Anatomical basis of syringomyelia occurring with hindbrain lesions

Thomas H. Milhorat, John I. Miller, Walter D. Johnson, David E. Adler, Ian M. Heger

Research output: Contribution to journalArticle

72 Scopus citations

Abstract

HINDBRAIN LESIONS THAT distort or compress the cervicomedullary junction are commonly associated with syringomyelia. As a basis for discussing pathogenetic mechanisms, the upper end of the central canal of the spinal cord was examined histologically in six aborted fetuses and 14 adults dying of natural causes; the results were correlated with magnetic resonance images in 40 normal subjects. The central canal of the medulla, which extends from the cervicomedullary junction to the fourth ventricle, was found to migrate dorsally, elongate in dorsoventral diameter, and dilate beneath the tip of the obex to form a large, everted aperture. This opening communicates directly with the subarachnoid space through the foramen of Magendie and is indirectly continuous with the main body of the fourth ventricle. In adults, the aperture of the central canal is located approximately 1.0 cm below the tela choroidea inferior and 3.5 cm below the midpoint of the fourth ventricle. Analysis of magnetic resonance imaging scans in 45 patients with syringomyelia and simple hindbrain lesions revealed two patterns of cavity formation: 1) lesions that obstructed the upper end of the central canal or its continuity with the subarachnoid space produced a noncommunicating type of syringomyelia; and 2) lesions that obstructed the basilar cisterns or the foraminal outlets of the fourth ventricle produced a communicating type of syringomyelia (hydromyelia) in association with hydrocephalus. Evidence is presented that syrinxes occurring with hindbrain lesions are not caused by a caudal flow of cerebrospinal fluid from the fourth ventricle into the central canal of the spinal cord.

Original languageEnglish (US)
Pages (from-to)748-754
Number of pages7
JournalNeurosurgery
Volume32
Issue number5
DOIs
StatePublished - May 1993

Keywords

  • Central canal of spinal cord
  • Cerebrospinal fluid
  • Chiari malformation
  • Hindbrain lesions
  • Hydrocephalus
  • Syringomyelia

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Milhorat, T. H., Miller, J. I., Johnson, W. D., Adler, D. E., & Heger, I. M. (1993). Anatomical basis of syringomyelia occurring with hindbrain lesions. Neurosurgery, 32(5), 748-754. https://doi.org/10.1227/00006123-199305000-00008