1
|
Kovalenko RA, Osipova NV, Mineev VA, Mitrofanova LB. Symptomatic arachnoiditis ossificans associated with syringomyelia: a clinical case and a brief literature review. HIRURGIÂ POZVONOČNIKA (SPINE SURGERY) 2023. [DOI: 10.14531/ss2023.1.93-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Objective. To present a clinical case of arachnoiditis ossificans associated with syringomyelia and a brief literature review with an emphasis on its etiology, pathogenesis and methods of diagnosis and treatment.Material and Methods. A clinical case of a 68-year-old patient with symptomatic arachnoiditis ossificans is described. The diagnosis was established on the basis of the results of intraoperative biopsy, histological examination of the resected fragment and confirmed in the postoperative period using CT of the spinal cord, multislice CT myelography, etc. Analysis of the course of the pathology raised the following questions: diagnostic criteria and optimal tactics for treating this disease. A brief review of cases of arachnoiditis ossificans described in the literature for the period from 1982 to the present is given.Results. A review of cases of ossifying arachnoiditis described in the literature showed that today there is no single tactic for diagnosing and treating this disease. In most cases, the diagnosis is established intraoperatively (65 % of analyzed cases). At the preoperative stage, CT provides reliable visualization of ossification. When choosing therapy, it is necessary to be based on the severity of the clinical picture, the degree of ossification of the arachnoid membrane and the presence of concomitant pathology of the affected spinal cord department (such as syringomyelia).Conclusion. The presence of a growing neurological deficit should be considered an indication for surgical treatment of patients with arachnoiditis ossificans. The goals of surgery should include decompression of neural structures and restoration of normal cerebrospinal fluid circulation.
Collapse
Affiliation(s)
- R. A. Kovalenko
- Almazov National Medical Research Centre
2 Akkuratova str., St. Petersburg, 197341, Russia
| | - N. V. Osipova
- Pavlov First Saint Petersburg State Medical University
6–8 L’va Tolstogo str., St. Petersburg, 197022, Russia
| | - V. A. Mineev
- Almazov National Medical Research Centre
2 Akkuratova str., St. Petersburg, 197341, Russia
| | - L. B. Mitrofanova
- Almazov National Medical Research Centre
2 Akkuratova str., St. Petersburg, 197341, Russia
| |
Collapse
|
2
|
Zuev AA, Epifanov DS. [Treatment of patients with ossifying arachnoiditis and progressive syringomyelia (analysis of three cases and a literature review)]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 82:71-80. [PMID: 29795089 DOI: 10.17116/oftalma201882271-80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To date, only 12 cases of ossifying arachnoiditis with concomitant syringomyelia have been reported in the world literature. In this article, we presented our experience of treating three patients with syringomyelia associated with ossifying arachnoiditis. OBJECTIVE based on the literature data and our own experience, we tried to define the most optimal treatment approach for this disease. MATERIAL AND METHODS We analyzed the data of 15 patients (12 cases reported in the literature and 3 our own cases). The diagnosis was established on the basis of complaints, medical history, patient examination, MRI and CT of the spinal cord, and intraoperative data. Progression of syringomyelia was evaluated by comparison of the neurological status and calculation of the Vaquero index before and after surgery; the Domenicucci classification was used to evaluate the severity of ossifying arachnoiditis. Surgical treatment included several stages: decompressive laminectomy, elimination of spinal cord fixation, excision of ossifying arachnoiditis, shunting of the syrinx, and repair of the dura mater. RESULTS An analysis of the patient data reported in the literature (12 cases) and those in our series (3) revealed that in the early postoperative period, 7 (46.7%) of these 15 patients had improvements, 5 (33.3%) patients had no changes, and 3 (20%) patients experienced a worsening. At present, there is no clear algorithm for diagnosing and treating this disease. CONCLUSION Further investigation of the problem may facilitate an earlier diagnosis of the disease and provide more effective medical care.
