Department of Surgery, Division of Pediatric Neurosurgery, British Columbia’s Children’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Neurosurg Focus. 2011 Dec;31(6):E13. doi: 10.3171/2011.9.FOCUS11208.
The natural history of syringomyelia in pediatric patients remains uncertain. Although symptomatic and operative cases of syringomyelia are well studied, there are fewer articles in the literature on the nonoperative syrinx and its clinical and radiological course. The purpose of this research was to analyze the natural history of untreated syringomyelia in pediatric patients presenting with minimal neurological symptoms.
A review of the neurosurgery database at British Columbia's Children's Hospital identified all pediatric patients (< 18 years of age) with syringes identified on MR imaging. Patients were included in this study if they had at least 2 MR images of the spine, at least 1 year apart, while receiving nonoperative treatment. Magnetic resonance imaging was used to determine changes in the size of the syrinx over time. Clinic notes were analyzed to establish demographic and clinical features and to determine any clinical changes over time.
A total of 17 patients were included in the study. Symptoms at presentation were often mild and included limb numbness (3 cases), headaches (2 cases), mild sensory deficits (2 cases), mild motor deficits (3 cases), and intermittent incontinence (7 cases). The consultant neurosurgeon believed that the syrinx was not contributing to the symptoms in these 17 patients. The syrinx either remained unchanged (7 cases) or diminished in size (8 cases) in a total of 15 patients (88%). In the remaining 2 patients the authors noted an increase in syrinx size, in 1 of whom the clinical course also worsened. Both of these patients had a Chiari malformation and subsequently underwent craniocervical decompression. Overall, the mean change was -0.7 mm of maximal axial diameter (range -2.6 to +2.7 mm). Sixteen patients (94%) exhibited no worsening of symptoms over time.
Syringomyelia often remains stable in patients receiving nonoperative treatment. However, given that 2 (12%) of 17 syringes in this series enlarged, it is likely appropriate to include periodic imaging in the follow-up of these cases.
小儿患者脊髓空洞症的自然病程尚不确定。虽然症状性和手术性脊髓空洞症病例研究较多，但文献中关于非手术性脊髓空洞症及其临床和影像学病程的文章较少。本研究旨在分析有轻微神经症状的小儿患者未治疗的脊髓空洞症的自然病程。
对不列颠哥伦比亚省儿童医院神经外科数据库进行回顾性研究，确定所有在磁共振成像上发现脊髓空洞症的小儿患者（年龄＜18 岁）。如果患者在接受非手术治疗时至少有 2 次脊柱磁共振成像，且间隔至少 1 年，那么将其纳入本研究。磁共振成像用于确定空洞的大小随时间的变化。分析临床记录以确定人口统计学和临床特征，并确定随时间的任何临床变化。
共纳入 17 例患者。发病时的症状通常较轻，包括肢体麻木（3 例）、头痛（2 例）、轻度感觉障碍（2 例）、轻度运动障碍（3 例）和间歇性尿失禁（7 例）。顾问神经外科医生认为，空洞症并没有导致这 17 例患者的症状加重。15 例患者（88%）的空洞症要么保持不变（7 例），要么体积缩小（8 例）。在其余 2 例患者中，作者注意到空洞症的体积增大，其中 1 例患者的临床病程也恶化。这两例患者均存在 Chiari 畸形，随后行颅颈减压术。总体而言，最大轴向直径的平均变化为-0.7 毫米（范围-2.6 至+2.7 毫米）。16 例患者（94%）随时间无症状恶化。
接受非手术治疗的患者脊髓空洞症通常保持稳定。然而，鉴于本研究中 17 例空洞症中有 2 例（12%）增大，在这些病例的随访中可能需要定期进行影像学检查。
