Turkish Neurosurgery 2019 , Vol 29 , Num 3
Spinal Subarachnoid Hemorrhage Induced Intractable Miotic Pupil. A Reminder of Ciliospinal Sympathetic Center Ischemia Based Miosis: An Experimental Study
Mehmet Dumlu AYDIN1,Ayhan KANAT2,Coskun YOLAS3,Celalettin SOYALP4,Mehmet Resid ONEN5, Ilhan YILMAZ6,Nuh Cagri KARAAVCI1,Muhammet CALIK7,Orhan BAYKAL8,Leyla RAMAZANOGLU9
1Ataturk University, Faculty of Medicine, Department of Neurosurgery, Erzurum, Turkey
2Recep Tayyip Erdogan University, Faculty of Medicine, Department of Neurosurgery, Rize, Turkey
3Erzurum Education and Research Hospital, Department of Neurosurgery, Erzurum, Turkey
4Yuzuncu Yil University, Faculty of Medicine, Department of Anesthesiology, Van, Turkey
5Umraniye Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
6Sisli Hamidiye Etfal Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
7Ataturk University, Faculty of Medicine, Department of Pathology, Erzurum, Turkey
8Ataturk University, Faculty of Medicine, Department of Opthalmology, Erzurum, Turkey
9Fatih Sultan Mehmet Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
DOI : 10.5137/1019-5149.JTN.24446-18.1 AIM: To examine ischemic neurodegeneration of the ciliospinal center on permanent miosis following subarachnoid hemorrhage (SAH).

MATERIAL and METHODS: Nineteen rabbits were examined in this study. The animals were divided into three groups, as control (GI, n=5), sham (GII, n=5) and study group (GIII, n=9). Pupil diameters were measured after giving 0.5 mL physiological saline for sham and autologous arterial blood for the study group into the cervico-thoracic subarachnoid space. After three weeks of follow up, the cervico-thoracic cord and bilateral superior cervical sympathetic ganglia were removed. The pupil diameter values were compared with degenerated neuron volumes of sympathetic ganglia and degenerated neuron densities of thoracic sympathetic nuclei which were studied by stereological methods.

RESULTS: The mean pupil diameter was 5180 ± 370 μm and the mean degenerated neuron density of the ciliospinal center was 4 ± 1/mm3 in animals of the control group (GI). These values were 9850 ± 610 μm, 10 ± 3/mm3 in sham (GII), and 7.010 ± 440 μm and 98 ± 21/mm3 in the study (GIII) groups. There was an inverse relationship between degenerated neuron density of the ciliospinal nuclei and pupil diameters.

CONCLUSION: We showed and reported for the first time that ciliospinal sympathetic center ischemia-induced neurodegeneration may have been responsible for permanent miosis following SAH. Keywords : Subarachnoid hemorrhage, Miotic pupil, Ciliospinal sympathetic center, Mydriasis, Miosis, Rabbit

Corresponding author : Mehmet Dumlu AYDIN, nmda11@hotmail.com