Collapse
Affiliation(s)
- A A Zuev
- Pirogov National Medical Surgical Center, Nizhnyaya Pervomayskaya Str., 70, Moscow, Russia, 105203
| | - D S Epifanov
- Pirogov National Medical Surgical Center, Nizhnyaya Pervomayskaya Str., 70, Moscow, Russia, 105203
| |
Collapse
|
3
|
Maulucci CM, Ghobrial GM, Oppenlander ME, Flanders AE, Vaccaro AR, Harrop JS. Arachnoiditis ossificans: Clinical series and review of the literature. Clin Neurol Neurosurg 2014; 124:16-20. [DOI: 10.1016/j.clineuro.2014.06.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/09/2014] [Accepted: 06/15/2014] [Indexed: 12/21/2022]
|
4
|
Arachnoiditis ossificans of the thoracic spine. J Clin Neurosci 2013; 21:386-9. [PMID: 24291474 DOI: 10.1016/j.jocn.2013.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 07/12/2013] [Indexed: 01/30/2023]
Abstract
Arachnoiditis ossificans is a rare disorder characterized by the development of calcifications of the arachnoid membrane of the thoracic and lumbar spines. It is an extremely rare cause of spinal canal stenosis and consequent neurological compromise, and its origins and optimal management remain unclear. We review of the literature that illustrates the challenges of diagnosis and treatment of arachnoiditis ossificans. A patient with arachnoiditis ossificans is discussed to illustrate the presentation, treatment, and prognosis of the disease.
Collapse
|
5
|
Ibrahim GM, Kamali-Nejad T, Fehlings MG. Arachnoiditis ossificans associated with syringomyelia: An unusual cause of myelopathy. EVIDENCE-BASED SPINE-CARE JOURNAL 2013; 1:46-51. [PMID: 23637667 PMCID: PMC3623106 DOI: 10.1055/s-0028-1100914] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
OBJECTIVE The pathophysiology of arachnoiditis ossificans (AO) and its association with syringomyelia remains a rare and poorly understood phenomenon. Here, we present a case of AO associated with syringomyelia, a review of literature, and a discussion of current understanding of disease pathophysiology. METHODS A literature review was performed using MEDLINE (January 1900-May 2010) and Embase (January 1900-May 2010) to identify all English-language studies that described AO with syringomyelia. The current report was added to published cases. RESULTS Over 50 cases of AO are reported in literature, of which only eight are associated with syringomyelia. The various presumptive etiologies of syrinx formation include abnormalities in blood circulation, ischemia, hydrodynamic alternations in cerebrospinal fluid (CSF) flow, tissue damage, or incidental coexistence. Changing CSF dynamics related to decreased compliance of the subarachnoid space and subsequent paracentral dissection of the spinal cord may be implicated in the disease process. magnetic resonance imaging (MRI) scanning may identify the syrinx but fail to diagnose the calcified arachnoid. Five patients, including the current case, improved clinically following laminectomy and decompression. CONCLUSIONS Syringomyelia in association in AO is a rare phenomenon. A high index of suspicion is required and both MRI and computed tomography (CT) are recommended for diagnosis. The pathophysiology of syringomyelia in AO remains an area of ongoing research.
Collapse
Affiliation(s)
- George M Ibrahim
- Division of Neurosurgery and Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital, University of Toronto, Ontario, Canada
| | | | | |
Collapse
|
6
|
Abrams J, Li G, Mindea SA, Haynes CM, Cheng I. Arachnoid ossificans containing metaplastic hematopoietic marrow resulting in diffuse thoracic intrathecal cysts and severe myelopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21 Suppl 4:S436-40. [PMID: 21892775 DOI: 10.1007/s00586-011-2005-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 08/10/2011] [Accepted: 08/18/2011] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To present a rare case of multiple compressive thoracic intradural cysts with pathologic arachnoid ossification, review the literature and present the surgical options. Few reports have identified the existence of arachnoid calcifications and intrathecal cysts causing progressive myelopathy. The literature regarding each of these pathologies is limited to case reports. Their clinical significance is not well studied, although known to cause neurologic sequelae. METHODS An 81-year-old female clinically presents with rapidly progressive myelopathy. Pre-operative magnetic resonance imaging identified multiple compressive thoracic intrathecal cysts. Surgical exploration and decompression of these cysts identified calcified plaques within the arachnoid. Histopathologic examination revealed fibrocalcific tissue undergoing ossification with bone marrow elements. RESULTS Due to progressive myelopathy, the thoracic cysts were decompressed and calcified plaques were excised, once identified intra-operatively. CONCLUSIONS On last examination, the patient's neurologic status had not improved, but had stabilized. The rate of neurologic improvement from excision and decompression is variable, but it may still be warranted in the face of progressive neurologic deficits.
