Turkish Neurosurgery
Spinal Subarachnoid Hemorrhage Induced Intractable Miotic Pupil: A reminder of Ciliospinal Sympathetic Center Ischemia Based Miosis: Experimental Study
Mehmet Dumlu Aydin1, Ayhan Kanat2, Coşkun Yolaş3, Celalettin Soyalp4, Mehmet Önen5, İlhan Yilmaz6, Nuh Cagri Karaavci1, Muhammet Calik7, Orhan Baykal8, Leyla Ramazanoğlu9
1Ataturk University, Faculty of Medicine, Department of Neurosurgery, Erzurum,
2Recep Tayyip Erdogan University, Faculty of Medicine, Department of Neurosurgery, Rize,
3Erzurum Education and Research Hospital, Department of Neurosurgery, Erzurum,
4Yuzuncu Yil University, Faculty of Medicine, Department of Anesthesiology, Van,
5Umraniye Education and Research Hospital, Department of Neurosurgery, İstanbul,
6Sisli Hamidiye Etfal Education and Research Hospital, Department of Neurosurgery, Istanbul,
7Ataturk University, Faculty of Medicine, Department of Pathology, Erzurum,
8Ataturk University, Faculty of Medicine, Department of Opthalmology, Erzurum,
9Fatih Sultan Mehmet Education and Research Hospital, Department of Neurosurgery, Istanbul,
DOI: 10.5137/1019-5149.JTN.24446-18.1

Aim:Although basic pupillodilatatory function of ciliospinal center is well known, neuropathological mechanism of permanent miosis has not been adequately investigated in ciliospinal center pathologies. In this study, ischemic neurodegeneration of ciliospinal center on permanent miosis examined following SAH.Material and Methods:19 rabbits were examined in this study. The animals were divided into three group, as control (GI, n=5), SHAM (GII, n=5) and study group(GIII,n=9). Pupil diameters were measured after giving 0.5 cc of serum saline for SHAM, and autolog arterial blood into cervicothoracic subarachnoid space for study group. After three weeks follow up, their cervicothoracic cord and superior cervical sympathetic ganglia were taken out bilaterally. The pupil diameter values were compared with degenerated neuron volumes of sympathetic ganglia, degenerated neuron densities of thoracic sympathetic nuclei which were studied by stereological methodsResults:The mean pupil diameter was 5.180±370µm, mean degenerated neuron density of ciliospinal center was 4±1/mm3in animals of control group (G1 These values were detected as 9850±610µm, 10±3/mm3, in SHAM (GII); and the 7.010±440µm and 98±21/mm3 in study group(GIII). There was an inverse relationship between degenerated neuron density of ciliospinal nuclei and pupil diameters.Conclusion:Although there is abroad belief about that the main cause of miosis is oculomotor nerve injuries during SAH, we shown that ciliospinal sympathetic center ischemia induced neurodegeneration may have been responsible for permanent miosis following SAH which has been reported first time.

Corresponding author : Mehmet Dumlu Aydin