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Levi V, Franzini A, Di Cristofori A, Bertani G, Pluderi M. Subacute posttraumatic ascending myelopathy (SPAM): A potential complication of subarachnoid shunt for syringomyelia? J Spinal Cord Med 2020; 43:714-718. [PMID: 30156977 PMCID: PMC7534218 DOI: 10.1080/10790268.2018.1512735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Context: Treatment of primary spinal syringomyelia is still controversial. Among others, shunting syrinx fluid to the subarachnoid, peritoneal or pleural space has been utilized with varying success. Shunt obstruction, migration, and infection represent the most common complications of these procedures. Findings: The authors present the case of an 81-year-old woman who developed an unusual neurological deterioration resembling a subacute posttraumatic ascending myelopathy (SPAM) after the insertion of a syringosubarachnoid shunt for the treatment of slow-growing D10 syringomyelia. Conclusion/Clinical Relevance: To date, no cases of SPAM secondary to the insertion of a syringosubarachnoid shunt for the treatment of syringomyelia have been reported. The potential pathogenesis related to this phenomenon is discussed.
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Affiliation(s)
- Vincenzo Levi
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Franzini
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Di Cristofori
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giulio Bertani
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Mauro Pluderi
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Jugović D, Bošnjak R, Rotim K, Feigl GC. MINIMALLY INVASIVE TREATMENT OF IDIOPATHIC SYRINGOMYELIA USING MYRINGOTOMY T-TUBES: A CASE REPORT AND TECHNICAL NOTE. Acta Clin Croat 2020; 59:177-182. [PMID: 32724291 PMCID: PMC7382868 DOI: 10.20471/acc.2020.59.01.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Syringomyelia is characterized by a fluid-filled cavity within the spinal cord. Expansion of the syrinx often results in the clinical course of progressive neurologic deficit. Surgery for syringomyelia generally aims to treat the underlying cause, if it is known. However, little is known about idiopathic syringomyelia, which requires specific management. In our paper, an alternative, minimally invasive treatment option for large symptomatic idiopathic cervicothoracic syrinx is described and discussed. We present a case of a 44-year-old male without a history of spinal cord trauma, infection, or other pathologic processes, who presented for thoracic pain. Due to progressive pain and left leg paresis, magnetic resonance imaging (MRI) was performed and revealed extensive septated syringomyelia from T5 to T7 and hydromyelia cranially. We applied minimally invasive technique for shunting the idiopathic syrinx into the subarachnoid space using two Richards modified myringotomy T-tubes. Postoperative MRI revealed significant decrease in the syrinx size and clinical six-month follow-up showed improvement of clinical symptoms. This minimally invasive treatment of syringomyelia was found to be an effective method for idiopathic septated syrinx, without evident underlying cause. However, long-term follow-up and more patients are necessary for definitive evaluation of this technique.
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Affiliation(s)
| | - Roman Bošnjak
- 1Department of Neurosurgery, Bamberg General Hospital, Bamberg, Germany; 2University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia; 3Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia; 4Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6University of Applied Health Sciences, Zagreb, Croatia; 7Department of Neurosurgery, Tübingen University Hospital, Tübingen, Germany; 8Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Krešimir Rotim
- 1Department of Neurosurgery, Bamberg General Hospital, Bamberg, Germany; 2University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia; 3Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia; 4Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6University of Applied Health Sciences, Zagreb, Croatia; 7Department of Neurosurgery, Tübingen University Hospital, Tübingen, Germany; 8Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Günther C Feigl
- 1Department of Neurosurgery, Bamberg General Hospital, Bamberg, Germany; 2University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia; 3Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia; 4Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6University of Applied Health Sciences, Zagreb, Croatia; 7Department of Neurosurgery, Tübingen University Hospital, Tübingen, Germany; 8Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA
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Klimov VS, Gulay YS, Evsyukov AV, Moysak GI. [Syringosubarachnoid shunting in treatment of syringomyelia: a literature review and a clinical case report]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 81:58-65. [PMID: 28665389 DOI: 10.17116/neiro201781358-65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In the article, we describe a clinical case of syringomyelia associated with an Arnold-Chiari type 1 malformation, evaluate the efficacy of syringosubarachnoid shunting, and analyze the literature data of domestic and international researchers involved in investigation and treatment of the pathology. Application of syringosubarachnoid shunting in the described case resulted in a clinical improvement in the form of regression of paresis and hypoesthesia, which demonstrated the efficacy of the shunting technique for correction of the syringomyelia symptoms.