Collapse
Affiliation(s)
- Joshua Abrams
- Department of Orthopedics, Stanford University Medical Center, Stanford, CA, USA.
| | | | | | | | | |
Collapse
|
7
|
Huang H, Li Y, Xu K, Li Y, Qu L, Yu J. Foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia: case report and literature review. Int J Med Sci 2011; 8:345-50. [PMID: 21647327 PMCID: PMC3107467 DOI: 10.7150/ijms.8.345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 05/16/2011] [Indexed: 11/05/2022] Open
Abstract
It is very rare that a foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia, and currently there are few treatment experiences available. Here we reported the case of a 43-year-old male patient who admitted to the hospital due to weakness and numbness of all 4 limbs, with difficulty in urination and bowel movement. MRI revealed a foramen magnum arachnoid cyst with associated syringomyelia. Posterior fossa decompression and arachnoid cyst excision were performed. Decompression was fully undertaken during surgery; however, only the posterior wall of the arachnoid cyst was excised, because it was almost impossible to remove the whole arachnoid cyst due to toughness of the cyst and tight adhesion to the spinal cord. Three months after the surgery, MRI showed a reduction in the size of the arachnoid cyst but syrinx still remained. Despite this, the symptoms of the patient were obviously improved compared to before surgery. Thus, for the treatment of foramen magnum arachnoid cyst with compression of the spinal cord and syringomyelia, if the arachnoid cyst could not be completely excised, excision should be performed as much as possible with complete decompression of the posterior fossa, which could result in a satisfying outcome.
Collapse
Affiliation(s)
- Haiyan Huang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, PR China
| | | | | | | | | | | |
Collapse
|
8
|
Papavlasopoulos F, Stranjalis G, Kouyialis AT, Korfias S, Sakas D. Arachnoiditis ossificans with progressive syringomyelia and spinal arachnoid cyst. J Clin Neurosci 2007; 14:572-6. [PMID: 17368029 DOI: 10.1016/j.jocn.2006.02.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Revised: 02/14/2006] [Accepted: 02/16/2006] [Indexed: 12/01/2022]
Abstract
We present a 30-year-old man with progressive spastic paraparesis. Spinal imaging revealed extensive calcification of the thoracic cord and cauda equina arachnoid, an intradural extramedullary cyst and evidence of rapidly progressing syringomyelia. Radiological diagnosis was arachnoiditis ossificans and an attempt at surgical decompression was made because of progressive neurologic deterioration. Due to tenacious adhesion of the calcified plaques to the cord and roots, only cyst drainage was achieved; the patient had no clinical improvement. A literature review revealed only two other cases reported in the literature with co-existence of arachnoiditis ossificans and syringomyelia. In none of the previous cases was there an intradural extramedullary arachnoid cyst, nor did the syrinx progress in such a rapid fashion. An attempt is made to explain possible pathophysiological mechanisms leading to this unusual pathology.
Collapse
Affiliation(s)
- F Papavlasopoulos
- Department of Neurosurgery, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
| | | | | | | | | |
Collapse
|
9
|
Lawson-Smith M, Green AL, Teddy PJ. Cord compression secondary to intradural ossification. J Clin Neurosci 2006; 13:272-5. [PMID: 16503491 DOI: 10.1016/j.jocn.2005.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 02/28/2005] [Indexed: 11/20/2022]
Abstract
The authors describe two patients presenting with a previous history of spinal trauma and a several-year history of sensory changes secondary to spinal cord compression. Both patients underwent laminectomy and spinal decompression operations. In both cases intradural bone causing neural compression was removed at operation. Potential mechanisms to explain intradural ossification and the relevant literature are reviewed.
