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The Cause of Syringomyelia and its Surgical Treatment

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Abstract

HYDROMYELIA is a dilatation and syringomyelia is a diverticulum of the central canal of the spinal cord. The terms are used interchangeably; the conditions frequently coexist and are clinically indistinguishable.

The Thesis

Both hydromyelia and syringomyelia originate in embryonal life as a result of distention of the central canal by ventricular fluid, caused by atresia of the outlets of the fourth ventricle. The rational treatment is to open the obstructed foramen of Magendie.

The Evidence

  1. In embryonal life the central canal of the spinal cord is a portion of the closed neural tube. It becomes a vestigial structure after the foramens of the fourth ventricle open into the subarachnoid space. Conversely, if the foramens fail to open (atresia), the central canal of necessity remains a part of the ventricular system.

  2. Early forms of hydromyelia and syringomyelia are present in infants having Dandy-Walker**1 or Arnold-Chiari deformities,4–10 while severe forms are found in adults having either of these deformities.11–15

  3. There is evidence that both Dandy-Walker and Arnold-Chiari deformities of the hindbrain are produced by embryonal “hydrocephalus due to atresia of the outlets of the fourth ventricle.3,12

  4. In all patients with hydromyelia or syringomyelia, the foramen of Magendie is occluded.11,12 The obstruction is due to a membrane, the attachments of which indicate that it is a persisting remnant of the embryonic rhombic roof, or to a cerebellar hernia that squeezes together the cerebellar tonsils, or to both conditions coexisting.

  5. In patients having hydromyelia or syringomyelia, the. . .


 

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