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Syringobulbia Mark R. Lee, MD, PhD Pediatric Neurosurgery

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Presentation on theme: "Syringobulbia Mark R. Lee, MD, PhD Pediatric Neurosurgery"— Presentation transcript:

1 Syringobulbia Mark R. Lee, MD, PhD Pediatric Neurosurgery
Dell Children’s Medical Center

2 Syringobulbia Very rare entity Slit-like fluid cavity in brainstem
Associated with Chiari malformation Tumors Tethered cord Idiopathic

3 Syringobulbia and Chiari Malformation
Strongly associated with Chiari malformation with syringomyelia But very rare… 3-5% of patients with Chiari malformation

4 Symptoms Head and neck pain Snoring Diplopia Sensory disturbances
Unsteady gait Dysphagia Paresthesias and numbness

5 Clinical Findings Cranial nerve deficits Nystagmus Weakness
All patients Unilateral not uncommon Nystagmus Weakness Hyperreflexia Scoliosis

6 MRI Findings

7 Treatment Restore CSF pathways between cranial and spinal compartments
Decompression of craniovertebral junction Posterior fossa decompression Suboccipital craniectomy C1 laminectomy Duraplasty (or dural splitting)

8 Syringobulbia in a pediatric population
Syringobulbia in a pediatric population. Neurosurgery, 2005 Greenlee, Menezes, et. al

9 Resolution of Syringobulbia

10 Timing of Syringobulbia Resolution?

11 What Causes Syringobulbia?
“Always” associated with syringomyelia Propagation of syringomyelia into brainstem. “rupture” of cervical syrinx Extension of dilated central canal Direct entry of CSF into brainstem “opening” in floor of 4th ventricle

12 “Clefts” in the Brainstem

13 Syringomyelia and Chiari Malformation

14 Extension of Syringomyelia into Brainstem

15 Summary Syringobulbia is rare Associated with syringomyelia
? Extension of syringomyelia Has cranial nerve dysfunction Treated with craniovertebral decompression Outcomes are usually good

16 Thank You for Your Attention!

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