Preoperative demonstration of postinflammatory syringomyelia

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• Syringomyelia is a condition characterized by the formation of fluid-filled cavities (syrinxes) within the spinal cord.
• Arachnoiditis is inflammation of the arachnoid mater, a membrane surrounding the brain and spinal cord.
• The link between arachnoiditis and syringomyelia has been rarely reported and not previously described in radiographic literature.

Observation:

• Eight patients with various causes of arachnoiditis (postinfectious, posthemorrhagic, iatrogenic, idiopathic) were evaluated.
• Patients presented with progressive neurological deficits disproportionate to myelographic findings.
• Metrizamide computed tomography (CT) was used to visualize the spinal cord.

Findings:

• Metrizamide accumulation within the central spinal cord was identified on CT scans, both at and above the level of arachnoiditis.
• This accumulation was observed even in patients with a normal cord diameter.
• Syrinx cavities were demonstrated in affected patients.

Implications:

• This study highlights a rare mechanism for the development of syringomyelia secondary to arachnoiditis.
• Metrizamide CT is a valuable tool for diagnosing this condition.
• Surgical intervention (shunting) provided partial relief or arrest of symptoms in the studied patients.