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!