occurring years after the trauma. In this study we compared the relationship between the onset and character of the pain, the time of the spinal injury, the operative findings, and the results of the DREZ procedure and evacuation of the traumatic spinal cyst. We believe that the combination of paraplegia, pain and spinal cyst has not been emphasized in the neurosurgical literature although it is well known that cystic formation can follow spinal trauma. Two patients developed spinal cysts with nontraumatic lesions of the spinal cord. A single cyst was found in 14 patients while four had two separate cysts. The diagnosis was made on the basis of history and clinical examination with radiographic confirmation using delayed CT scan and myelography and more recently magnetic resonance imaging. Intraoperative ultrasound was employed in the study of some patients. All patients were treated with combined DREZ lesions and evacuation of the cysts with good pain relief in 77.7%.

Cine MR in the evaluation of normal and abnormal CSF flow: intracranial and intraspinal studies

Evaluation of intracranial and intraspinal CSF flow was accomplished by the use of cardiac gated gradient echo magnetic resonance (MR) technique. Normal patterns of pulsatile flow within the ventricles, cisterns and cervical subarachnoid space were established by this technique and these observations were compared to prior description of CSF flow. With systole there is downward (caudal) flow of CSF in the aqueduct of Sylvius, the foramen of Magendie, the basal cisterns and the dorsal and ventral subarachnoid spaces while during diastole, upward (cranial) flow of CSF in these same structures is seen. The relationships between the cardiac cycle and the CSF pulsations are demonstrated on both magnitude reconstruction and phase reconstruction MR images. Calculations of actual fluid velocity within CSF containing spaces can be obtained from the phase reconstruction images and holds promise for a more accurate analysis of CSF flow. In conditions which result in alterations of flow, cine MR dramatically shows either obstruction or excessively turbulent flow within the CSF pathways. The site of obstructed flow whether in the third ventricle, aqueduct, fourth ventricle, or subarachnoid space can be appreciated by changes in or absence of the normal hypointense signal. Cystic cord lesions such as congenital syringohydromyelia and posttraumatic spinal cord cysts may show pulsatile flow of CSF, a fact which can relate to progressive enlargement of these cysts. The distinction between myelomalacia and cyst formation in the cord is facilitated by the technique. Although the use of cine MR for the analysis of CSF flow is in its infancy, our experience indicates that this technique is useful in a wide range of pathological conditions including, but not limited to, conditions resulting in hydrocephalus or cystic cord lesions.

CSF pulsations within nonneoplastic spinal cord cysts.

Because of its sensitivity to fluid motion, MR imaging was used to investigate fluid dynamics in syringomyelia. Three major findings characterized syringomyelia: pulsatile fluid in cysts, nonpulsatile fluid in cysts, and damaged cord tissue. The fluid in preoperative syrinx cavities pulsated in a fashion similar to subarachnoid CSF. Pulsation was more prominent in large cysts but was also seen in small cysts. Nonpulsatile cysts were generally of smaller diameter, were shorter in length, and often were single; they could, however, coexist with pulsatile cysts. Nonpulsatile cysts had etiologies similar to those of pulsatile cysts: Chiari malformation, trauma, and unknown. Damaged cord, characterized by abnormal high signal on T2-weighted sequences, was seen in 15 of 16 patients and could be either focal or diffuse but was always adjacent to syrinx cavities. Postsurgical MR scans had a lower incidence of pulsatile cysts. In five patients with both pre- and postoperative MR scans, shunting of the cyst reduced the size of the pulsating cyst (two patients) or reduced the size of the cyst and eliminated pulsation altogether (three patients). Axial, T2-weighted images are recommended in the investigation of spinal cord cysts to determine the presence or absence of pulsatile fluid. The presence of pulsation indicates a nonneoplastic cyst. The absence or reduction of CSF pulsation may prove to be a valuable indicator of the success of a shunting procedure.

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.

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.

Post-traumatic spinal-cord cyst. A case report.

Post-traumatic spinal-cord cyst. A case report.