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Isolated thoracic syrinx in children with Chiari I malformation

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Abstract

Introduction

Syrinx has been reported in 25–85 % of children with Chiari malformation type I (CMI), and it is most commonly cervical in location. As a result, cervical MRI is routinely included in an evaluation for CMI. Isolated thoracic syrinx without involvement of the cervical cord in this population is uncommon but clinically important because its presence may influence the decision to operate, surgical techniques employed, or interpretation of follow-up imaging. The purpose of this study was to determine the incidence of isolated thoracic syrinx in a large group of children evaluated for CMI.

Methods

We retrospectively reviewed all patients under 21 years of age who were evaluated for CMI at Columbia University/Morgan Stanley Children’s Hospital of New York from 1998 to 2013. All patients underwent MRI of the entire spine as part of the CMI evaluation, regardless of whether surgery was planned. The proportion of patients exhibiting isolated thoracic syrinx was determined. Presenting signs, symptoms, and imaging findings were then studied in an attempt to identify any clinical features associated with isolated thoracic syrinx.

Results

We identified 266 patients evaluated over the study period. One-hundred thirty-two patients (50 %) presented with a syrinx, and 12 patients (4.5 % of all patients evaluated and 9.1 % of all patients with a syrinx) had an isolated thoracic syrinx. Demographic variables, clinical presentation, and extent of tonsillar ectopia showed great heterogeneity in this group, and no factor was consistently associated with isolated thoracic syrinx.

Conclusions

Isolated thoracic syrinx is an uncommon but clinically significant finding in children with CMI. Our data demonstrate that the presence of a CMI-related thoracic syrinx cannot be reliably predicted clinically and is therefore likely to be missed in patients who do not undergo complete spinal cord imaging. MRI of the entire spinal cord should be considered for all children undergoing initial evaluation for CMI.

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Authors and Affiliations

  1. Department of Neurological Surgery, Columbia University, New York, NY, USA

    Benjamin C. Kennedy, Richard C. E. Anderson & Neil A. Feldstein

  2. Department of Otolaryngology Head and Neck Surgery at UT Southwestern, Dallas, TX, USA

    Kathleen M. Kelly

  3. Children’s Hospital of New York, Columbia University, New York, NY, USA

    Richard C. E. Anderson & Neil A. Feldstein

Authors
  1. Benjamin C. Kennedy
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  2. Kathleen M. Kelly
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  3. Richard C. E. Anderson
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  4. Neil A. Feldstein
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Corresponding author

Correspondence to Benjamin C. Kennedy.

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No financial support was utilized in the preparation of this manuscript.

Prior presentation

The current work has not been presented but has been submitted for presentation to the CNS/AANS Joint Section on Pediatric Neurosurgery Annual Meeting, 2015.

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Kennedy, B.C., Kelly, K.M., Anderson, R.C.E. et al. Isolated thoracic syrinx in children with Chiari I malformation. Childs Nerv Syst 32, 531–534 (2016). https://doi.org/10.1007/s00381-015-3009-7

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  • DOI: https://doi.org/10.1007/s00381-015-3009-7

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