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Affiliation(s)
- V S Klimov
- Federal Neurosurgical Center, Novosibirsk, Russia
| | - Yu S Gulay
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Evsyukov
- Federal Neurosurgical Center, Novosibirsk, Russia
| | - G I Moysak
- Federal Neurosurgical Center, Novosibirsk, Russia
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Canova G, Boaro A, Giordan E, Longatti P. Treatment of Posttubercular Syringomyelia Not Responsive to Antitubercular Therapy: Case Report and Review of Literature. J Neurol Surg Rep 2017; 78:e59-e67. [PMID: 28428929 PMCID: PMC5393916 DOI: 10.1055/s-0037-1601327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Posttubercular adhesive arachnoiditis is a rare, late complication of tubercular meningitis. Syringomyelia can develop as a consequence of intramedullary cystic lesions and cerebrospinal fluid (CSF) flow disturbance around the spinal cord, even after successful chemotherapy. We reviewed the literature related to posttubercular syringomyelia treatment and suggest a new combined surgical approach. A 25-year-old Nigerian male patient presented with legs numbness, urinary disturbance, and legs weakness. Spinal magnetic resonance revealed a T5-T7 syringomyelia, secondary to adhesive spinal arachnoiditis related to a history of tuberculous meningitis. Adhesiolysis by direct visualization with a flexible endoscope was performed and a handmade S-italic syringe-subdural shunt was placed to restore CSF flow. During the postoperative course, the neurological deficits improved together with the resolution of the syrinx. Long-term magnetic resonance imaging follow-up documented no recurrences or shunt displacements. We suggest that, when antitubercular therapy is not effective to resolve postarachnoiditis syrinx, arachnolysis with a flexible endoscope together with the placement of an S-italic shunt allowed free CSF communication between the syrinx and the subarachnoid space. Furthermore, we support that the use of an s-shaped shunt could prevent displacement or migration of the device and allows an easier revision in case of acute or late complications.
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Affiliation(s)
- Giuseppe Canova
- Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
| | - Alessandro Boaro
- Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
| | - Enrico Giordan
- Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
| | - Pierluigi Longatti
- Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
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Wang DD, Martin KW, Auguste KI, Sun PP. Fast dynamic imaging technique to identify obstructive lesions in the CSF space: report of 2 cases. J Neurosurg Pediatr 2015; 15:519-23. [PMID: 25723723 DOI: 10.3171/2014.11.peds13620] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Disorders of CSF dynamics such as syringomyelia and obstructive hydrocephalus can be caused by thin mobile obstructive lesions not visible on traditional MRI sequences. New imaging techniques with balanced steady-state free precession (bSSFP) and dynamic imaging with bSSFP cine allow visualization of these pulsatile structures within the CSF space. The authors present 2 cases involving pediatric patients-one who developed presumed idiopathic syringomyelia and one with presumed communicating hydrocephalus in association with Pfeiffer syndrome-who harbored thin dynamic obstructive lesions seen on bSSFP cine studies using 1.5-T MRI. In combination with traditional CSF cine studies and bSSFP, bSSFP cine sequence was able to detect dynamic membranous adhesions not seen on traditional MRI sequences. These previously undetectable lesions on traditional MRI sequences were the etiology of CSF obstruction, and tailored surgical approaches were performed to avoid shunting in both patients. These reports demonstrate the clinical utility for using these novel imaging tools for the detection of thin adhesions and dynamic lesions in the central nervous system. Balanced SSFP cine sequences can supplement conventional MR modalities to identify these otherwise poorly visualized lesions responsible for presumed communicating hydrocephalus or idiopathic syringomyelia.
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Affiliation(s)
- Doris D Wang
- Department of Neurological Surgery, University of California, San Francisco; and
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