Collapse
Affiliation(s)
- Matthew Lawson-Smith
- Department of Neurosurgery, Radcliffe Infirmary, Oxford Functional Neurosurgery, Woodstock Road, Oxford, OX2 6HE, UK
| | | | | |
Collapse
|
10
|
Domenicucci M, Ramieri A, Passacantilli E, Russo N, Trasimeni G, Delfini R. Spinal arachnoiditis ossificans: report of three cases. Neurosurgery 2004; 55:985. [PMID: 15934184 DOI: 10.1227/01.neu.0000137281.65551.54] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE Although the clinical and histological features of the pathological entity of spinal arachnoiditis ossificans (AO) have been established for some time, less attention has been paid to the treatment. We propose a classification of spinal AO evaluating the possibilities and indications for surgical or conservative treatment. CLINICAL PRESENTATION Type III has a lumbar localization, presents with less neurological involvement, and usually requires conservative treatment. In Types I and II, which are usually thoracic, clinical worsening justifies surgical decompression or partial removal, whereas total removal is rarely achievable. INTERVENTION The literature was reviewed, and the reports on three patients were added to the published cases. On the basis of a reappraisal of the computed tomographic and magnetic resonance imaging documentation and the surgical descriptions, the cases of AO were classified into three types: semicircular (Type I), circular (Type II), and englobing the caudal fibers (Type III). The indications for treatment were evaluated in terms of surgical possibilities and outcome. CONCLUSION The classification proposed on the basis of radiological findings allows sufficient clinical differentiation of AO and evaluation of the possibilities for surgical treatment. The latter is conditioned by the type of arachnoiditis, degree of neurological involvement, and presence of any concomitant pathological findings.
Collapse
Affiliation(s)
- Maurizio Domenicucci
- Department of Neurological Sciences (Neurosurgery), Rome University "La Sapienza," Rome, Italy.
| | | | | | | | | | | |
Collapse
|
11
|
Lolge S, Chawla A, Shah J, Patkar D, Seth M. MRI of spinal intradural arachnoid cyst formation following tuberculous meningitis. Br J Radiol 2004; 77:681-4. [PMID: 15326049 DOI: 10.1259/bjr/90641678] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Secondary intradural arachnoid cyst involving the spine is uncommon. It is usually secondary to trauma, haemorrhage, surgery or inflammation. We present two cases of treated tuberculous meningitis, which presented with gradual onset of quadriplegia and paraplegia, respectively. MRI revealed intradural (cervical and thoracic) arachnoid cysts (ventral and dorsal to the spinal cord) with myelomalacic cord changes. Ventral location of such spinal arachnoid cysts, and being secondary to tuberculous arachnoiditis are distinctively uncommon features. The rarity of this condition and the relevance of MRI in the accurate diagnosis have been discussed here.
Collapse
Affiliation(s)
- S Lolge
- Department of Radiology, King Edward VII Memorial Hospital, Parel, Mumbai, India
| | | | | | | | | |
Collapse
|
12
|
Faure A, Khalfallah M, Perrouin-Verbe B, Caillon F, Deschamps C, Bord E, Mathe JF, Robert R. Arachnoiditis ossificans of the cauda equina. J Neurosurg Spine 2002; 97:239-43. [PMID: 12296687 DOI: 10.3171/spi.2002.97.2.0239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The authors describe a case of arachnoiditis ossificans (AO) of the cauda equina. The lesion is a rare pathological entity usually confined to the thoracic and high lumbar regions that can cause progressive spinal cord and cauda equina compression, inducing severe neurological deterioration. The authors analyze the clinical symptoms, radiological features, histological data, and treatment options relating to this case and 13 others described in the literature; additionally, they consider the possible mechanisms responsible for ossification of the leptomeninges. Although clustered arachnoidal cells are usually implicated in its pathogenesis, an environment induced by arachnoiditis and disturbed cerebrospinal fluid flow appears to be a more important factor. A therapeutic strategy is proposed for AO for which no effective treatment currently exists.
