Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.
Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Neuroscience Institute, New Orleans, LA, USA.
Clin Neurol Neurosurg. 2022 Nov;222:107413. doi: 10.1016/j.clineuro.2022.107413. Epub 2022 Aug 19.
Spontaneous resolution of syringomyelia has rarely been reported in the literature. Rarer still are cases wherein this process is associated with pregnancy and parturition. We review theories on syringomyelia development and spontaneous resolution to better understand the role pregnancy and parturition may play in both processes.
We present a 30-year-old female with MRI-confirmed spontaneous syrinx regression following caesarean delivery of a full-term pregnancy. We additionally review the literature to identify previously reported cases of spontaneous syrinx regression both independent of and associated with pregnancy.
Including the present case, 39 cases describing spontaneous regression of syringomyelia have been reported in the literature, of which only four are associated with pregnancy and parturition. 75% of all reported cases were associated with type I Chiari malformation, though several disorders of the craniocervical junction and spinal canal were implicated. Complete syrinx regression was achieved in 33.3% of cases and 5% of cases described recurrence of syringomyelia following the spontaneous resolution.
Syringomyelia likely develops due to disturbance of the physiologic flow of cerebrospinal fluid around the craniocervical junction and the obex. Several mechanisms including fissuring of the spinal cord parenchyma and reduction of subarachnoid scarring are likely involved in this process. In the setting of pregnancy, additional mechanisms surrounding the increased intraabdominal forces imparted by a growing fetus, Valsalva-like strain experienced during labor, and hemodynamic changes that occur to accommodate gestation are likely implicated. Nevertheless, patients should continue to be monitored periodically for syrinx recurrence.
文献中鲜有报道脊髓空洞症自发缓解。更罕见的是，这种情况与妊娠和分娩有关。我们回顾了脊髓空洞症发展和自发缓解的理论，以更好地理解妊娠和分娩在这两个过程中可能起到的作用。
我们报告了 1 例 30 岁女性，在剖宫产足月分娩后 MRI 证实存在自发性脊髓空洞症消退。我们还回顾了文献，以确定先前报道的与妊娠无关和相关的自发性脊髓空洞症消退病例。
包括本病例在内，文献中已有 39 例描述了脊髓空洞症的自发消退，其中仅有 4 例与妊娠和分娩有关。所有报道的病例中，75%与 Chiari Ⅰ型畸形有关，但也涉及颅颈交界区和椎管的几种疾病。33.3%的病例完全消退，5%的病例在自发消退后出现脊髓空洞症复发。
脊髓空洞症可能是由于颅颈交界区和枕骨大孔周围脑脊液生理流动的紊乱而发展的。包括脊髓实质裂和减少蛛网膜下腔瘢痕在内的几种机制可能参与了这一过程。在妊娠的情况下，与胎儿不断增大所产生的腹内压力增加、分娩时经历的类似瓦尔萨尔瓦动作的张力以及为适应妊娠而发生的血流动力学变化有关的其他机制可能也与此有关。然而，患者仍应定期监测脊髓空洞症的复发情况。
