Acute onset of postoperative syringohydromyelia
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Published on: February 14, 2025
K Santosh Mohan Rao1, Chidambaram Balasubramaniam1, K Subramaniam1
1Department of Neurosurgery, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India.
Insights
Acute syringomyelia developed rapidly in an infant after spinal cord detethering surgery. This case challenges the traditional view of syrinx formation as a slow, chronic process, suggesting a need to re-evaluate understanding of syringohydromyelia.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Spinal Cord Disorders
Background:
- Syringohydromyelia is often associated with tethered cord syndrome.
- Traditionally, syrinx development is considered a chronic, progressive condition.
Observation:
- An infant presented with acute onset syringomyelia immediately following surgical excision of a lumbosacral transitional lipoma and spinal cord detethering.
- Post-operative flaccid paraplegia was noted, prompting emergency MRI.
Findings:
- Emergency MRI revealed a large, acute syringomyelia.
- The infant underwent emergency myelotomy and syrinx fluid release with good eventual recovery.
Implications:
- This case challenges the established understanding of syringohydromyelia development.
- It suggests that rapid syrinx formation can occur post-operatively in infants, necessitating a re-evaluation of diagnostic and treatment paradigms for syringohydromyelia in this population.
Abstract:
Syringohydromyelia is a frequent finding in cases of tethered cord syndrome. The classical teaching is that the development and progression of a syrinx is a chronic process. We present a case report of an acute onset syringomyelia in an infant, who underwent an excision of a lumbosacral transitional lipoma and detethering of the cord. Immediately after recovery, the infant was found to have flaccid paraplegia. An emergency magnetic resonance imaging revealed a large acute onset syringomyelia for which he underwent an emergency midline myelotomy and release of fluid from the syrinx. Though the eventual recovery was good, this made us re-visit our understanding of the concept of syringohydromyelia. The case details and a plausible hypothesis for the rapid development of the syrinx are presented.
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