Collapse
Affiliation(s)
- Alexis Faure
- Department of Neurotraumatology, University Hospital (Hôtel-Dieu), Nantes, France.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Eroles Vega G, Castro Vilanova MD, Mendivil Ferrer M, Gómez Rodrigo J, Lacambra Calvet C, Ruiz-Capillas JJ, Quiñones D. [Arachnoiditis and intraspinal lesion. Complications of tuberculous meningitis in 2 patients with human immunodeficiency virus infection]. Rev Clin Esp 2001; 201:575-8. [PMID: 11817224 DOI: 10.1016/s0014-2565(01)70917-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Radiculomyelitis (arachnoiditis) (RMA) is a severe complication of tuberculous meningitis (TM). Two patients with HIV infection and TM are here reported. These patients developed RMA. In Spain only four cases of RMA have previously been reported (only one of them was HIV-positive). Clinical manifestations (subacute paraplegia, radicular pain, sensitive level and neurogenic bladder) are reported. Cerebrospinal fluid had inflammatory features, wit predominance of mononuclear cells and remarkable increase in protein content. Magnetic resonance imaging (MRI) is the most suitable diagnostic method. The therapeutic possibilities of this complication are discussed.
Collapse
Affiliation(s)
- G Eroles Vega
- Servicio de Medicina Interna, Hospital Severo Ochoa, Avenida de Orellana, s/n. 28911 Leganés, Madrid
| | | | | | | | | | | | | |
Collapse
|
14
|
Manabe Y, Shiro Y, Warita H, Hayashi T, Nakashima H, Abe K. Fluctuating monoplegia due to venous insufficiency by spinal arachnoiditis ossificans. J Neurol Sci 2000; 178:163-6. [PMID: 11018709 DOI: 10.1016/s0022-510x(00)00371-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This is the first report of a patient with venous insufficiency following compressive arachnoiditis ossificans (AO). Symptoms of fluctuating monoplegia and sensory disturbance appeared monthly, lasting several weeks each time. Spinal magnetic resonance imaging (MRI) showed high T2-weighted signal intensity in the posterior portion of the column from T11 to T12 and an intradural lesion with low T2-weighted signal intensity. Neurological function and MRI improved markedly following an operation on AO. The symptoms seen in the present case were due to posterior venous insufficiency following compressive AO.
Collapse
Affiliation(s)
- Y Manabe
- Department of Neurology, Okayama University Medical School, 2-5-1 Shikata-cho, 700-8558, Okayama, Japan.
| | | | | | | | | | | |
Collapse
|
15
|
Kahler RJ, Knuckey NW, Davis S. Arachnoiditis ossificans and syringomyelia: a unique case report. J Clin Neurosci 2000; 7:66-8. [PMID: 10847657 DOI: 10.1054/jocn.1998.0144] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 62-year-old male presented with progressive quadriparesis. Magnetic resonance imaging of the spine revealed a spinal cord syrinx but failed to detect extensive arachnoiditis ossificans noted on insertion of a syringopleural shunt. A postoperative computed tomography scan clearly demonstrated the abnormality and its extent. We present a rare case of syringomyelia resulting from spinal arachnoiditis ossificans and review the relevant literature.
Collapse
Affiliation(s)
- R J Kahler
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Queen Elizabeth II Site, Perth W.A., Australia.
| | | | | |
Collapse
|
16
|
Slavin KV, Nixon RR, Nesbit GM, Burchiel KJ. Extensive arachnoid ossification with associated syringomyelia presenting as thoracic myelopathy. Case report and review of the literature. J Neurosurg 1999; 91:223-9. [PMID: 10505510 DOI: 10.3171/spi.1999.91.2.0223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case of progressive thoracic myelopathy caused by the extensive ossification of the arachnoid membrane and associated intramedullary syrinx. Based on their findings and results of the literature search, they describe a pathological basis for this rare condition, discuss its incidence and symptomatology, and suggest a simple classification for various types of the arachnoid ossification. They also discuss the magnetic resonance imaging features of arachnoid ossification and associated spinal cord changes. The particular value of plain computerized tomography, which is highly sensitive in revealing intraspinal calcifications and ossifications, in the diagnostic evaluation of patients with a clinical picture of progressive myelopathy is emphasized.
