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Syringomyelia and the arachnoid web

A R Brodbelt1, M A Stoodley

  • 1The Prince of Wales Medical Research Institute, University of New South Wales, and the Department of Neurosurgery, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia. abrodbelt@doctors.org.uk

Acta Neurochirurgica
|October 2, 2003
PubMed

Insights

Arachnoid webs can cause syringomyelia (spinal cord syrinxes) by obstructing cerebrospinal fluid flow. Dividing these webs and shunting the syrinx improved patient symptoms and MRI findings.

Area of Science:

  • Neurosurgery
  • Neurology
  • Radiology

Background:

  • Syringomyelia, characterized by fluid-filled cavities within the spinal cord, can lead to progressive myelopathy.
  • Arachnoid webs, focal adhesions in the subarachnoid space, are an underrecognized cause of spinal cord pathology.

Observation:

  • Three patients presented with progressive myelopathy and thoracic syrinxes identified via magnetic resonance imaging (MRI).
  • Intraoperative findings confirmed thoracic arachnoid webs obstructing the subarachnoid compartment in all cases.
  • Ultrasound revealed caudal movement of the web with cardiac pulsation in one patient.

Findings:

  • Surgical division of the arachnoid webs and syrinx shunting resulted in clinical improvement in all patients.
  • Follow-up MRI demonstrated resolution or significant reduction of the syrinxes post-intervention.
  • Arachnoid webs, potentially focal arachnoiditis, are challenging to visualize on standard MRI.

Implications:

  • The proposed mechanism involves reduced subarachnoid space compliance, increased pulse pressure, and potentiated perivascular flow leading to syrinx formation.
  • Restoring subarachnoid space compliance through web division is a key treatment strategy.
  • Surgical intervention for arachnoid webs offers a viable treatment for associated syringomyelia.

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