Chiari I型奇形に伴う脊髄空洞症における難治性感覚障害例の形態学的・電気生理学的検討

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Morphological and electrophysiological analysis was conducted to elucidate the pathophysiology which causes the discrepancy between radiological and clinical findings in post-operative syringomyelic patients with Chiari type I malformation. MRI analysis were performed on 28 cases of syringomyelia treated in our institute from 1988 to 1995 diagnosed with Chiari type I malformation with hemi-lateral symptoms in which the syrinx postoperatively collapsed or shrank. The expansion of syrinx in the direction of posterior gray horn was measured at the C6 level from the pre-operative MRI findings and compared with the outcome. A significant difference in the expansion of syrinx in the direction of posterior gray horn was found between improved and non-improved group. Median nerve somatosensory evoked potential (SEP) was carried out bilaterally on 13 patients and lower cervical N13 (lcN13), which is presumed to display the post-synaptic potential of posterior gray horn, was monitored. The diminishing rate of the lcN13 amplitude of the symptomatic side was measured in relation to the contralateral side. In all of the 13 patients, the amplitude of lcN13 was minimized in the symptomatic side. A significant difference in the diminishing rate of lcN13 was found between the improved and non-improved groups. The expansion of the pre-operative syrinx is related to the diminishing rate of lcN13. There seems to be a common marginal limit between the expansion of syrinx and the reduction of the potential of posterior gray horn in the transition of the outcome. The results from this study suggest that irreversible damage of posterior gray horn is the cause of discrepancy between radiological and clinical findings.
日本脊髄外科学会の論文
2004-03-31

Chiari I型奇形に伴う脊髄空洞症における難治性感覚障害例の形態学的・電気生理学的検討

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