Collapse
Affiliation(s)
- K V Slavin
- Department of Neurological Surgery, Oregon Health Sciences University, Portland 97201-3098, USA.
| | | | | | | |
Collapse
|
17
|
Slavin KV, Nixon RR, Nesbit GM, Burchiel KJ. Extensive arachnoid ossification with associated syringomyelia presenting as thoracic myelopathy. Neurosurg Focus 1999. [DOI: 10.3171/foc.1999.6.5.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case of a patient in whom progressive thoracic myelopathy was caused by the extensive ossification of the arachnoid membrane and associated intramedullary syrinx. Based on their findings and the results of a literature search, they describe a pathological basis of this rare condition, discuss its incidence and symptomatology, and suggest a simple classification of various types of the arachnoid ossification. They also discuss magnetic resonance imaging features of arachnoid ossification and associated spinal cord changes. Emphasis is placed on the particular value of plain computerized tomography, which is highly sensitive for detecting intraspinal calcifications and ossifications, in the diagnostic evaluation of patients whose clinical picture indicates progressive myelopathy.
Collapse
|
18
|
Revilla TY, Ramos A, González P, Alday R, Millán JM. Arachnoiditis ossificans. Diagnosis with helical computed tomography. Clin Imaging 1999; 23:1-4. [PMID: 10332589 DOI: 10.1016/s0899-7071(98)00085-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Arachnoiditis ossificans (AO) is a rare entity in which ossification of the leptomeninges occurs. This report illustrates a patient with AO of the cervical and dorsal spine, diagnosed by helical computed tomography with multiplanar reconstruction. It demonstrates the value of computed tomography in diagnosing calcified plaques and the utility of multiplanar reconstruction in giving an exact anatomic reference to neurosurgeon.
Collapse
Affiliation(s)
- T Y Revilla
- Sección de Neurorradiologia, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | | |
Collapse
|
19
|
Ng P, Lorentz I, Soo YS. Arachnoiditis ossificans of the cauda equina demonstrated on computed tomography scanogram. A case report. Spine (Phila Pa 1976) 1996; 21:2504-7. [PMID: 8923640 DOI: 10.1097/00007632-199611010-00020] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This case report illustrates a patient with arachnoiditis ossificans of the cauda equina of sufficient severity to be demonstrable on a computed tomography scout view. OBJECTIVES The diagnosis of extensive arachnoiditis ossificans by computed tomography does not necessitate surgical intervention. The authors patient had only mild, chronic symptoms when treated expectantly. SUMMARY OF BACKGROUND DATA The value of axial computed tomography in visualizing and characterizing the lesions of arachnoiditis ossificans has been well documented. Arachnoiditis ossificans involving the cauda equina is uncommon. To the authors' knowledge, this report represents the first case of arachnoiditis ossificans of the cauda equina in which the arachnoid calcifications were of sufficient density to be obvious on a computed tomography scan. METHODS The patient was reviewed by a neurologist for paraesthesia in his right foot, occasional backaches, and urinary frequency. Physical examination revealed only a mild loss of lumber lordosis and an area of hypoesthesia in the right foot. He then was investigated with computed tomography, which showed extensive arachnoiditis ossificans. Because his symptoms were mild, surgery was not contemplated. RESULTS The patient's symptoms remained minimal despite being treated conservatively. CONCLUSIONS The value of computed tomography in delineating the lesions of arachnoiditis ossificans and the outcome of surgery for resection of its compressive osseous plaques have been well described. Despite extensive arachnoid calcification caused by arachnoiditis ossificans involving the cauda equina that was visible on a computed tomography scan, this patient continued to have only low-grade symptoms when treated conservatively.
Collapse
Affiliation(s)
- P Ng
- Department of Radiology, Westmead Hospital, New South Wales, Australia
| | | | | |
Collapse
|
20
|
|